What is “chemical restraint” and is it a form of nursing home abuse?

Instead of addressing staffing shortages, some nursing homes are resorting to chemical restraints to manage residents, a practice with disturbing implications.

When a loved one in a nursing home suddenly seems “off”—way too drowsy, perpetually confused, or emotionally flat—it’s not always just “old age” showing up. That uneasy feeling could indicate a serious problem.

“Chemical restraint” directly involves using drugs to control a person’s behavior for reasons other than treating a diagnosed medical condition. This practice is a serious issue. It is a recognized form of nursing home abuse, and federal law makes it illegal.

This situation may sound disturbingly familiar, and if it does, your concerns about potential abuse are probably justified. Speaking with a nursing home abuse lawyer can help you determine if your loved one’s rights have been violated. The Hughey Law Firm is here to help you understand your rights and the options available to you. We offer a “no win, no fee” promise in many cases.

Call us at (843) 881-8644 for a straightforward conversation.

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Common Drugs Used to Restrain

Certain medications frequently appear when chemical restraint is suspected.

• Antipsychotics: Drugs like Risperdal, Seroquel, and Haldol are frequently culprits. They are often used “off-label” (meaning, for a purpose not approved by the FDA) to manage agitation in dementia patients. Research indicates that Risperidone, for instance, is used off-label in a significant percentage of chemical restraint cases;
• Sedatives and Anxiolytics: Medications such as Ativan or Valium, designed to calm anxiety or induce sleep, are also misused to keep residents subdued;
• Dissociative Anesthetics: While less common, these drugs are also used to detach residents from their surroundings, effectively restraining them.

The Insidiousness of Chemical Restraints

Chemical restraints are a particularly harmful form of nursing home abuse due to their insidious nature. Often presented as “necessary medication” or under “doctor’s orders,” chemical restraint can be challenging for families to recognize as a form of nursing home abuse.

Too often, families are kept in the dark. If they do ask questions, they might be told the medication is for the resident’s “safety” or to “manage agitation” or “difficult behaviors.” This misleading information makes it harder to realize that what’s happening is actually a form of abuse.

The Sobering Reality of Chemical Restraints

Chemical restraint is a disturbingly widespread crisis rather than an isolated issue in elder care, as indicated by genuinely disturbing statistics.

• A 2024 analysis published by Undark revealed that a shocking 21.3% of nursing home residents receive antipsychotics. Many of these prescriptions are not for diagnosed psychiatric conditions but are used as chemical restraints;
• In some facilities, the situation is even more dire. According to 2023 findings from the Long Term Care Community Coalition (LTCCC), also reported by Undark, over 50% of residents in certain nursing homes are being chemically subdued;
• The Food and Drug Administration (FDA) has estimated that 15,000 nursing home residents die each year due to the unnecessary use of antipsychotic drugs. This figure is based on FDA testimony and is widely cited to highlight the deadly risks of this practice;
• AARP has found that 16% of nursing home patients are given antipsychotics without an appropriate diagnosis, further indicating the scale of misuse.

Why is This Happening?

The reasons behind this widespread misuse of medication aren’t complicated, but they are deeply troubling. They often point to systemic failures and a disregard for residents’ fundamental rights.

• Staffing shortages are a major driver. When there aren’t enough caregivers, providing proper, individualized attention becomes nearly impossible. Medication becomes a “quick fix” to manage residents who may require more time and specialized care;
• A lack of proper training in de-escalation techniques or managing dementia-related behaviors contributes significantly. Untrained staff may resort to medication because they don’t know how to handle challenging situations appropriately;
• In some cases, the prioritization of profits over patient well-being is a clear factor. Providing adequate staffing and training costs money, and some facilities may cut corners to boost their bottom line;
• Sadly, low-income nursing homes often exhibit even higher rates of antipsychotic misuse. The same Undark report highlighted that these facilities show rates 37% higher than others, suggesting a disproportionate impact on vulnerable populations.

Is Chemical Restraint Abuse? Is It Illegal?

Make no mistake: using medication to control a resident for convenience or discipline is not merely poor care; it is unequivocally abuse. This practice robs elderly individuals of their dignity, their autonomy, and their overall quality of life.

