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Josephine Chalupa had the shower cap on — never a good sign. It meant she was on a tear, hating anyone and anything that crossed her path at the nursing home in Norwood where she lived.


She made a nasty comment about a visitor’s shoes and shouted when anyone sat next to her. She demanded someone pull a tooth that was giving her so much trouble. She pinned a supervisor against the wall with her walker so she could yell at him about how much she hated the food.

“There was a lot of rage,” said her daughter, Christin Chalupa. “She was always yelling and screaming, just hating life in general.”

Chalupa, 91, was suffering from serious side effects of a fistful of drugs, her daughter said, including an antipsychotic medication that nursing home patients are frequently given by overworked staff to make them docile.

Today, Chalupa is friendly and social. She participates in activities, chats with relatives and is polite to the staff, her daughter said. The dramatic change came when the nursing home weaned her off the medications and, rather than drugging her when she became agitated, found other ways to keep her calm.

Josephine Chalupa may well be the personification of a new trend in nursing home care — fewer drugs and more personalized attention.

Across the nation, nursing home patients like Chalupa are frequently being drugged with antipsychotics to make them easier to control.

While the drugs caused Chalupa to become agitated, they generally make patients less demanding. Often, loved ones find them slumped in wheelchairs, unaware of their surroundings and barely able to speak.

“It’s a very prevalent problem — a form of chemical restraint,” said Robyn Grant, director of public policy at the National Consumer Voice for Quality Long-Term Care, a patient advocacy group. “These drugs turn people into zombies and families are saying their loved one doesn’t even recognize them.”

Nationwide, 25 percent of nursing home patients are on antipsychotics, according to a study by the federal Centers for Medicare & Medicaid Services. It is even more widespread in North Jersey, where facilities report up to 37 percent of their patients have been given the drugs. The Centers for Medicare & Medicaid Services has set a directive that facilities should reduce their use of the medications by 15 percent, but few homes have complied.

That’s because nursing home administrators say there is no easy fix. Weaning patients off drugs is complicated. And keeping them off requires facilities to completely rethink their programs and staffing at a time when many are facing cuts in federal and state funding.

“Treating these patients isn’t an exact science, and we may have to introduce new medications while discontinuing others — it’s difficult to find that balance,” said Matthew Russo, administrator of the Armenian Nursing Home and Rehabilitation Center in Emerson, where 23.9 percent of the patients were on the drugs in 2012.

Federal health officials say getting elderly patients off antipsychotic drugs is crucial because such medications pose a risk of serious complications when taken by those who aren’t suffering from a mental illness.

“The elderly can be affected with a higher incidence of stroke, cardiac and respiratory problems and even death,” said Dr. Diego Coira, chairman of the department of psychiatry and behavior medicine at Hackensack University Medical Center.

Research has shown that the risk of death doubles when these drugs are given to patients with dementia. The drugs can also render elderly patients who don’t need them immobile, leading to inadequate food and liquid intake, incontinence, infections and bedsores, experts said.

“These medications do have a place, Coira said, “but they are overused.”