California Nursing Home Abuse Lawyer Blog

A Recent Study Confirms Adverse Effects of Polypharmacy in Los Angeles Nursing Homes

March 9, 2012 | by Law Offices of Ben Yeroushalmi

While we are fortunate to be living in a modern world that is constantly making advancements in the field of medicine, the side effects of pharmaceuticals can often be dangerous and have implications that must be assessed. The March issue of the Journal of American Medical Directors published an article titled “Exploring Variation in Rates of Polypharmacy Across Long Term Care Homes.” The study on polypharmacy, which the article defines as “the use of multiple, concurrent drug therapies” produced startling results on just how many medications nursing home residents today are taking on average.

If a patient was on nine or more drug regimes at once, the study considered this a practice of polypharmacy and compared the quality of life of these patients to those who were taking fewer medications. The study found that patients subject to polypharmacy were more likely to have comorbidities. This group comprised about 15.5% of nursing home patients taking nine or more drugs simultaneously. Only 2.9% of patients were taking no drugs, and the remaining 81.6% were using anywhere between one and eight drugs at once. The most commonly used drugs include diuretics, proton pump inhibitors, and enzyme inhibitors.

Additionally, the study noted that in general, psychoactive drugs are also one of the most frequently used drugs in nursing homes. Previous studies have established that psychoactive drugs, although intended for treatment of illnesses such as schizophrenia, are often administered to patients who suffer from dementia. Because dementia patients may have episodes of agitation, nursing homes often find it convenient to sedate these residents with psychoactive drugs in order to prevent these episodes from occurring. However, this improper use of pharmaceuticals is an example of a chemical restraint and is in direct violation with the Patients’ Bill of Rights. Furthermore, studies have concluded that the use of psychoactive drugs in dementia patients has reciprocal effects and can actually cause agitation and worsen the overall condition of the patient.

In addition to triggering agitation in dementia patients, drug use can also cause delirium. It is important that you monitor your loved one’s drug intake, as well as the staff that is administering these drugs to him or her. Sometimes, understaffing and disorganization among staff can lead to mix-ups between patients’ drugs. Taking another patient’s drugs can have detrimental effects on health, and may even cause death. The study also noted that the more prescribing physicians a patient had, the more likely polypharmacy was to occur. This can be attributed to that fact that care facilities may not be properly documenting medical records. In terms of administration and management, documentation of medical charts is extremely important. All attending physicians must be able to clearly and easily see every medication that a patient is taking, in order to assess the costs and benefits of prescribing additional drugs.
Unfortunately, not all skilled nursing facilities have your loved one’s best interests at heart. What you can do is make frequent visits to check up on your loved one’s health and well-being. It is recommended that you have a general awareness of medications that are more likely to cause adverse drug reactions and overdoses. Also ensure to assess the facility’s staffing levels and closely monitor nurses, because tampering with patients’ drugs can sometimes occur in healthcare facilities.

Delirium: A Common Issue in Los Angeles Nursing Homes that Is Difficult to Diagnose and Proposes Questions Regarding the Quality of Care Provided by Nurses

March 3, 2012 | by Law Offices of Ben Yeroushalmi

The March 2012 issue of the Journal of American Medical Directors Association features an article titled “Detection of Delirium and Its Symptoms by Nurses Working in a Long Term Care Facility.” Because delirium is often difficult to recognize, the article studied the accuracy of nurses in diagnosing delirium in their patients. Although often associated with dementia, delirium distinguishes itself from dementia because it is a disorder that is usually reversible, while dementia is a chronic illness that develops over a span of time. Delirium affects a patient’s attention span, consciousness levels, and overall cognitive abilities. Patients typically experience disorientation, memory loss, difficulty with perception, agitation, and a disrupted sleep cycle.

While delirium can be caused by infections, such as sepsis, some other causes of delirium, according to the article, include dehydration, medications, and the use of a physical restraint. Previous studies have also cited chemical restraints as a significant factor that contributes to the development of delirium. Some commonly used chemical restraints are antipsychotic drugs, which effectively sedate and restrain patients, but have many extremely serious side effects, including delirium.

