Medication Abuse in Nursing Homes

As of April 29th of this year (2015), there were approximately 15,700 nursing facilities in the United States according to the Centers for Disease Control and Prevention (CDC). Of these facilities 68.2% were listed as having “for-profit” ownership. In 2012, Ohio had 951 certified nursing facilities with about 75% of them identified as for-profit entities.

With approximately 1.4 million residents in the nation’s nursing homes, the responsibility of providing medication in this setting is of critical importance. The proper administration of medicines is necessary in order to maintain the life and health of the individuals receiving care. Nursing homes that are government-funded by Medicare and Medicare (which comprise the majority of such facilities for the elderly in this country) are required to keep medication errors under five percent, but many do not. The National Health Policy Forum has reported that each individual nursing home patient is receiving 8 to 10 routine medications and 2.7 additional types of medication.

Understaffing, poor training and high turnover rates among nursing home personnel contribute to mistakes in the dosage, frequency and timing of medication. In some cases, the resident may receive a drug intended for someone else or may be double-dosed because the nurse has missed a medication and does not want to record her error. In a worst-case-scenario, an employee may be stealing medication, such as Oxycontin, and substituting a worthless look-alike pill in its place. Medical records are then altered to show the resident was given the proper drug although they were not.

What other types of medication abuse are occurring in many nursing homes?

Other areas where medication errors originate are in:

  • Patient assessment — The patient is not properly assessed initially for needed medication or reassessed to see if there is a continuing need for a type of drug he or she was given upon entering the facility. Sometimes a resident may need to be assessed after a fall to see if it is necessary to add or remove medication.
  • Patient monitoring — There may be a lack of monitoring for the effects of medications, a lack of monitoring for adverse drug reactions, or failure to recognize these reactions by nursing home staff. Signs of an adverse drug reaction in a nursing home patient include dizziness, hallucinations, delirium, falls, and bleeding. These can result in death.

Antipsychotic medication abuse in nursing homes

In addition to all of the above concerns about distribution, assessment and monitoring of medications, there have been several news reports in the past few years centering on the inappropriate use of antipsychotic medications in nursing homes. In many cases, these medications are being used to control residents’ behavior instead of reducing the effects of mental illness. Several studies, including one by The Boston Globe newspaper, found that the powerful drugs were often used as a form of chemical restraint to calm and quiet residents even though alternative methods were available such as environmental modifications and non-pharmacologic approaches.

Dementia and Alzheimer’s abuse in nursing homes

Even more tragic, dementia and Alzheimer’s patients, historically the main recipients of these antipsychotic medications, were discovered to be at risk of death from the intake of these drugs. At minimum these patients suffered a severely decreased quality of life by taking the antipsychotic medications.

The abuse was going on despite the “black box” warnings on the cartons of the medicines which came into the nursing homes citing “increased mortality among elderly patients with dementia-related psychosis.” It is believed at least 300,000 nursing home residents were receiving these unnecessary drugs at the time the reports of medication abuse surfaced in 2012.

Several individuals and pharmaceutical companies immensely profited by taking illegal kickbacks to prescribe the drugs to thousands of elderly and mentally ill patients in U.S. nursing homes. The Government Accountability Office (GAO) recently reported (March 2015) that more than one third of the elderly dementia patients living in nursing homes in 2012 were prescribed antipsychotics. The report points the finger at the U.S. Department of Health and Human Services which supervises the operation of Medicare and Medicaid. It says the following is responsible for the dilemma:

  1. Lack of oversight in promoting awareness about the dangers of antipsychotics and use
  2. Misuse of the drugs
  3. Failure to investigate fraudulent payments of federal dollars to providers and pharmaceutical companies.

According to the Alzheimer’s Association, 5.1 million people in the U.S., 65 or older, currently suffer from some form of dementia. Dementia is an umbrella term for a group of cognitive disorders typically characterized by memory impairment, as well as marked difficulty in the domains of language, motor activity, object recognition, and disturbance of the ability to plan, organize, and abstract. Generally speaking, it is a disease of the older population.

Antipsychotic drugs include Risperdal, Haldol, Zyprexa, Abilify, Seroquel, Geodon and Closapine and others. They are typically used to treat schizophrenia, severe bipolar disease, delusions and hallucinations according to the American Society of Consultant Pharmacists.

CMS reported in 2012 that more than 25% of patients in nursing facilities in the United States were receiving antipsychotic medication—many of them not exhibiting a need for such drugs. In 2012, CMS launched an initiative with the goal of decreasing the use of antipsychotics in nursing homes by 15% by the end of December 2012. The Center later extended the deadline to the end of 2013. In September 2014, CMS announced the National Partnership to Improve Dementia Care and stated that the 15% goal of reducing antipsychotic use that they had set two years earlier had been met. New goals of a 25% reduction in use of the drugs by the end of 2015 and a 30% reduction by the end of 2016 were set. So far, Hawaii, North Carolina, Vermont and Georgia have exhibited the greatest rates of reduction, according to the CMS.

However, National Public Radio (NPR) published a study of recently compiled government data in December 2014. It concluded that harsh penalties were almost never used when it was discovered that nursing home residents received unnecessary drugs.

Texas, which has the highest rate of abuse of antipsychotic drug distribution, was highlighted in the NPR report which claimed officials there were less likely to be censured than nursing homes in other states. Inspectors grade deficiencies in nursing home operation according to the severity of the deficiency. Only two percent of those deficiencies reported in Texas ranked at the level that would trigger a fine or worse, NPR noted. NPR summed up the situation by observing that after almost five years of alleged efforts to remedy the antipsychotic drug problems, one fourth of nursing home residents are still getting largely unnecessary, potentially lethal medications. This is despite the fact they were guaranteed the right to be free of chemical restraint 28 years ago when Congress passed the Nursing Home Reform Act back in 1987.

What to do about medication abuse in nursing homes

If you notice a marked personality change in a nursing home resident, or they seem overly tired or listless, it may be due to misuse of prescribed medications. The use of an antipsychotic drug in a nursing facility should include:

  • An appropriate indication for its use. Relatives should inquire who prescribed the drug and why and immediately ask to speak with the doctor or a nurse if the answer is unsatisfactory
  • A specific and documented goal of therapy available for review.
  • Ongoing monitoring of the resident to evaluate the effectiveness of achieving the therapy goal. Documentation should be made of any adverse effects from the medication and what action was taken.
  • Use of the medication only for the duration needed and at the lowest effective dose.

If you do not get satisfactory results from the medical personnel at the nursing home, you should continue to pursue the matter. Share your concerns with the supervisor on duty, the director of nursing or the nursing home administrator. These people are required by law to have a written policy concerning the resident’s care. When your loved one enters the home, you should receive a copy of this policy. It is probably reasonable to give administrators 24 hours to respond to any complaints unless you believe that your loved one is in danger.

If you cannot get satisfactory results from the nursing home, you need to think about contacting national and state agencies. You can report the incident to the National Center on Elder Abuse which is associated with the Administration on Aging. Consult the state resources pages in your phonebook to locate the Center. Other ways to report abuse are to:

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