Nearly 900 citations for improper psychotropic medication use highlight a decades-old problem regulators have struggled to solve
A new study from The Schiller Kessler Group examining federal nursing home citation data has identified the improper use of psychotropic medications and chemical restraints as one of the most persistent and troubling categories of elder abuse in American nursing homes, with 883 citations issued nationwide, 8.4% of all abuse-related violations during the most recent inspection cycle.
A chemical restraint, as defined in the study, is any medication used to sedate, subdue, or restrict a resident’s movement or cognition rather than to treat a legitimate medical condition. In effect, researchers say, it means medicating a resident into compliance instead of providing attentive, individualized care.
“For many decades, the Senate Special Committee on Aging has documented numerous cases involving nursing home patients being tranquilized to make them easier to manage,” the study notes, pointing out that this practice persists despite the Nursing Home Reform Act of 1987 explicitly establishing a resident’s right to be free from unnecessary chemical restraints.
A new rule, but an uncertain impact
The study highlights a regulatory change implemented in April 2025, under which the use of psychotropic medication to sedate residents purely for staff convenience is now subject to the most severe classification available to federal inspectors: an immediate jeopardy-level citation. However, researchers note that of facilities previously cited for this violation, the vast majority retained their operating licenses, continued accepting Medicare and Medicaid residents, and continued operating under the same ownership and management, raising doubts about whether the amendment alone will meaningfully change facility behavior.
Fines that don’t function as a deterrent
The study’s financial analysis found that nursing home operators paid over $467 million in fines across more than 6,600 facilities between April 2023 and March 2026. Spread across those facilities, researchers calculated an average penalty of approximately $70,800, a figure they describe as a “manageable penalty” given that a typical nursing home generates well over $10 million in annual revenue. For large multi-facility operators, the study argues, such fines effectively function as a minor line-item cost rather than a genuine deterrent.
That conclusion is reinforced by repeat-violation data: nearly 1 in 11 cited facilities, 8.8%, accumulated three or more separate abuse citations within a single inspection cycle. “When the financial cost of a citation remains far lower than the cost of adherence to compliance, there’s little incentive for a facility to implement meaningful improvement in staffing, oversight, or care practices,” a spokesperson for Injured in Florida, which conducted the study, explained.
Recognizing the warning signs
Because nearly 70% of federal citations originate from resident or family complaints rather than routine inspection, the study places significant emphasis on helping families recognize the warning signs of abuse. Physical abuse, the most visible category, may present as bruises, burns, fractures, or injuries inconsistent with a resident’s condition; in a survey of family members cited in the study, 24.3% reported having personally witnessed a physical abuse incident. Understaffing compounds this risk, with 72% of nursing homes operating below pre-pandemic staffing levels in 2024, a factor linked to increased resident-on-resident violence.
Emotional and psychological abuse is harder to identify, often mistaken for symptoms of aging or illness, yet surveys referenced in the study found 81% of long-term care staff had witnessed emotional abuse, and 40% admitted to committing at least one emotionally abusive act themselves. Financial exploitation, particularly of cognitively impaired residents, may show up as unexplained bank withdrawals, sudden legal document changes, or missing valuables. Sexual abuse, described in the study as one of the most underreported forms of mistreatment, saw the National Ombudsman Reporting System log 1,816 complaints in 2024, a 60% increase since 2017, with 60% of victims suffering from dementia or another cognitive impairment.
Why victims stay silent
The study points to research from the Long Term Care Community Coalition identifying fear of retaliation as the primary reason residents don’t report abuse. Because residents are often entirely dependent on facility staff, including their abusers, for daily care, filing a complaint carries real risk: researchers cite documented cases of retaliatory withholding of pain medication, ignored call lights, delayed meals, and neglected basic care needs following a complaint.
The study concludes that meaningful reform requires both proactive federal oversight capable of identifying abuse before a family member is forced to intervene, and penalty structures scaled to reflect a facility’s actual pattern of harm rather than treating every citation as an isolated event.
