There’s good news and bad news in a recently released report from the Centers for Medicare and Medicaid Services (CMS) concerning the use of antipsychotic drugs on long-term residents in America’s nursing homes. The good news: since late 2011, the percentage of residents being given these powerful medications has dropped from 24 percent to about 16 percent. But the bad news, say advocates for the rights of those living in nursing homes, is that this figure – about one resident in six – remains far too high.
We discovered this revealing article that was just printed in the Washington Post, titled “New report details misuse of antipsychotics in nursing homes.” It paints a picture of understaffed nursing homes relying on the overuse of strong mood-altering drugs to help keep their residents docile and controllable. “U.S. nursing homes have significantly reduced the use of powerful antipsychotic drugs among their elderly residents, responding to pressure from many directions,” says the article. “Yet advocacy groups insist that overmedication remains a major problem, and want the pressure to intensify.”
Experts who have studied this issue call the drop in the use of these drugs “dramatic” – but they acknowledge that the reduction in the use of antipsychotic drugs doesn’t necessarily mean that nursing home residents are receiving better, more drug-free care. One doctor, a University of Massachusetts geriatrician, says he is concerned that “some nursing homes might be finding other medications that sedate their patients into passivity without drawing the same level of scrutiny as antipsychotics.”
Other advocacy groups, including the AARP, say that “even the lower rate of antipsychotic usage is excessive, given federal warnings that elderly people with dementia face a higher risk of death when treated with such drugs.” Attorney Kelly Bagby of the AARP Foundation says the rate of antipsychotic drug use in nursing homes “should be zero,” contending that these drugs “are frequently used for their sedative effect, not because they have any benefit to the recipients,” says the Washington Post report.
Now the international non-profit organization Human Rights Watch is weighing in on the issue of giving unsuspecting nursing home residents heavy-duty drugs to keep them under control. “On paper, nursing home residents have strong legal protections of their rights, but in practice, enforcement is often lacking,” said the Human Rights Watch report. The organization conducted more than 300 interviews and visited 109 nursing homes in six states, and they also analyzed data from HHS (the Department of Health and Human Services). They found that, ten years ago, well over a quarter million nursing home residents with dementia were receiving antipsychotic drugs. Today, that number is lower, but still strikingly high, estimated at just below 180,000 who are getting regular doses of powerful medications without ever having been diagnosed with any ailment that those drugs are supposed to treat.
As the Post declares, antipsychotic drugs, which are frequently administered without the consent of residents or family members, were never intended for the treatment of dementia. “The powerful class of drugs is intended, instead, to treat serious mental illnesses such as schizophrenia and bipolar disorder.” These drugs have severe side-effects that can alter a patient’s consciousness and adversely affect an individual’s ability to interact with others. The Human Rights Watch report adds, “[These drugs] can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there.” Some nursing home executives dispute this rationale, claiming that drugged residents often require higher levels of care and not lower, but drug use opponents aren’t buying that argument. As the lead author of the Human Rights Watch report, Hannah Flamm, put it, “Would you want to go into nursing home if there’s a one in six chance you’d be given a drug that robs you of your ability to communicate? It’s hard for me to applaud the reduction when it’s inexcusable to ever misuse these drugs.”
In spite of the fact that most seniors never want to end up in a nursing home, millions eventually will. An article on this website quotes U.S. Census Bureau and other data to show that at any given time about 5 percent of seniors are living in a nursing facility, rising to about 50 percent of those over age 90. About one-fourth of today’s seniors will probably spend at least some time in a nursing home or other skilled care facility. This means families need to do their homework when selecting the right place for a loved one. You’ll find an excellent resource to help you evaluate housing choices by contacting one of our preferred partners at AgingOptions called Better Care Management. We encourage you to get in touch with them for guidance if you’re in that challenging place of trying to seek out care options for yourself or someone you love.
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(originally reported at www.washingtonpost.com)