In the days before nursing homes were under so much regulation, many homes used heavy medication to "manage" residents. Elders who slept most of the day, as well as all night, didn't require as much staff time. Therefore, many homes considered drugging people efficient and cost containing.
Anti-psychotics were frequently prescribed when people had dementia. For some, a light dose may have been just the right thing, but one medication doesn't suit all elder issues. Gradually, nursing homes came under more intense scrutiny about safety and most states put strict guidelines in place about hygiene, restraints and, of course, medications for the convenience of the staff.
There are still many states where these rules aren't strong enough, or if they exist they are not well enforced. Talk to any group of people with loved ones in a nursing home and you are bound to find a few who feel that too much medication is given.
They may be right. However, my experience was the reverse. My loved ones – several of them over many years – lived their last years at a nursing home just two blocks from my home. Whenever there was a medication change, I was notified. The reason for the prescription was discussed. If there was an antibiotic prescribed, the need was explained. Rarely, over the course of the full 15 years that I had loved ones in the home, did I have a medication complaint.
When I did, it was because the prescribing doctor made it too hard for the nursing home staff to get their hands on an "as needed" prescription for my dad's panic attacks. The physician didn't let them keep enough on hand. Of course, Dad's worst episodes were on weekends – Murphy's Law in action. Also, of course, the doctor wasn't around on weekends.
Getting Dad his desperately needed dose of a drug used to treat anxiety was often a nightmare. Dad had dementia that kicked in after brain surgery. Frequently, he would have panic attacks so severe that if people induced them on purpose, they would have to be accused of torture. The medication worked well to relax him and get him through the attacks.
However, it only worked if the staff could have a supply on hand to give to him. Those weekends with Dad in hell and the staff and me railing against the system, as we tried to get him his prescribed medications, live on in my brain. This was definitely a case where this excellent facility should have had more say over the amount of the drug needed to be kept on hand.
The flip side of my story comes from a friend of mine whose dad was living in another nursing home in our town. This home also had a very good reputation, though I'd heard a few more grumbles from people about over-medicating. My friend felt his dad was being over-medicated with an antipsychotics, even though the father was in a special dementia wing where they should have been able to handle his symptoms. My friend may have been right. At any rate, he moved his dad to a nursing home in a nearby small town. The home was run by a reputable non-profit area chain, and the family was happier with the care.
To medicate or not to medicate?
The old practice of over-medicating just to keep people "manageable" so that they didn't need so much staff attention is, in my opinion, dead wrong. Still, if someone is in psychological agony, and a medication can help them feel calmer or more at peace, I think it should be used. Antipsychotics have come under fire lately as not being effective for people with Alzheimer's disease, but as soon as one study comes out with that finding, another appears contradicting it. So, I suggest we just stick with our elder and see what works best for that particular person. We can let the researchers duke it out at their leisure.
To me, human interaction comes first. Hands-on care and an attempt to find out what is bothering the person should be rule number one at all times. But if the person clearly needs a medication to feel better, and that medication improves quality of life, why shouldn't they have it? With dementia, this is not always a clear line, so family members need to be alert. But people who know the elder well need to be alert in any case. Medications that work for awhile can suddenly cause side effects. That happened to my dad. One medication he was given for nerve pain put him in far worse agony than he'd have been without it. It took some digging, but we found the source of his pain and "cured" him by withdrawing the medication.
Dosages are tricky. Allergies occur. Medicating elders is no walk in the park. Yet, that shouldn't put us in a mode where they are left to suffer needlessly because we have a "no medication" rule.
My dad's panic attacks were something I would not wish on anyone. He needed the medication to help make his life bearable. His need for the drug was episodic. But one hour of such misery shouldn't have to be suffered when relief is one tablet away. Medicating elders in nursing homes, or in their own homes, is about common sense and knowing the elders well so we can watch for unique reactions. Then we can work with modern medicine to limit unnecessary drugs, maximize human contact, but give medication where it is the most humane solution.