Why Are Nursing Homes Giving Antipsychotic Drugs to Residents with Dementia?
Nursing homes across the country are routinely giving antipsychotic drugs to dementia patients to control their behavior, according to a federal report released earlier this year.
The Department of Health and Human Services Office of Inspector General (OIG) conducted a comprehensive review of 40 nursing home inspections, which revealed ‘alarming instances’ of drugs being administered inappropriately. The review’s key findings include:
- Nursing homes eased the burden on staff by giving dementia patients antipsychotics — drugs that carry an FDA ‘black box’ warning about increased mortality risks
- Nursing home pharmacists failed to identify medical concerns
- Medical directors failed to prevent inappropriate use of antipsychotics
- Inadequate policies and procedures undermined resident safeguards
Federal regulations don’t prohibit the use of antipsychotic medications, but it must be ‘clinically necessary’ and dose reductions attempted. Nursing homes should document reasons for continued use, and try alternative, non-pharmacological interventions before resorting to antipsychotics.
Nursing home lobbyists claim that the current laws are too restrictive and prevent residents who need antipsychotics from receiving them. Unsurprisingly, drug manufacturers concur, and are joining the nursing home industry in calls for sedative rules to be loosened.
Contrary to the way interest groups are framing it, inappropriate antipsychotic use has nothing to do with residents being undermedicated, and everything to do with facilities being understaffed. As the report shows, understaffed nursing homes are sedating residents to make them easier to manage, despite the associated health risks, which include falls, strokes, cognitive decline, and death.
A second OIG report from this year reveals a further damning dimension to the misuse of antipsychotics: an alarming number of facilities are falsely diagnosing residents with schizophrenia to justify administering medications like Risperdal and Haldol.
None of these disturbing trends are new. An OIG report from 2021 shows a long-standing problem with the way The Centers for Medicare & Medicaid Services (CMS) gathers data from nursing homes.
In brief, the percentage of nursing home residents given antipsychotic drugs is used by CMS as a quality measure. This quality measure is one of the metrics used to determing a facility’s star rating. Because residents diagnosed with schizophrenia are not counted towards the quality measure, nursing homes have an incentive to make inappropriate diagnoses.
The report found that self-reported information from nursing homes gives a misleading picture of both improper antipsychotic use and falsified diagnoses of schizophrenia. By looking at separate data sources the OIG found that:
- 12,091 residents who had received antipsychotics never appeared in facility records as having received them
- Nearly a third of residents reported as having schizophrenia did not have Medicare claims for that diagnosis
- Self-reporting from nursing homes failed to provide key details about drug use, such as which antipsychotics were prescribed, at what strength, and for how long
Previous OIG investigations from 2011 also raised concerns about overuse of chemical restraints, and CMS has acknowledged ‘the potential for inconsistencies’ in self-reported data. This year’s twin reports confirm that the profit-first nursing home industry is continuing to game the system.
Nursing home residents and their families rely on the system to prescribe appropriate medications and track the way they are being used. Robust oversight and safeguarding are paramount.
Elderly residents of nursing homes are some of our most vulnerable citizens. They deserve accurate diagnoses of their conditions — and medications prescribed only to address those conditions rather than offset understaffing.
If you suspect your loved one has been inappropriately sedated or falsely diagnosed, talk to a California elder abuse attorney. Contact our elder abuse attorneys in Los Angeles, San Francisco/Bay Area, Sacramento, and Santa Barbara for a free consultation.
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