Over Medication in Nursing Homes

If you’ve ever visited a nursing home, you’ve probably seen residents slumped over on couches or in wheelchairs, seemingly doped up. That very well could be the case. According to a report from the Centers for Medicare and Medicaid Services (CMS) that came out in April 2014, as many as one in four nursing home residents receive at least one antipsychotic medication.

While some elderly nursing home patients have conditions (e.g., schizophrenia, Huntington’s Disease or Tourette’s Syndrome) for which antipsychotics are appropriate and approved, many nursing homes give antipsychotic drugs to older adults who have dementia, an “off-label” use. In fact, in 2011, The Office of the Inspector General (OIG) of the Department of Health and Human Services found that 83% of atypical antipsychotic drug claims were for elderly nursing home residents who had not been diagnosed with a condition for which antipsychotic medications were approved by the FDA. In that year, Medicare Part D spending on antipsychotic drugs totaled $7.6 billion.

The Omnibus Budget and Reconciliation Act of 1987 (also called the nursing home reform law) requires every nursing home to “provide care and services in order for each resident to attain or maintain his/her highest practicable level of physical, mental and psychosocial well-being.” That includes the right to be free from physical and chemical restraints.

Most of us who know a person with dementia would agree that caring for them can be challenging. Whether in a family home or a nursing home, they may exhibit aggressive or resistive behavior, and nursing homes often try to deal with the problem by medicating them into submission. In some nursing homes a culture of care develops in which antipsychotics are routinely prescribed and patients are not monitored to identify those who could be taken off the drugs. In one study, 22% of residents with dementia who were prescribed antipsychotics did not even have behavioral symptoms, and 29.5% had some behavior issues but they were non-aggressive – things like wandering or weeping.

What’s the problem with giving antipsychotics to people with dementia if it makes them calmer and makes life easier for the nursing home staff? When used for longer than 12 weeks, antipsychotic drugs can cause side-effects like shakiness and unsteadiness, falls, blood clots, stroke, worsening of dementia symptoms, and a higher mortality rate.

Three years ago, CMS became so concerned about the overuse of antipsychotics that they established the National Partnership to Improve Dementia Care in Nursing Homes, a collaboration of providers and provider associations, clinicians, researchers, advocates, government agencies, residents and families in every state. The success of the initiative was astounding. Over 18 months, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 15.1%; South Carolina nursing homes reduced their use by 25.3%.

Currently, 15.7% of the patients in SC nursing homes receive antipsychotic drugs for off-label use, compared to Louisiana, the “worst” state, where they’re prescribed for 26.5% of long-term residents, or Hawaii, the “best” state, where only 11.6% are on antipsychotics.

We’ve written before about the Nursing Home Compare tool on Medicare’s website, which allows the user to view and compare data about a number of factors, including safety inspections, staffing ratios and quality of care. The latter category provides information about the percentage of the nursing home’s residents who receive antipsychotic medications. There are 21 nursing homes listed for Columbia, and we chose three to illustrate the variance in rates locally: At the Rice Nursing Home, 8.2% of long-term residents get antipsychotics; at White Oak Manor, 18.8%; and at Brian Center Nursing Care-St. Andrews, 29.1%.

If you are investigating nursing homes for placement of your loved one, this Nursing Home Compare tool is a wonderful aid. When you visit potential residences, ask about the facility’s program to avoid use of pharmacological intervention, including a personal care plan. If your elderly loved one has suffered an injury as a result of a nursing home’s off-label prescription of antipsychotic drugs, call the Louthian Law Firm at (803) 454-1200, where we seek truth and find justice for elderly victims of abuse or negligence.