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Public Policy of the Brain Injury Network
Policy approved by the Board 12-11-10
Post-Acute Medical Environments, Assisted Living Facilities and Nursing Home Placements for People with Brain Injury; Use of Psychotropic Drugs; Quality of Life Issues:
Some people with brain injuries live in dependent situations, such as post-acute medical environments, assisted living facilities and nursing homes. They are entitled to non-pharmaceutical and psychosocial programming and interventions whenever possible. Pharmacological psychotropic treatment and care should not be emphasized over alternate therapies.
People with brain injuries in facilities must have meaningful human contact, appropriate ongoing assessments, and opportunities to make choices (for example, as to what they will wear, read or listen to on the radio). Additionally patients or residents should have formal activities, exercise and mental stimulation as part of their daily routine. People recovering from brain injury in these environments should have physical, cognitive, occupational, speech and other therapy as needed.
Structured living environments designed for people with brain injuries should shy away from a rigid, institutionalized medical model and to a more homelike environment. Design should emphasize privacy and ensure maximum mobility for patients or residents.
Staffing levels and staff training in said facilities needs to be commensurate with patient or resident load and patient or resident issues. Staff should have appropriate and ongoing training on how to work with individuals who have sustained brain injuries. Staff should be adequately supervised.
As previously stated, the first choice in managing patients or residents in such environments should not be the utilization of anti-psychotic drugs to control the person. If the person is exhibiting antisocial or puzzling behaviors a complete and appropriate medical assessment should be made to try to determine the reason for the behaviors. Therapies that involve the use of “off-label” psychotic medications to dull (or which dull) the patient should be resorted to only as a last resort. (In the United States, off-label use means using the medication for any purpose that is not specified in the labeling approved by the U.S. Food and Drug Administration.) Patients or residents put on these medications generally will experience a further cognitive decline. It has been established in research studies that the excessive use of tranquilizers will also cause a general health decline or even death so such medications should only be used as an absolute last resort when other options have failed or are medically impossible. It is an abusive of people with brain injuries to routinely drug them with antipsychotic drugs as a way to keep them compliant and manageable. It is a way facilities keep costs low. It is wrong.
Because of this circumstance and other factors, there needs to be more oversight of environments and facilities created specifically or used occasionally for people with brain injuries (example: nursing homes). It would be better for people with brain injuries to live in environments where they live with other people of similar age. In other words, it is not a very good idea to put younger people in facilities that are usually meant for the senior population, but it happens all the time.
In the best of all worlds there would be affordable facilities and living arrangements available everywhere for people with brain injuries. There are millions of people in the USA with brain injuries many of whom cannot live independently. More attention really needs to be paid to appropriate dependent living environments. The ultimate goal, where possible, is to return the individual to an independent living environment. However, this is not possible with many people, so dependent living facilities should maximize the quality of life experience for the residents.