Data shows that in more than one in five nursing homes in the United States, antipsychotics are administered to a significant percentage of residents, despite the fact that they do not have psychosis or related condition that warrants their use. Antipsychotic drugs, which are intended to treat severe mental illness such as schizophrenia, can leave people in a stupor. Both the FDA and the Centers for Medicare and Medicaid Services say it’s not appropriate in most cases for patients suffering from dementia to be prescribed antipsychotics. The FDA has given these drugs black-box warnings, the agency’s most serious medication alert, about potentially fatal side effects when antipsychotics are taken by patients with dementia, saying they can increase the risk of heart failure, infections and death.
Federal law has long prohibited the use of antipsychotics and other psychoactive drugs for the convenience of staff, a practice known as “chemical restraint.” The Nursing Home Reform Act, passed more than 27 years ago, gave residents the right to be free from “chemical restraints.” The law also says that nursing home residents should only receive antipsychotics if the drugs are medically necessary. However, in 2012, despite the law being on the book for almost three decades, the government finally started a campaign laying out new stricter guidelines and harsher penalties for the overuse of antipsychotics to urge nursing homes to cut back on their use of these drugs that are so dangerous for patients with severe illnesses. Unfortunately, according to a recent report by NPR, it appears these new regulations have had little success curtailing the practice, largely because they are rarely enforced.
The penalties for giving residents unnecessary medication can range from a “plan of correction,” to civil fines, to being kicked out of the Medicare and Medicaid programs. However, the NPR report found that when penalties are actually assessed the harshest penalties are almost never used when nursing home residents are given unnecessary drugs of any kind. As a result, antipsychotics continue to be overused in nursing homes across the country.
Not surprisingly, industry experts say there is a clear link between the rate of antipsychotic use in a nursing home and its staffing level. Homes that most often used these drugs for conditions not recommended by the FDA had fewer registered nurses, who direct care, and nurses’ aides, who provide most of the hands-on care. According to the recent report, the government rarely punishes these nursing homes that choose not to follow the guidelines, and when they do enforce the rules it is normally a nominal monetary penalty to the offending nursing home. This fact makes for an easy business decision for many nursing home administrators and owners – it is far cheaper to simply pay the fine and provide less resident care. Thus, the only ones actually being penalized under the “stricter” regulations are nursing home residents.
There is no question that the use of antipsychotic medications to control nursing home residents is extremely dangerous. The FDA estimates roughly 15,000 nursing home residents die every year from complications related to antipsychotics. Consequently, if you believe a family member or a loved one in a nursing home is being given unnecessary antipsychotic medications, you should immediately ask for a list of all medications that are being administered to the resident and the doses given daily. If you have a complaint about how a family member has been treated in a nursing home, you should report it to the appropriate state agency. For more information on nursing home abuse and neglect, please visit our “Nursing Home Resource Center” at the website of the Suthers Law Firm, www.sutherslaw.com.