There have been recent reports on the over-medicalization of older individuals in nursing homes and assisted living residences. This problem is not a new one.

Just imagine: you are overworked and there is not enough staff to take care of everyone. There is a resident that wanders all over the place and you cannot keep an eye on him. Or, there is a woman that keeps repeating the same half sentence every 20 seconds of so. Visitors might find it amusing but hearing this in the course of several hours, every day, non-stop, is driving you crazy. Here is another scenario: you are somewhat trained in elder care but do not have the tools or the time to deal with a troublesome resident who may get violent. The man in room 24 keeps yelling and swearing; you need to calm him down because the family of another resident is complaining. They say they pay good money and they do not like to hear swearing. How do you stop Mister B from spitting on you or stealing his neighbor’s cookies? How do you control unwanted behavior? How do you cope?

Drugs that can control behavior such as antipsychotic medications seem like a good answer to all your problems. Although it is the ancillary care staff that deal with these front line issues, it is the physician who prescribes. But you might just be thankful that he or she does that so that you can go ahead with your job of cleaning messes and bringing food. You get the job done, and everyone seems more or less controlled at the end of your shift; your supervisor is pleased. More than likely there were many under you care so you did not have much time to ponder the mental state of your charges. You can go home and be happy that at least everyone who was under your care got washed and fed in a timely manner. Even if the pay is bad, you know that you can keep your job at least for the immediate future.

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NPR is doing a series on the issue of medication in nursing homes, “Old and Overmedicated.” I was glancing at the many comments the series has been generating. It is rather telling that the reason medication is now being questioned is the adverse health effects it is generating. I wonder whether the question would have been raised at all if the medications had not been found to be harmful. What is the premise for medicating someone? To control them but why do we need to control them? Some nursing home administrator would respond that this is the best way to ensure good care is provided. Immediately, I think, really is that the best way?

The latest is installment of the series focuses on a nursing home that emphasizes activities. Not surprisingly keeping individuals busy is a way of getting them to behave or at least to control some of their outbursts. This nursing home (Ecumen) has found that they could reduce the use of medication and especially antipsychotic drugs by doing activities with the residents. Funny that–human contact can be beneficial! This story reminds me of a case I encountered a few years back. This resident was in a room by himself and could not participate in activities because of the nature of his cognitive disabilities. Since the nursing home could provide him with any type of human contact except the one he had when he was fed or toileted, he was spending most of his time alone. He was somewhat agitated and would yell often, but the nursing home staff just assumed it was his nature. His family got him a companion who would sit, watch television and do activities with him. The resident became calmer; the power of human companionship! The lesson here is to increase staffing in nursing homes. Unfortunately, for-profit homes (and even non-profit ones) do not necessarily gauge their care according to calmness or serenity of the residents. Rather they measure pressure sores, bruises and weigh the residents to make sure they are not starving. If they can give this basic care and get the residents to cooperate through powerful medication and if they perceive this method of achieving a clean and fed body as more expedient, then they will simply stick with the tried and true method. In addition to the mindset that perceives pill popping as a surer means, there is another assumption at work. It is that people with dementia or those that have severe cognitive disabilities do not readily relate to others; they are ‘other’ and unreachable. However, anyone who has spent any time with such persons realizes this is false. This brings me to another point and a concern that I have had for some time. The work of a care aid or a personal worker is far more than simply feeding and cleaning: it is being there for someone who is isolated. If only nursing homes or the system that allows nursing homes to operate as they do would take into consideration the many facets of caring for another human being, then staffing would be increased and care workers would be given the training and the time they need to perform their job in a caring manner.