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‘Chemical Restraints’ Deprive Older People of Liberty

UN Expert Describes Care Facilities as de Facto Prisons

The daughter of Lenora Cline, 88, who has Alzheimer’s disease, had to persuade the nursing home where she lives to discontinue antipsychotic medications. Los Angeles, August 2017.  © 2017 Ed Kashi for Human Rights Watch

A new report by the United Nations independent expert on the rights of older persons presents disturbing findings about the deprivation of liberty of older people. The independent expert, Claudia Mahler, found that, “[i]n some countries, older people are more likely to be de facto deprived of liberty in care facilities than in prisons” and that the use of chemical restraints – medication to control behavior without a therapeutic purpose – is “widespread and abusive.”

The report drew on Human Rights Watch's research in several countries.

In the United States, during an average week in 2018, more than 179,000 older people in nursing homes were given antipsychotic drugs without an appropriate diagnosis. The use of antipsychotic drugs in older people with dementia can have debilitating side effects and nearly doubles the risk of death.

In 2019, staff in aged care facilities in Australia did not obtain informed consent from older people or their family members to use antipsychotic drugs. Despite regulations introduced that year to minimize their use, chemical restraints were reportedly used in more than 150 aged care facilities between July 2020 to July 2021.

During the Covid-19 pandemic, increases in psychotropic drug prescriptions for older people in nursing homes in the United Kingdom and Canada may have added risks to those already among the most threatened by the coronavirus.

Lack of home and community-based support services can force older people into institutions against their will. In 2021, about 820,000 people in the United States were on waiting lists to receive home and community-based services, reflecting decades of underinvestment in the Medicaid-run program. In Russia, inadequate funding and delivery of home and community-based support services for older people leave many with few options other than to live in an institutional setting like a nursing home.

The independent expert’s report highlights the potential dangers to older people living in care facilities. No one should be deprived of their liberty because of their support needs. Governments should ensure older people have access to the support services they require to live with dignity in their communities, instead of being deprived of their liberty in a care facility. Those who choose to live in a facility for older people should also have their rights respected. Governments should prohibit the use of chemical restraints to control the behavior of older people and ensure their rights are protected.

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