One of the reasons that families pay nursing homes to care for their loved ones is because it is difficult to handle people dementia. The families are paying for the knowledge, training, experience, and care provided by professionals who will treat their loved one with concern and dignity despite the difficulties. It turns out that in many cases, what the family is actually getting for their money is simply the administration of unnecessary and antipsychotic drugs–frequently when there is no medical condition calling for the treatment.
According to data collected by CMS (Center for Medicare and Medicaid Services), in one state, 28 percent of nursing home patients were given antipsychotic drugs. What is stunning, however, is that, according to the same study, 22 percent of those patients receiving antipsychotic drugs did not have a medical condition calling for the treatment. These drugs are intended to treat schizophrenia, not dementia.
Why do nursing homes give these psychotropic drugs so freely? It makes it easier on the nursing home. “Way too many patients in nursing homes are treated with antipsychotics purely to sedate them or to control behaviors that are difficult for the staff,” said Robert A. Stern, an Alzheimer’s specialist and brain researcher at Boston University School of Medicine. “[Nursing homes] are indeed understaffed, they are indeed under-trained, and it takes an awful lot of well-trained people to manage the difficult behaviors that can be exhibited by people with dementia.”
And there is a consequence to these drugs. “Twice in the last five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, including increased confusion, sedation, and weight gain.” reported the Boston Globe. Safety concerns regarding their use are increasing; in 2005, the Food and Drug Administration issued warnings regarding the risk of death among older adults with dementia taking these agents to control behavioral symptoms. A large clinical trial recently concluded that the adverse effects of atypical antipsychotic drugs outweighed the benefits in patients with Alzheimer’s disease.
In a recent study by Yong Chen, M.D., M.H.S., of the University of Massachusetts Medical School, the researchers found that the organizational culture at some nursing homes may encourage the prescribing of antipsychotics, the authors note. “Future research is needed to determine why such a prescribing culture exists and whether there are adverse health consequences as a result of our observed facility-level antipsychotic prescribing rate,” they conclude. “This study may also inform future policies to target nursing homes with high antipsychotic prescribing rates to improve quality of care for nursing home residents.”
Using antipsychotics as a chemical restraint for the convenience of the nursing home staff is against the law in Texas. The Resident’s Bill of Rights published by the Texas Department of Aging Disability Services states that every resident has the right to “be free … chemical restraints that are administered for the purpose of discipline or convenience and not required to treat the resident’s medical symptoms.”