The key to finding a suitable nursing home for your loved one requires close observation of both the quality and quantity of the facility’s staff. With proper staffing levels, dehydration, among many other health issues, is avoidable. Therefore, if a nursing home has blamed your loved one’s delirium on dehydration, the facility is ultimately at fault for failing to prevent dehydration in the first place. The use of restraints, both chemical and physical, is often another consequence of understaffing. When nurses are preoccupied with so many other patients, they may find it difficult to provide each patient with the individualized care that he or she needs and resort to the use of restraints.

With respect the issue of quality of staffing, the study results showed that nurses recorded more cases of delirium than there actually were. Although treatments for delirium may not actually be harmful to patients who do not actually suffer from it, the results still reveal the poor training programs that facilities often provide to their nurses.

Beyond this specific case that studied accuracy in identifying cases of delirium, the study has further implications that nurses may be inaccurately diagnosing other medical problems, while some may be failing to do so at all. Sometimes in skilled nursing facilities, employees are actually directed to improperly document and diagnose illnesses, in a practice known as “downcoding,” to avoid liability and injury claims against them. Other facilities “upcode” in order to maximize reimbursement claims from government health agencies. We would like to increase your awareness of the manipulation of medical records that occurs in skilled nursing facilities. If you are ever in doubt of the accuracy of your loved one’s medical records, it is best for you to monitor his or her records and physical health yourself, or get a second opinion.

Although the staff at nursing home in which the study was conducted mistakenly overestimated the cases of delirium at their facility, other facilities may be underestimating the number of their patients who suffer from delirium. If the nursing home is failing to recognize that your loved is suffering from delirium, he or she is not receiving proper treatment for it. The study emphasizes the importance of recognizing the onset of delirium early so that the cause can be identified and the problem can be treated immediately, before progressing and worsening. If your loved one’s nursing home is failing to provide your loved one with proper care, he or she is a victim of elder abuse and nursing home neglect.

New Discovery that Physical Training Improves Incontinence

March 2, 2012 | by Law Offices of Ben Yeroushalmi

The February 2012 of Clinical Interventions in Aging published an article titled “Effect of Physical Training on Urinary Incontinence: A Randomized Parallel Group Trial in Nursing Homes.” While previous studies have proven that physical training and resistance exercises are effective in improving muscle strength, the significance of physical training in improving urinary incontinence was unknown thus far. After three months, the study was concluded and showed results to suggest that physical training does indeed have a positive effect on improving urinary incontinence in elderly adults.

Incontinence is a common, serious problem in skilled nursing facilities that is recognized as a loss in control of the bowel or the bladder. Regardless of the different diseases that sometimes contribute to the onset of incontinence, the nursing home is obligated to provide its patients with proper incontinence care, as to avoid the progression of any additional health complications, such as pressure ulcers and urinary tract infections.

Because incontinence often marks a decline in the ability to perform activities of daily living, incontinent patients must rely on the nursing home staff to maintain their hygiene and help them use the toilet. Therefore, it is absolutely necessary that the nursing home is not understaffed, so that incontinent patients can receive the care that they need. Furthermore, the mental well-being of incontinent patients is reliant on mental support from the nursing home staff. Because incontinence can often make patients feel embarrassed or ashamed, nurses must be encouraging to patients in order to help them maintain their dignity.

The study confirms that incontinence in nursing homes, unfortunately, worsens over time when left untreated. More optimistically, however, the study also reveals that it is possible to control or reverse the progression of incontinence. For this reason, it is extremely important that the nursing home staff begin treatment early. In addition to physical therapy, some other treatments include prompted voiding, pelvic muscle exercises, and changes in nutrition fluid intake. The patients in the study, however, were exclusively participating in physical training and not using any of these other treatments. The study suggests that in the future, a combination of physical therapy with these other, more established treatments may lead to even better results. Furthermore, the study strives to eventually develop and experiment with a physical training program that directly targets incontinence care, with the hope that such a program will improve incontinence even more.

Because the future of incontinence care appears to be so optimistic, as improvements in treatments are continually being discovered and implemented, there is no reason that your loved one should be denied of his or her proper care. In fact, inadequate incontinence care is an act of nursing home neglect and elder abuse that is in direct violation of your loved one’s rights.

Recent Study Links the Lack of Direct Care from Registered Nurses to an Increase in Pressure Sores in Los Angeles Nursing Homes

February 24, 2012 | by Law Offices of Ben Yeroushalmi

A recent article titled “Observing How RNs Use Clinical Time in a Nursing Home: A Pilot Study” observes how RNs allocate their time between direct and indirect care of their patients. While direct care generally involves physical and psychological care and the administration of treatments, indirect care is more administrative, including documentation and reading of medical records and care supervision and management of nursing aides and certified nursing assistants.

