Historically, nursing homes and long-term care facilities have had issues when it comes to the unnecessary or improper medication of their elderly residents and patients. Antipsychotic medications have often been used to sedate those with Alzheimer’s, dementia and mental and emotional problems, and justified as the only way to truly keep them in control. Staffers see these medications as the easy way out rather than to find other ways to help the patients remain calm. Excessive antipsychotic drugs can actually lead to infections or cardiovascular damage. There is also the issue of perpetually increasing the usage of these medications, as staffers use some drugs to sedate patients, and then others to wake them up and help them be more alert. This creates a dangerous and possibly deadly cycle of constant medication that can cause permanent damage and can even be lethal. Furthermore, as with the use of medications and drugs, there is also the risk of the patient becoming addicted.
This has caused increased inquiry from the government. For example, pharmaceutical company Johnson & Johnson settled for over $2 billion with the government over civil and criminal charges that its subsidiary encouraged nursing homes to buy and use its antipsychotic medication product for dementia patients when it was only approved for use of those with the psychosis called schizophrenia.
There has been a slow movement to reduce the use of antipsychotic drugs at nursing homes and care facilities, and some of those facilities have started to follow. The fight to reduce the use of antipsychotic medications has been mounted from multiple sides. The media has increasingly reported on this problem, and government agencies have studied them and made efforts to reduce and mitigate the inappropriate use of medications. The latter agencies are vital in this effort because it is the state governments and the federal government that make rules and regulations for medical providers including nursing homes.
Addressing the Problem
For example, the Centers for Medicare and Medicaid Services (CMS) within the United States Department of Health and Human Services (HHS) has done studies on the matter and has formulated recommendations to solve the problem. In an early 2013 presentation and in more recent press releases this year, CMS has reported on the problems of antipsychotic medications and the initiative to fix this issue through better oversight and a national partnership. As to statistics, CMS identified, for example, how in a mere three-month span in 2010, nearly 40% of nursing home residents received antipsychotic medications in spite of not suffering from psychosis. Staffers presumably saw some cognitive impairment or other behavioral problems as grounds for the use of the medications which are really only meant to treat patients actually suffering from a psychosis of some type. And in another study cited by CMS, over 17% of patients receiving antipsychotic medications took in excess of the recommended dosages.
CMS also noted how expensive the use of these medications are, which makes for an economic problem in terms of health care costs. CMS has focused its initiative not just on a reduction in the use of antipsychotic medications, but on ways to improve care through other treatment options so that there will not even be a perceived need for antipsychotic medications unless in the most serious and severe of situations. The goal is to reduce this inappropriate usage by 25% in the next year.
Hopefully as time goes by, there will be stronger rules and better oversight as to the use of antipsychotic medications, and facilities that abuse those medications as a shortcut to do their jobs will be held accountable and deterred from doing it any further.
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