After seeing several recent reports that nursing homes throughout the nation are improperly using antipsychotic medications to “chemically restrain” residents with dementia, I feel compelled to point out that this is an area where Illinois can and should serve as a national model.
Since the 1980s, the media and watchdog groups have documented nursing homes — particularly understaffed facilities — using antipsychotic medications to deal with aggressive and confrontational patients, who often suffer from dementia.
Studies as far back as the early 2000s revealed that improperly prescribed antipsychotic medication nearly doubles the risk of death for people with dementia. These drugs make patients drowsy and more likely to fall, and increase the risk of heart attacks. In large enough doses, they can even lead to problems such as bedsores, which can become infected and lead to amputation or death.
Commendably, the federal government has long discouraged improper use of these medications by requiring nursing homes to report when they are prescribed. Overuse of antipsychotics can result in lowered “quality of care” scores and dissuade people from sending their loved ones to specific facilities.
However, there’s a loophole.
Prescriptions written for patients diagnosed with an uncommon condition such as schizophrenia that truly must be treated with antipsychotics don’t need to be reported. On the surface, this makes sense: Nursing homes shouldn’t be penalized for providing proper medical care.
However, we’ve seen a sharp increase in schizophrenia diagnoses in nursing homes. It’s telling that 1 in 9 nursing home residents has a schizophrenia diagnosis, while only 1 in 150 members of the general population does. Compounding the likelihood that many of these diagnoses are false, the medical literature indicates that schizophrenia normally develops by the age of 40.
This problem needs to be addressed at a national level, but we already have an effective solution here in Illinois.
In this state, before an antipsychotic drug can be prescribed to a nursing home resident, either that person or their designated caregiver must give written, informed consent. No nursing home in Illinois can administer these medications to a patient without their consent except in temporary, emergency circumstances.
Our law also requires reporting on staffing levels, another factor that can lead to improper use of antipsychotics. The use of “chemical restraints” is much more common in facilities that don’t have enough employees to provide their residents proper care.
When we passed this law in 2019, it took a lot of hard work. The nursing home industry has a powerful lobby, and both the AARP and I had to work very hard to overcome it. But, we did not give up, because older adults deserve to live their lives with dignity and in the best health they possibly can.
I urge the members of our congressional delegation to pass a similar law at the federal level, and until they do, I encourage other states to follow Illinois’ lead. I stand ready to assist any legislator who wants to take on this cause with my advice and experience.
Older adults with dementia can’t stand up for themselves. Their family and friends are often already struggling to provide them with support. We, as a society, must stand up for them and end this unjust practice.
Jacqueline Y. Collins is a state senator who represents Illinois’ 16th District.
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