The results of the study showed that RNs spent 59% of their time in indirect care, and only 31% in direct care. The remaining 10% was classified as unproductive time, including breaks and mealtimes. Of the time spent in direct care, the majority, 94.6%, was spent in executing general care procedures. The remaining 5.4% was spent in clinical care, which involves the direct care of pressure ulcers, pain management, and nutrition and weight loss. Because direct care from RNs is so valuable, the study encouraged RNs in skilled nursing facilities to allocate their time between direct and indirect care more wisely.

Despite common misconceptions that direct care is more beneficial than indirect care, previous studies have actually shown that both types of care are important. One study has proven that poor supervision, which is a type of indirect care, is actually related to an increase in cases of pressure ulcers, as well as job dissatisfaction and turnover. On the other hand, direct care is also associated with reduced pressure ulcers, as well as a decline in other adverse outcomes including urinary tract infections, catheterization, and weight loss, while improving the use of nutritional supplements and the maintenance of activities of daily living.

While the implementation of direct versus indirect care each has its own results, under both types of care, the development of pressure ulcers is affected. This is due to the fact that prevention of pressure ulcers is highly dependent on RN staffing levels and quality of care. In fact, pressure sore prevention is so reliant upon the nursing staff, especially RNs, that the prevalence of cases of pressure sores is actually considered to be an indicator of quality of care that a nursing home provides.

Not only does there have to be an adequate amount of staff, however, but this staff must also be well-trained on how to prevent, diagnose, and treat pressure ulcers. While prevention is a completely feasible and necessary part of patient care plans, when pressure sores do begin to form, it is key for nurses to be able to recognize these wounds in their early <a href="stages of development before they progress into more serious stages that can often result in death.

Patient Dumping: A Common Practice in Los Angeles Healthcare Facilities

February 21, 2012 | by Law Offices of Ben Yeroushalmi

Recently, the Los Angeles Times reported on a hospital that has been accused of patient dumping. Jesse Bravo, a patient at White Memorial Medical Center here in Los Angeles was admitted to the hospital for treatment of schizophrenia. When he was discharged, Bravo’s wife was not notified and instead, he was dropped off in front of a rehabilitation center. Bravo reportedly never actually went inside and spent several days on the street before police found him and brought him home his wife, who had filed a missing persons report. The couple is now suing the hospital for elder abuse, hospital negligence, and false imprisonment.

According to the article, over the past few years, patient dumping has become a serious problem. In response to this issue, Los Angeles law enforcement authorities have been strictly regulating policies against patient dumping. Chief Deputy City Attorney William Carter said that “The message was sent in the city of Los Angeles that this kind of activity would not be tolerated and would be closely watched.” Unfortunately, similar cases of elder abuse and neglect occur regularly, not only in hospitals, but also in nursing homes and other long-term care facilities.

In skilled nursing facilities, especially those that are understaffed, duties are often carried out carelessly and recklessly. This inattentiveness often leads to errors that are detrimental to the health of patients and sometimes even death. Patients with cognitive disorders such as dementia and Alzheimer’s disease are at an especially high risk of nursing home neglect. While their conditions require additional attention and care, nursing homes often fail to provide for these needs.

In a recent case taking place in a nursing home, a patient with memory problems was allowed to wander out into a seven lane road in forty-eight degree weather, wearing only pajamas. Furthermore, it took the facility two hours to notice the patient’s disappearance before they reported him missing. In another nursing home, a woman with dementia suffered from hypothermia when she was found outside in twelve degree weather at 4:00 a.m.

Although skilled nursing facilities may seem fully staffed, we often find that there is a discrepancy between the staffing levels of different shifts. For example, in the case discussed above, while the facility may or may not have been fully staffed during the day, they were most likely understaffed during their night shift, since the woman was clearly not being closely monitored, as she was able to wander from her bed outside into the cold.

When healthcare facilities are understaffed and are failing to provide your loved one with the care that he or she needs, they are violating the Patient’s Bill of Rights and committing elder abuse. Under the circumstances that their carelessness and neglect directly contribute to the death of a patient, the successors of the resident may be able to make a Wrongful Death claim.