Chemical restraints cause direct harm, both physical and psychological. They also significantly increase the risk of other injuries, such as falls and infections. This practice is not “care” in any sense. It is control achieved through medication, which is abusive.

The Law is Clear

Both federal and state laws are in place to protect nursing home residents from this harmful practice.

• Federal Law – The Nursing Home Reform Act (OBRA ’87): This landmark piece of legislation is crystal clear. It explicitly prohibits the use of chemical restraints for purposes of discipline or staff convenience. The law (specifically 42 U.S.C. § 1396r(c)(1)(A)(ii)) mandates that residents have the right to be free from such restraints when they are not required to treat specific medical symptoms. This means there must be a legitimate medical reason, properly diagnosed and documented, for the use of psychoactive drugs;
• South Carolina Regulations: South Carolina Department of Health and Environmental Control (DHEC) Regulation 61-17, which sets the Standards for Licensing Nursing Homes, incorporates these federal standards. Facilities operating in South Carolina are legally bound to comply with these regulations. Failure to do so results in penalties, including fines and potential loss of licensure;
• FDA Black Box Warnings: The FDA mandates “black box warnings”—its strongest warning—on antipsychotic drugs. These warnings specifically address the increased risk of death when these drugs are used in elderly patients with dementia-related psychosis. This FDA action highlights the severe dangers of using these medications off-label as chemical restraints;
• Medicare/Medicaid Regulations: Most nursing homes participate in Medicare and Medicaid programs. Under the Centers for Medicare & Medicaid Services (CMS) guidelines (found in 42 CFR § 483.25(l)), facilities risk losing their certification and funding if they improperly use chemical restraints. This provides a powerful financial incentive for compliance, though unfortunately, it is not always enough to prevent abuse.

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The Legal Battlefield: Understanding Your Rights and Their Wrongs

Informed Consent

A cornerstone of medical ethics and patient rights is informed consent. Generally, the use of any medication, particularly powerful psychoactive drugs, requires informed consent. This means the resident (if they have the capacity to make decisions) or their legal representative must be fully informed.

“Fully informed” involves a clear explanation of the drug, its intended purpose, the potential risks and benefits, available alternative treatments, and the right to refuse. Chemical restraints are frequently administered without obtaining this proper informed consent, or consent is obtained under misleading pretenses. While many states, like California (Welfare & Institutions Code §5325), have specific statutes detailing patient rights regarding psychotropic medications, the fundamental principle of informed consent is broadly applicable under general residents’ rights laws in places like South Carolina, too.

Negligence and Negligence Per Se

When a nursing home uses chemical restraints improperly, it represents a failure to provide an acceptable standard of care. This failure is known in legal terms as negligence. The facility had a duty to care for the resident, they breached that duty by misusing medication, and this breach caused harm.

In some situations, if a nursing home violates a specific statute designed to protect residents—such as the Nursing Home Reform Act’s prohibitions on chemical restraints—this violation constitutes “negligence per se.” In jurisdictions that recognize this doctrine, the act of violating the law itself is often sufficient to prove negligence, simplifying one aspect of a legal claim.

The Elder Justice Act (2010)

The Elder Justice Act, a federal law passed in 2010, provides additional protections for seniors. Among its provisions, it mandates the reporting of suspected elder abuse, which includes the misuse of chemical restraints, by certain individuals to law enforcement and other designated state authorities. This reporting requirement aims to bring instances of abuse to light so they are investigated and stopped.

The Devastating Toll: What Chemical Restraints Steal from Your Loved Ones

Physical Impact

The physical side effects of being chemically restrained are numerous and serious. They turn a relatively stable individual into someone frail and vulnerable.

• An increased risk of falls, by as much as 71% according to some research. These falls often lead to fractures, head injuries, and a downward spiral in health;
• A higher likelihood of developing infections, such as urinary tract infections or pneumonia, due to suppressed immune function and immobility;
• Pressure sores (bedsores) from being largely immobile and unable to shift position;
• Malnutrition and dehydration because a sedated person may be unable or unwilling to eat or drink adequately;
• Significant cognitive decline, which is sometimes irreversible even if the drugs are stopped;
• An increased risk of mortality, as starkly highlighted by the FDA’s black box warnings on antipsychotics used in elderly dementia patients.

