As we just recently covered, as recently as 2012 the Centers for Medicare and Medicaid Services (CMS) began a nationwide effort to push nursing homes and long-term care facilities to decrease their usage of antipsychotic medications to sedate and restrain patients. The use of antipsychotic medications for this purpose has long been a problem because they are often used in situations when they are not truly needed. Nursing home staff will use these drugs to keep dementia patients calm, when in fact only patients suffering from actual psychosis – such as bipolar disorder or schizophrenia – should even be considered candidates to receive these types of medications.
As recently reported, the Food and Drug Administration (FDA) has mandated “black box” warnings for antipsychotic drugs. This type of warning is exactly as it sounds – it tells the person intending to take it of all the side effects and potentially dire consequences. For example, a black box warning on antipsychotic medications may read “increased mortality in elderly patients with dementia-related psychosis.” Such warnings imply that these drugs should only be used in the most extreme circumstances. In spite of the risks of infection or death, NPR reports that nearly 300,000 nursing home patients are given antipsychotic drugs. The use of such drugs in unnecessary situations is a form of chemical restraint of the patient, and can be grounds for charges or claims of patient abuse and neglect.
The same article also notes how in spite of the government’s efforts to reduce the use of these drugs, it rarely comes down hard on nursing homes that still abuse them and use them as an easier way to control patients rather than give them the proper regimen and care. Texas, which has been rated the worst state for nursing homes in general, has also been the worst in terms of reducing the use of antipsychotic drugs. Hawaii, Alaska, and Michigan boast the lowest rates.
As 2014 nears a close, the national average of long-term nursing home patients that are given antipsychotic medications is 19%. This is a decrease from past numbers which indicates some improvement, but the government has not used punishments and sanctions. It has, however, conducted substantial training and has educated nursing home staffers about how to make individualized care plans such that they can better address the needs of specific patients, and deal with the sometimes violent or disruptive behavior, or the restless and sleepless behavior, in a way that would obviate the need for medications. And the result nationally has been a 15% decrease in the use of antipsychotic medications.
For whatever reason, Texas facilities have been noticeably bad about following through on training, but in general the program seems to have had a positive effect. A continued effort, as well as a bigger threat from the government to crack down for a failure to follow the program, could cause an even bigger decline in the use of these drugs. In a matter of time, antipsychotic medications will hopefully only be used in the most dire and necessary of circumstances, and not as a way out for staffers not wanting to do their jobs.
See Related Blog Posts: