Nursing Home Use Of Antipsychotics: A Boston Globe Series

I want to thank the Boston Globe writers, Kay Lasar and Matt Carroll, for doing the series on the use of anti-psychotic medications to treat Alzheimer’s disease  and persons without a mental illness called “A Rampant Prescription, A Hidden Peril.”  I applaud them for their research and investigation into the over use of these drugs in the majority of nursing homes.  The essence of the article is that nursing homes are using these medications to sedate residents who are deemed more problematic or having behavioral issues. The first article appeared on April 29, 2012. http://articles.boston.com/2012-04-29/news/31478153_1_nursing-home-antipsychotics-skilled-nursing-center

The article was based on data on more than 15,600 nursing homes across the country complied by the US Centers for Medicaid and Medicare.  The data examined by the writers was based on two areas.  First, the percentage of  long term residents without a psychosis who received medication contrary to US Nursing Home regulations.  Second, the characteristics of  each home, such as staffing levels, number if patients on Medicaid and the number reported by staff with behavioral problems.

Here are some of the findings:

1. 21% of US nursing homes (28% in Massachusetts) at least 1/4 of residents without illnesses recommended for medications.

2. “There is a clear link between the rate of anti-psychotic use in the nursing home and its staffing level.  Homes that most often used these drugs for conditions not recommended by regulators had fewer registered nurses…”

3.” The data do not include the reasons why patients received anti-psychotics, but homes that most often used them for conditions unrelated to psychosis tended to have more residents deemed by staff to have behavioral problems including wandering, being verbally or physically abusive or resisting care.”

4.  “… a greater percentage of residents covered by the government Medicaid program, which pays nursing home bills for people with limited incomes… They have fewer residents with private insurance, which pays a much higher rate than Medicaid.  That means these homes have less money for staff.”

As a patient advocate with several clients in nursing homes, I am constantly at odds with the staff  about these medications.   It seems anytime a patient is upset or in anyway agitated, the facility will call the psychiatrist or consulting mental health group and ask for a medication.  Sequel is the drug of choice.  Unfortunately, the side effects for some people is increased agitation.   The remedy is to increase the medication.  One of the main complaints from family members is why is loved one on these medications?

It can be a battle with a facility to stop anti-psychotic medications.  Most medical staff will try to dissuade you from discontinuing the medications.  It can be hard for families to insist because they feel they are not as medically knowledgeable.  I tell them to not back down and insist on a trial of stopping the medications.

This article brings to the forefront the use of anti-psychotics as medical restraints.  It is a question to ask when selecting a nursing home for a loved one about the use of anti-psychotic medications.  Here is a link that gives the information on nursing homes and antipsychotic use.   http://www.bostonglobe.com/lifestyle/health-wellness/2012/04/28/database/j8FWvjNHMaP6uo7hQ0mrHO/story.html?p1=News_links 

Part two tomorrow : Nursing Homes that don’t use anti-psychotics.