Last week a representative from the American Medical Directors Association (AMDA) testified before a United States Senate committee on the dangers of antipsychotic drug use in nursing homes across the country. AMDA Vice President Jonathan Evans was one of a few individuals asked to speak at the hearing entitled Overprescribed: The Human and Taxpayers’ Costs of Antipsychotics in Nursing Homes. The centerpiece of the hearing was a discussion of a topic that our Chicago nursing home lawyers have long been aware: the prescribing of antipsychotic drugs among residents with dementia. These drugs specifically come with a “black box” warning against the dangers of the drugs when taken by dementia patients. Yet, despite this warning, there has actually been an increase in prescriptions among these residents.
As the AMDA doctor explained, the drugs are usually prescribed specifically to affect the patient’s behavior. However, he noted bluntly, “Behavior is not a disease; behavior is communication.” In other words, these prescriptions are not medically necessary. Instead, they are often given only to make it easier for these individuals to be controlled. These drugs are often referred to as “chemical restraints” and they constitute a dangerous and unnecessary form of nursing home neglect.
Dr. Evans also explained that most physicians are not trained to properly handle dementia related behavior. Medical schools rarely train doctors in best practices for nursing homes or other long-term care settings. Better training is needed, the doctor suggests, because increased awareness among physicians has been shown to decrease dangerous antipsychotic drug prescriptions. He called for increased dementia training and education among a select group who could most benefit. Specifically, that group would include the members of the interdisciplinary team and nursing home surveyors.
Another aspect to this issue which is often forgotten is the demand that patients give informed consent to their care. Failure to receive that consent is a serious breach of ethics and opens the door to a wide range of legal liability, including medical malpractice lawsuits. Lack of informed consent in the long-term care context is a common form of nursing home abuse. This requirement demands that nursing home residents and their families be fully informed of the effects of this medication and the potential side-effects-which includes death for dementia patients. Failure to have this dialogue and exchange of information is inexcusable. Toward that end, Dr. Evans stated that the culture of health care in this context needed to change. That would include developing core competencies for physicians in long-term care settings. In addition, there is a need to empower medical directors to educate physicians on the best ways to connect with long-term caregivers and develop relationships with these patients and their families.
This latest hearing is a continuation of the ongoing federal inquiry into the quality of care provided to vulnerable nursing home residents nationwide. Debate about the care of dementia patients has been particular intense as of late. Many advocates have long been pressuring for rule changes which would require more education and effective treatment of these individuals who far too often are left to languish in long-term care facilities without any real thought to their quality of life.
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