Recent Study Shows that in addition to the Physical Health Benefits, Resistance Training also Promotes Mental Well-Being among the Elderly

February 20, 2012 | by Law Offices of Ben Yeroushalmi

Falls are becoming an increasingly prevalent problem in today’s skilled nursing facilities. Because the consequences of fall-related injuries are so detrimental to the health of elder adults and the costs associated with treating these injuries are so high, many recent studies have focused on fall prevention techniques. Many of these techniques center on improving the muscle strength of patients, since cardiovascular deterioration is one cause of falls in the elderly population.

The 2012 issue of The Journal of Nutrition, Health & Aging recently published an article titled “Physical Function Predicts Improvement in Quality of Life in Elderly Icelanders after 12 Weeks of Resistance Exercise.” The study reinforces the benefits of resistance training in elderly adults, while discovering some additional advantages that this new treatment has to offer. Before progressing with the study, however, the article outlines the underlying causes of the decline in muscle strength that is experienced by all elderly adults.

Although a weakening of muscles is inherent with old age, especially after the age of sixty, certain factors can accelerate this condition. One of the most basic causes is malnutrition. Because the body receives its energy and strength from nutrients that are in food, it is very important that your loved one is receiving nutritional meals at his or her skilled nursing facility. However, even in nursing homes with the healthiest meals, malnutrition is a likely possibility in understaffed facilities. In choosing a home for your loved one, we advise that you visit at various times throughout the day, as there is often a discrepancy between the staffing levels of different shifts. As it is one of the busiest and most hectic times of the day, it is crucial for you to ensure that your loved one’s facility is employing an adequate level of staff during mealtimes.

Another cause of muscle deterioration is inactivity, which is the area studied by the article. The study proposes the use of resistance training, in which participants perform exercises against an opposing force. As muscle strength improves, the opposing force is increased. While some studies have already proven that resistance exercises improve muscle strength, this study focuses on the effect of this treatment on overall health-related quality of life.

With 204 participants, the study proceeded by enrolling each individual into resistance training classes. The study was conducted over a period of twelve weeks. For three nonconsecutive days of each week, the participants attended their resistance exercise classes in groups of twenty to thirty. Three sets of exercises were repeated six to eight times and increased by five to ten percent each week. Over the course of the study, some tests, such as a walk that recorded the distance that the participant could walk in six minutes, were used to measure improvements in muscle strength.

Health-related quality of life was determined by a questionnaire that inquired about both psychological and physical functions, including functional status, vitality, social function, physical pain, emotions, general health, and mental health. The results of the study show that resistance training does more than simply improve the muscle strength of elderly adults. Overall, participants experienced an increase in health-related quality of life. This included improvements in mental health, such as an alleviation of mild depressive symptoms and anxiety symptoms.

While most nursing homes install railings in hallways to prevent falls and call buttons in case falls do happen, rehabilitation exercises are often overlooked as fall prevention techniques. However, these exercises are actually very effective in preventing falls because they directly address the loss of muscle strength experienced by the elderly that is one of the fundamental contributing causes of falls.

Los Angeles Nursing Homes Improperly Using Physical Restraints on Residents

February 12, 2012 | by Law Offices of Ben Yeroushalmi

A recent article in the Journal of Clinical Nursing, titled “Use of Physical Restraints in Nursing Homes and Hospitals and Related Factors: a Cross-Sectional Study,” studies the risks of using physical restraints in hospitals and nursing homes. The article defines a physical restraint as any device that limits the freedom of an individual’s movement. For example, bedrails, belts, geriatric tables, mechanical devices, straps, and vests are just a few of the different types of physical restraints that are commonly used in skilled nursing facilities.

By examining seventy-six nursing homes, the study aimed to identify the various factors that are related to the use of restraints in skilled nursing facilities. The study also considered the usage of physical restraints in hospitals as a basis of comparison in drawing conclusions about the reason that the use of physical restraints is so prevalent in nursing homes. While only 9.3% of hospital patients were found to be restrained, 26.3% of nursing home residents who participated in the study were subject to restraint at some point during their residency. Some shared characteristics of the patients who were restrained include disorientation and the presence of cognitive disorders, such as dementia, that may have caused the patient to wander. However, of the patients who were physically restrained, those who resided in nursing homes were usually determined to be at a lower risk of falling than those in hospitals.

