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Chemical restraint replaces physical restraint in SNFs

March 12, 2014
by Lois A. Bowers, Senior Editor
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Public reporting of the use of physical restraints has led to the increased use of antipsychotic medications—sometimes referred to as chemical restraints—in skilled nursing facility (SNF) residents whose cognition is severely impaired, according to a new study published online by the Journal of the American Geriatrics Society.

Researchers from the University of Chicago and the University of Pennsylvania retrospectively analyzed data from 1999 to 2008 to compare Medicare- and Medicaid-certified nursing homes subject to public reporting with those that were not. The investigation included 809,645 residents with severe cognitive impairment living in 4,258 SNFs in six states.

The use of physical restraints for residents with severe cognitive impairment declined significantly during the study period, the study authors found, and the drop was greater in facilities that had to report the use of restraints. Over the same time period, however, the use of antipsychotic drugs in those with severe cognitive impairment increased in nursing homes subject to public reporting. The researchers concluded that 36 percent of this increase occurred because of the public reporting requirement.

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It's interesting news, isn't it, Marcus? What do you think the solution is?

Get families more involved in this.

That sounds like a great idea. Family members who spend a lot of time with relatives in SNFs might notice the difference between the effects of dementia and the effects of medication in someone and could relay that information.


It is sad, isn't it, Jessica? The focus needs to be on what's best for residents. Do you think more staffing or training would help?

Yes, they need more training on how to deal with specific behaviors. Not only the nursing staff but the pharmacists and physicians as well.

I agree with training on behaviors as well. I believe it is getting better, though.

As with most studies, it takes a while for data to be published. The latest data in this study came from 2008. Let's hope it has gotten better since then and continues to do so. Training certainly can go a long way toward that.

More training. I know CMS and state regulations are getting stricter and are really focusing on med regimens. Nurses/doctors need to know what is regulation and what CMS states on anti-psychotics. The criteria for being on anti-psychotics.