Staffing levels ‘significantly impact’ the use of antipsychotic medication, new research has found
About 24,000 additional nursing-home residents will be sedated just to keep them under control as a result of the defeat of the Biden administration’s staffing mandate, new research says.
The chances of your parent or grandparent being subject to so-called “chemical restraint” by nursing-home staff is about 10% higher than it would have been if the staffing mandate had survived, according to the analysis just published by the Pension Research Council at the University of Pennsylvania’s Wharton School of Business.
This was based on a detailed analysis of staffing levels and sedative use across America’s 16,000 nursing homes between 2012 and 2021. Researchers Jong Meong Lim, Ken Moon and Minje Park obtained regulatory data on antipsychotic use, staffing levels and other information about nursing homes from the federal government’s Centers for Medicare and Medicaid Services through Freedom of Information Act requests.
“Our analyses consistently find that staffing levels significantly impact nursing homes’ antipsychotic medication use,” they report. “We find that increasing a nursing home’s nurse staff hours per resident day (HPRD) decreases its usage of antipsychotics by 6.039 residents on average, even after controlling for resident, zip code, and nursing home characteristics.”
As they explain, “patients placed under chemical restraints require less work. By reducing workloads rather than fulfilling them, nursing homes can hire fewer nurse staff while utilizing antipsychotic medications to still manage their patient load.”
They find that nursing homes run for profit are most likely to resort to such “chemical restraints” to control residents.
Co-author Ken Moon, a professor at Cornell’s SC Johnson College of Business, says the true figure may end up being even higher than 24,000. That’s because of the Trump administration’s nationwide purge of immigrants without legal status, which is making it even harder for nursing homes to find staff. (The nursing-home industry has also complained about this.)
Previous studies have also shown a correlation between higher staffing levels, better care and less abuse of sedatives or “chemical restraints” in nursing homes. However, this is the first to look specifically at the possible impact of the staffing mandates pushed by the Biden administration.
The staffing mandates, which were proposed by the Biden administration in 2024, would have set minimum levels of nursing staff per resident. They were defeated earlier this year as a result of a concerted campaign by the nursing-home industry and its political allies. The rules were blocked by the courts in April and seemingly killed for good by the Trump administration’s One Big Beautiful Bill, which was passed by Republican majorities in both houses of Congress and which the president signed into law earlier this month. The law imposed a moratorium on the rules until 2034.
There are inevitable caveats. Nursing homes are still subject to various regulations at the federal and state levels. (How well facilities are monitored and regulations enforced is a subject for debate.) The Biden staffing mandate couldn’t wave a magic wand: Nursing-home operators complained that they already couldn’t find enough staff at prevailing wages and that many of them couldn’t afford the extra workers required, and they warned that some nursing homes would simply close down instead. The 24,000 figure comes from applying the theoretical staffing levels to nursing homes’ 2019 occupancy levels. Obviously, this involves projections and estimates.
In an emailed statement, Holly Harmon of the nursing-home industry’s trade association, AHCA/NCAL, said “our providers are committed to strengthening the long term care workforce, but they need meaningful support.” The industry, she added, urges policymakers to support its “Better Way” policy priorities.
Alas,
one of those includes protecting Medicaid — the main financial support
for America’s nursing homes — from cuts. (The Republican megabill signed
into law by President Donald Trump earlier this month, includes deep
cuts to federal Medicaid spending — more than $1 trillion over 10 years,
according to the Congressional Budget Office).
It’s long been known that some or many understaffed nursing homes have resorted to the use of antipsychotic medications, typically meaning sedatives and tranquilizers, to make up for a shortage of staff. A U.S. Senate subcommittee reported as long ago as 1975 on this abuse of medications as a way to keep residents docile and easy to manage. A recent study suggested that nearly one resident in four is being medicated in this way.
Some nursing-home operators have responded to increased oversight by exploiting regulatory loopholes, critics also argue. This includes diagnosing more residents with conditions such as schizophrenia, where the use of antipsychotics draws less scrutiny, they say.
But look on the bright side. Based on the evidence of recent decades, including during the pandemic, hardly anybody outside of a nursing home really cares what happens to the people inside.
They figure it won’t happen to them, anyway. It will only happen to other people. Of course it will.
Full Article & Source:
Opinion: Nursing homes may start sedating your elderly parents — and, eventually, you — because they don’t have enough workers
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