Nurses in healthcare facilities often restrain patients unnecessarily. Usually, this phenomenon can be explained by understaffing. A previous study has shown that 37% of nursing homes used restraints because of shortages in staffing. As nurses are assigned far more responsibilities than they can single-handedly accomplish, they often feel that they are left with no other option than to restrain their patients. However, it is the duty of the skilled nursing facility to hire an appropriate amount of staff to sufficiently provide your loved one with the individualized care that he or she deserves and requires.

The patients who were physically restrained in nursing homes were also found to be more incontinent than those in hospitals. Incontinence is actually one of the consequences of restraint usage, so therefore, it makes sense that incontinence rates are higher in skilled nursing facilities, since use of physical restraints in nursing homes is so prevalent. Incontinence can lead to serious psychological problems, such as feelings of loss in dignity that no human being should ever have to experience. Some other psychological problems related to the use of physical restraints in general include embarrassment, feelings of confinement, aggression, social isolation, and anxiety. Furthermore, additional health complications include pressure ulcers, aspiration and breathing problems, agitation, constipation, decreased cardiovascular endurance and balance, and increased dependency in activities of daily living.

The study asserts that physical restraints fail to decrease the occurrence of falls, and that when falls do happen, the consequences are actually worsened by the presence of a physical restraint. There have been instances when fractures and suffocation directly caused by restraints have led to death. A direct quote from the article sums up the danger of using physical restraints effectively and concisely: “Physical restraints restrict persons in their human rights, do not protect them from harm, but are always harmful and should be avoided.” The use of physical restraints is ethically and legally wrong. It is extremely important for you to ensure that your loved one’s rights are not being violated, and that his or her physical and mental well-being is not at risk.

Healthcare Facilities Found Guilty of Cheating the Government and Putting Patients’ Lives at Risk

February 11, 2012 | by Law Offices of Ben Yeroushalmi

On February 8, 2012, Bloomberg News reported that fourteen hospitals in New York are paying $12 million to settle the allegations that they made false claims to Medicare. Beginning in 2000, and for eight years thereafter, these hospitals overcharged Medicare for kyphoplasty surgeries that were performed on osteoporosis patients with spinal injuries.

As shocking as this may sound, similar fraud against Medicare occurs quite often. Just recently, a total of about forty hospitals have paid $39 million for similar cases of overcharging Medicare. Sometimes, these false claims are referred to as “upcoding” because the healthcare facilities upcode their patients’medical conditions, so that they can report a higher reimbursement rate.

Just a month ago, the federal government investigated another case in which pharmaceutical companies were manipulating their financial statements in order to profit from government health programs. You can learn more about this case and the incentives pharmaceutical companies and other healthcare businesses have to cheat Medicare by reading this California Nursing Home Abuse Blog.

Some skilled nursing facilities cheat government health programs for reasons other than to profit. For example, some facilities use Medicare or Medi-Cal money to order antipsychotic drugs that were never prescribed by a physician in the first place. These drugs are usually used as chemical restraints, to sedate dementia patients who have episodes of aggravation. However, studies have shown that the use of chemical restraints actually worsens aggravation and also makes patients twice as likely to die from an overdose. Furthermore, the use of restraints can not only lead to death, but is also a direct violation of the Patients’ Bill of Rights. The use of restraints is most commonly found in nursing homes that are understaffed and unable to personally attend to each patient and provide him or her with the individualized care that he or she needs.

In an attempt to stop fraud against the United States government and to encourage witnesses of such fraud to speak up, the federal government passed the False Claims Act, which states that whistle-blowers can sue on behalf of the government and receive a share of any claims that are made. This further proves how serious fraud against the government is, especially when the lives and well-being of nursing home residents are being put in danger.

Los Angeles Nursing Homes Cause Patients Who Are at the End of Their Lives to Suffer the Pain of Pressure Sores Instead of Providing Treatment

February 10, 2012 | by Law Offices of Ben Yeroushalmi

On February 2, 2012, the International Wound Journal published an article titled “Wound Outcomes in Patients with Advanced Illness.” The article studied elderly adults who were sustaining serious wounds, in addition to suffering from advanced illnesses, such as cancer. The patients had various types of wounds, including pressure ulcers, malignant wounds, skin tears, inflammatory wounds, and venous leg ulcers, arterial leg and foot ulcers. The goal of the study was to observe the potential for wounds to heal completely, despite the presence of an advanced illness.