The Psychological Impact

• Residents may exhibit symptoms akin to a “chemical lobotomy,” especially those with dementia. This manifests as severe apathy, withdrawal from social interaction, and an inability to communicate or engage with their surroundings;
• Depression, anxiety, and pervasive fear are common emotional responses to being drugged and controlled;
• A profound loss of dignity, self-worth, and autonomy as their ability to think clearly and act independently is stripped away;
• Paradoxical agitation occurs. This means that as the drugs wear off, or sometimes even while on them, the resident may become more agitated or distressed than before, potentially leading staff to administer even more medication, creating a vicious cycle.

Warning Signs of Chemical Restraint

Certain signs should raise immediate red flags if you observe them in your loved one.

• Unexplained Excessive Drowsiness or Sedation: Is your loved one constantly sleepy, difficult to wake, or seemingly “out of it” much of the time, especially if this is a new development?
• Sudden Changes in Cognitive Function: Are they experiencing increased confusion, disorientation, or an inability to concentrate that cannot be attributed to their underlying conditions?
• Withdrawal, Apathy, or Emotional Flatness: Have they become unusually withdrawn, uninterested in activities they once enjoyed, or do they seem emotionally blunted?
• New or Worsened Difficulty Communicating or Ambulating: Are they suddenly having trouble speaking, forming words, or walking steadily, without another clear medical reason?
• Unusual or Repetitive Movements: Some psychoactive drugs cause side effects like tremors, restlessness (akathisia), or involuntary muscle movements (tardive dyskinesia)
• Medication Administered Without a Clear Medical Diagnosis or Explanation: If new psychoactive drugs are started, especially without a clear, diagnosed condition that warrants them, or if the reasons given seem vague or focused on behavior control, be suspicious.

Your Action Plan

If you suspect your loved one is being chemically restrained, don’t dismiss your instincts.

1. Document Everything Meticulously: Keep detailed notes of your observations. Record dates, times, specific symptoms (e.g., “Mom was asleep in her chair at 2 PM, couldn’t be roused for dinner at 5 PM”), names of staff members present, and any explanations given by staff. Photos or videos, if appropriate and permissible, are also valuable;
2. Request a Meeting with Nursing Home Staff and the Attending Physician: Schedule a formal care conference. Prepare your questions in advance. Ask directly about all medications your loved one is receiving, their dosages, the exact medical diagnosis each drug is intended to treat, and why it was prescribed;
3. Ask Specific Questions About Medications: Inquire about non-pharmacological alternatives that were tried before resorting to these drugs. Ask about the expected duration of treatment and the plan for monitoring side effects and attempting to reduce or discontinue the medication;
4. Consult with an Independent Physician for a Second Opinion: If possible, have your loved one evaluated by a doctor who is not affiliated with the nursing home. This physician reviews their medication list and overall condition to provide an unbiased assessment;
5. Report Your Concerns to Authorities: You have the right to file a formal complaint. In South Carolina, report nursing home abuse and neglect to the South Carolina Department of Health and Environmental Control (SC DHEC) and the Long-Term Care Ombudsman Program. The Ombudsman program advocates for residents’ rights.

• Bring All This Information to Your Attorney: Nursing home abuse lawyers typically work on a contingency fee basis, meaning there is zero cost upfront to have them review your case.

Don’t Let Them Get Away With It.

If you see the signs, if your gut tells you something is deeply wrong with how your loved one is being medicated, don’t wait. The health, dignity, and even the life of your family member could be at stake.

Our experienced personal injury attorney is ready to listen, to believe you, and to discuss how we will fight back against this egregious form of nursing home abuse. Call us now at (843) 881-8644 for a no-cost, confidential consultation.

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Nathan Hughey

Nathan Hughey, an attorney and fourth-generation South Carolinian, founded Hughey Law Firm in 2007. Before that, he spent five years defending nursing homes and insurance companies. Leveraging his experience, he now advocates for those injured or wronged by such entities, securing over $290 million in verdicts and settlements.