By Suzanne Paolucci, LCSW, Elder Care Coordinator
Senators Herb Kohl, D-Wis., Chuck Grassley, R-Iowa, and Richard Blumenthal, D-Conn., have introduced bipartisan legislation to address the growing costs and concerns about the overuse of antipsychotics in nursing homes and other long-term care facilities. The Improving Dementia Care Treatment in Older Adults Act, S. 3604. Bill would require nursing homes to obtain informed consent before an antipsychotic medication is prescribed for a resident with dementia. It also includes other important provisions, such as education for prescribers; monthly reports on instances where antipsychotics are administered to nursing home residents with dementia for uses not approved by the FDA; and a study on the appropriate prescribing of antipsychotics for hospital patients.
“The safety and dignity of older nursing home residents, in particular, is at risk because of a growing use of antipsychotic drugs for symptoms related to conditions other than those the drugs are effective in treating. Alzheimer’s victims and older people with other dementias are particularly at risk for receiving these drugs inappropriately,” Grassley said.
The legislation is based on findings in a report last year from the Inspector General for the Department of Health and Human Services, a study published in the Journal of the American Medical Association, a heightened warning about such drug use from the Food and Drug Administration, and lawsuits associated with the overutilization of antipsychotics.
The Food and Drug Administration has approved antipsychotic drugs to treat numerous psychiatric conditions, but studies conducted during the last decade have concluded that these medications can be harmful when used by frail elders with dementia who do not have a diagnosis of serious mental illness. Despite warnings from the Food and Drug Administration and the medical research community, antipsychotic prescription rates in long-term care facilities for patients with dementia and no diagnosis of psychosis remain high. The Inspector General report issued in 2011 found that 305,000, or 14 percent, of the nation’s 2.1 million elderly nursing home residents had at least one claim for these drugs. The senators said they hope to have their legislation considered by the end of this year.
Families can and should be proactive prior to this legislation passing. When investigating possible placement to a Nursing Facility it is recommend to always review quality measures and inspection reports of the facility. Medicare’s Nursing Home Compare is a wonderful tool that helps families learn more about prospective facilities. The website now includes a quality measure that looks at the percentage of nursing home residents that receive antipsychotic medications. The National average is 21% and the New York State Average 23.4%. See: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1 Facilities prescribing antipsychotics greater than the national average should raise some red flags.
Families should also have an on-going dialogue with facility staff and should always feel entitled to know more about their loved one’s treatment. Below are some important questions to ask:
1. Ask the medical doctor the reason for the particular medication being prescribed.
2. How long and how often will the drug used?
3. How often will the Doctor be monitoring the benefits and risks of such medication usage?
4. How will your loved one’s medical condition be affected?
5. What are the known side effects?
6. Report any side effects you notice your loved one experiencing.(Antipsychotics can cause side effects that may include sedation, tremors, increased rigidity and seizures)
7. What are the reasonable alternative treatments to using an antipsychotic medication? Can the facility suggest any non-medical interventions?
8. What are your loved one’s rights to accept or refuse the medication being prescribed?
9. What are your loved one’s rights to revoke consent for medication for any reason at anytime?
Finally, if you are still uncertain about the benefits of your loved one being prescribed a certain medication, request an independent pharmacological review and always remember your loved one’s rights are to be treated with dignity and respect.
