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Horror in American nursing homes: The dangerous practice that they keep getting away with

An NPR inquiry found that antipsychotics are incorrectly prescribed to hundreds of thousands


Joanna Rothkopf
December 9, 2014 8:40PM (UTC)

In August 2008, the Food and Drug Administration issued a warning regarding the use of antipsychotic drugs (specifically a drug called Seroquel) on elderly patients. While this particular type of antipsychotic had been demonstrably effective in patients with mental illnesses like schizophrenia, when used on older patients with dementia symptoms, the use of these drugs was associated with increased mortality.

In 2012, the government began an attempt to reduce prescriptions for antipsychotic medications in nursing homes. Additionally, the law prohibits the use of psychoactive drugs for easy sedation, calling the concept "chemical restraint." However, according to NPR, almost 300,000 nursing home residents are still taking antipsychotics, and the facilities that prescribe them are getting away with it.

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Another inquiry from the Boston Globe found that one in five U.S. nursing homes prescribe antipsychotics to patients without conditions that would necessitate their use.

This largely falls in the hands of the Centers for Medicare and Medicaid Services (CMS), which according to some, has been silent on the issue.

NPR's Ina Jaffe and Robert Benincasa report:

[Center for Medicare Advocacy senior policy attorney Toby] Edelman says that what the government needs to do is enforce the Nursing Home Reform Act that was passed 27 years ago. That law says residents have a right to be free from "chemical restraints." It also says that nursing home residents should only receive antipsychotics if the drugs are medically necessary. And remember, the drugs are not approved by the FDA to treat symptoms of dementia. Edelman says the government needs to stop thinking of the nursing home industry as a partner.

"The initiative has been all about training, teaching, cajoling, encouraging, but not enforcing the law," she says...

NPR's analysis of CMS data found that harsh penalties are almost never used when nursing home residents get unnecessary drugs of any kind. Inspectors grade these deficiencies according to the severity of the offense. And only 2 percent of the infractions were ranked at a level that might trigger a fine or worse.

Dr. Patrick Conway, chief medical officer of CMS assured NPR that the agency takes its job "incredibly seriously." He said, "There are many near misses, whether it's hospitals or nursing homes, where medication might be given that's not needed and doesn't cause permanent harm. We view that as a learning opportunity."


Joanna Rothkopf

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Related Topics ------------------------------------------

Age Antipsychotic Elderly Medicine Nursing Home Sedation

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