Nursing Home Overmedication
One of the most difficult decisions most families face at some point in their lives is having to place a loved one in a nursing home or other similar facility. Most of us will take on this challenge at some point and, as heart wrenching as it often is, sometimes there really is no other practical choice. For a family, that decision comes with tremendous responsibility to remain diligent in making certain that their loved ones are adequately fed, hydrated and regularly moved, to prevent bed sores that can easily lead to a terminal infection. Recently, through my own experiences, I've come to learn of another nursing home hazard to guard against, namely the possibility that our loved ones are being grossly overmedicated with drugs, being used off-label, to suppress the anxiety or aggression that can sometimes come with Alzheimer's disease and dementia.
A 2011 study by the U.S. Department of Health and Human Resources found that found that 88 percent of Medicare claims for antipsychotics prescribed in nursing homes were for treating symptoms of dementia. The problem is that not only are antipsychotic drugs not approved to treat dementia, they come with a specific, black box warning that elderly patients with dementia-related psychosis who are treated with antipsychotic drugs are at an increased risk for heart failure, infections and death. Nevertheless, estimates by patient advocates reveal that approximately 300,000 nursing home residents nationwide continue to receive antipsychotic medications to "calm" their dementia-related symptoms.
In recent years, substantial effort has been focused on this nationwide problem. In 2012, the federal Centers for Medicare and Medicaid Services ("CMS") undertook a concerted effort to reduce nursing home use of antipsychotic drugs, but missed their target. In 2013, Johnson & Johnson agreed to a $2.2 billion settlement of civil and criminal charges with the U.S. Department of Justice for its aggressive off-label marketing of antipsychotic drugs to nursing homes. Nevertheless, reduction in the overuse of these drugs in the nursing home setting has proven extremely difficult and, according to CMS, over 20 percent of long-stay nursing home residents continue to receive these drugs. What's even more alarming is that the residents receiving antipsychotics are not always the aggressive or difficult ones. One study, found that 22 percent of dementia residents on antipsychotics did not have any behavioral symptoms and 29.5 percent had non-aggressive behavioral symptoms. Another study revealed that antipsychotics were being used off-label in nursing homes to treat relatively benign behavioral symptoms such as wandering, crying or "resisting care."
Although many nursing homes undoubtedly find it more convenient to manage resident anxiety, confusion, or behavioral issues with antipsychotics, this practice amounts to chemical restraint, plain and simple. It's really not much different than strapping a patient down for shock therapy but, given the well-developed body of research regarding the substantial risks to dementia patients subject to this practice, it is dangerous and misguided.
Our loved ones deserve better, and there are alternatives. Residents often become agitated because they are in pain or discomfort. Simply giving them due attention, to identify and address those underlying causes, can make a substantial difference. In addition, evidence continues to mount showing that well-targeted, non-drug therapies, such as aromatherapy, music therapy, massage therapy, behavior management techniques, and animal-assisted therapy, can benefit dementia patients and help reduce certain behavioral issues. CMS studies have shown that changes promoting such therapies may be achievable without a substantial investment in additional resources and, when compared to the risks and costs of the off-label antipsychotics, these alternatives seem like a relative bargain.
Although strides have been made towards reducing the practice of chemically restraining nursing home residents, this practice unfortunately remains relatively widespread today. Therefore, it continues to fall to those of us with parents, grandparents, friends or other relatives in such facilities to remain diligent in an effort to enhance the quality of life for our loved ones, to protect them from substandard care and to help promote goal-directed, person-centered care for each and every resident. Please take the time to learn about the type of medication your loved ones are being prescribed. Read the labels on that medication. If you feel a resident is being subjected to improper chemical restraint, speak up. Contact the director of nursing at the facility. Contact your loved one's doctor. If that doesn't work, report the practice to OHFLAC, the State agency that regulates nursing homes and other similar facilities, or contact an experienced attorney who can help get your loved one's life back on track and ensure the safest and best care for their particular circumstances.
One of the most difficult decisions most families face at some point in their lives is having to place a loved one in a nursing home or other similar facility. Most of us will take on this challenge at some point and, as heart wrenching as it often is, sometimes there really is no other practical choice. For a family, that decision comes with tremendous responsibility to remain diligent in making certain that their loved ones are adequately fed, hydrated and regularly moved, to prevent bed sores that can easily lead to a terminal infection. Recently, through my own experiences, I've come to learn of another nursing home hazard to guard against, namely the possibility that our loved ones are being grossly overmedicated with drugs, being used off-label, to suppress the anxiety or aggression that can sometimes come with Alzheimer's disease and dementia.
