Prescribing Silence: Elder Justice “No Harm” Newsletter (Volume 8, Issue 2)

In the Elder Justice Newsletter, we highlight citations, including deficiencies related to abuse, neglect, and substandard care, that have been identified as not causing any resident harm. The goal of this brief newsletter is to shed light on the issue of so-called “no harm” deficiencies, which typically result in no fine or penalty to the nursing home.

This Issue: Prescribing Silence Through Chemical Restraints

Although federal law has prohibited the use of chemical restraints in nursing homes for more than 30 years, inappropriate drugging remains a serious threat to resident safety and dignity. In March of this year, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released two reports confirming that nursing homes continue to misuse antipsychotic medications and, in some cases, even inappropriately diagnose residents with schizophrenia to justify their use. These medications are powerful drugs intended to treat specific psychiatric conditions, such as schizophrenia and bipolar disorder. They are not intended to simply sedate residents or manage behaviors associated with dementia or distress. When nursing homes rely on these drugs instead of identifying and addressing the underlying cause of a resident’s symptoms, they not only fail to provide appropriate care but also compromise residents’ dignity and autonomy while exposing them to serious risks, including falls, stroke, and increased mortality.

This issue of the Elder Justice Newsletter highlights six nursing homes cited for inappropriate drugging and other failures related to unnecessary psychotropic medications and chemical restraints. Surveyors documented residents receiving duplicate or excessive antipsychotic medications, sedatives administered without appropriate clinical justification or monitoring, medications continued despite family objections, and failures to implement required non-pharmacological interventions before resorting to drugs. These cases demonstrate that, despite longstanding federal protections, inappropriate drugging continues to place residents at unnecessary risk and underscores the need for strong oversight and enforcement to ensure residents receive safe, person-centered care.

Note: References to “PRN” or “as-needed” in the following citations relate to prescriptions in which the prescriber has allowed for nursing staff to determine when to administer a medication rather than a set dosage (such as twice a day for ten days). PRN prescriptions are of special concern because they provide opportunities for abuse, in particular the administration of a drug for the convenience of staff rather than for the resident’s benefit.

This newsletter focuses on the following “no harm” violations:

• Chemical restraints by convenience: Resident given duplicate antipsychotics without required safeguards.
• No parameters, no non-drug care: Resident repeatedly given sedating gel.
• More Risperdal than intended: Duplicate orders and missing behavioral interventions.
• Short-staffed for weeks: Residents left waiting hours for help and stuck in bed.
• Trying to get up: PRN Ativan given without documented behaviors or non-drug care.
• Medication oversight failures: Duplicate orders and missing safety monitoring.

Do YOU think these deficiencies caused “no harm”? Click to download the newsletter or read it in the PDF below.