The study split the participants into four groups based on the length of time that they were able to live with the wound before passing away. The divisions were as such: 7 days or less, 8 to 30 days, 31 to 91 days, and 92 to 182 days. The wound type that occurred most often in the patients studied were pressure ulcers. The results of the study showed variations in the complete healing of pressure sores, depending on their level of severity. Most pressure ulcers that had only progressed to the first or second stage were usually able to heal successfully and completely. However, only one stage three pressure ulcer in the entire study was able to heal completely, while no stage four ulcers were observed to have healed completely.

The results of the study merely emphasize the importance of identifying and diagnosing wounds early on in their stages of development. Many prevention techniques are available and are generally very successful in preventing the development of pressure sores. However, in order for any of these prevention techniques to be carried our properly and achieve their full effectiveness, facilities must be adequately staffed, as each technique requires careful attention to each individual patient.

Although the article defined an advanced illness as one that would cause the patient to die within six months, the study succeeded in disproving the common assumption that dying patients cannot fully recover from wounds. Unfortunately, many skilled nursing facilities leave patients to suffer in the last days of their lives because they are misinformed that there is no point in trying to heal the wounds of patients who are on their deathbeds. In choosing a nursing home for your loved one, make sure that the staff is knowledgeable and willing to provide your loved one with the best care possible, up until the end of his or her life. Any refusal on the part of the skilled nursing facility to provide your loved one with the care that he or she needs in order to achieve the best quality of life is considered an act of nursing home neglect.

Recent Study Proves that Los Angeles Nursing Homes Need to Be More Careful in Administering High Dosages of Drugs

February 3, 2012 | by Law Offices of Ben Yeroushalmi

A recent article, titled “Anemia in Nursing Homes: A Complex Issue,” was published in the Journal of American Medical Directors and studied the nature of anemia in skilled nursing facilities, including its causes and treatments. The article cited iron deficiency, protein malnutrition, frailty, and weight loss as some causes for anemia. In caring for anemic residents, the nursing home staff needs to be cautious because this condition not only leads to decreased muscle strength, mobile impairment, and an increased risk for falls, but is also very tricky to treat.

The study aimed to disprove the common misconception that taking a high dosage of iron, up to 200 milligrams daily, is a simple way to overcome anemia. Participants were divided into three groups, each taking a different dosage of iron daily. One group took 15 milligrams, the second took 50 milligrams, and the third group took 150 milligrams. The study was conducted over two months. At the conclusion, the researchers determined that regardless of the dosage amount, each group experienced the same increase in iron levels.

Ultimately, we can take from this study that in caring for our loved ones, it is best to maintain all medications at the lowest dosage possible. In the case of anemic patients, those who were taking a higher dosage of iron experienced side effects, including abdominal pain. They were also less likely to adhere to their prescription, taking only portions of their medication, rather than the entire dosage. The study asserted that a dosage as low as 30 milligrams is sufficient in effectively treating anemia. It was also noted that since iron interferes with the absorption of other drugs, it should not be taken in conjunction with other medications.

In order to best assure your loved one’s health, regular check-ups and updates to his or her medication prescriptions are recommended. Furthermore, proper documentation and updated records must be kept in an orderly fashion, so that current physicians can be aware of the patient’s medical history, as well as medications that the patient is currently taking, or has taken in the past. Keeping organized records of a patient’s medical history also facilitates physicians in lowering dosages, when possible, as the patient’s condition is treated and his or her health improves. Organization of medical charts has a significant impact on keeping your loved one’s drug intake to a minimum.

Often, disorganization and lack of documentation in skilled nursing facilities is a result of understaffing. When nurses are assigned too many duties and responsibilities, they tend to overlook or skip certain steps in the caretaking process that they deem unimportant. However, it is the responsibility of the skilled nursing facility to employ a sufficient amount of staff and ensure that every measure is being taken to maintain the highest practicable health and well-being of the residents.

Carelessness and improper documentation of prescribed drugs can lead to overdoses, adverse drug reactions (ADRs), and sometimes even death. In addition to monitoring your loved one’s iron intake, other drugs that are commonly abused or misused in nursing homes are antipsychotics. Drugs that are improperly used are considered chemical restraints. The use of restraints is both a threat to your loved one’s physical and mental well-being and a direct violation of the Patients Bill of Rights.