Chemical restraint replaces physical restraint in SNFs

Public reporting of the use of physical restraints has led to the increased use of antipsychotic medications—sometimes referred to as chemical restraints—in skilled nursing facility (SNF) residents whose cognition is severely impaired, according to a new study published online by the Journal of the American Geriatrics Society.

Researchers from the University of Chicago and the University of Pennsylvania retrospectively analyzed data from 1999 to 2008 to compare Medicare- and Medicaid-certified nursing homes subject to public reporting with those that were not. The investigation included 809,645 residents with severe cognitive impairment living in 4,258 SNFs in six states.

The use of physical restraints for residents with severe cognitive impairment declined significantly during the study period, the study authors found, and the drop was greater in facilities that had to report the use of restraints. Over the same time period, however, the use of antipsychotic drugs in those with severe cognitive impairment increased in nursing homes subject to public reporting. The researchers concluded that 36 percent of this increase occurred because of the public reporting requirement.