Penalties needed for nursing homes that drug seniors government inspector says

The Washington Post has a story about government inspectors going after nursing homes over the issue of dispensing neuroleptic drugs for dementia. The article bears the very promising headline, Gov’t inspector says penalties needed to curb use of psychiatric drugs in nursing homes.

Government inspectors told lawmakers Wednesday that Medicare officials need to do more to stop doctors from prescribing powerful psychiatric drugs to nursing home patients with dementia, an unapproved practice that has flourished despite repeated government warnings.

This is, in my opinion, a very good move.

An inspector for the U.S. Department of Health and Human Services told the Senate Committee on Aging that the federal government’s Medicare program should begin penalizing nursing homes that inappropriately prescribe antipsychotics, according to written testimony obtained by the Associated Press.

Yay! Somebody is suggesting doing something that makes sense for a change. It’s an action that is sorely needed as the extent of this “off label” prescribing practice is beyond alarming.

A report by [Health and Human Services Inspector General] Levinson’s office issued in May found that 83 percent of Medicare claims for antipsychotics were for residents with dementia, the condition specifically warned against in the drugs’ labeling. Fourteen percent of all nursing home residents, nearly 305,000 patients, were prescribed antipsychotics. The HHS Inspector General’s office Medicare claims during a 2007 six month period.

As nursing home staff are disregarding these warning labels, penalties are called for. If nursing homes aren’t penalized it will mean many more needless deaths.

Bravo, government inspector, but this is only the tip of the iceburg when it comes to “off label” drugging. This is not a problem that exists just among the elderly. We need to penalize foster care workers and juvenile justice facilities that would use powerful neuroleptic drugs on children and adolescents as a controlling devise as well. Hopefully there, too, the government will get around to doing the only thing that will help curtail “off label” prescribing practices, and that’s punishing the biggest offenders.

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2 Responses

  1. Nursing homes in Australia are probably about the best in the world but they are still pretty bad. They are all government funded so of course there are not enough beds or staff to satisfy demand. If you are wealthy you would have a section of a house fitted out and hire your own staff.

    The majority of residents are physically frail and/or demented. The dementia can be easily demonstrated by CT or MRI and and tallies with cognitive testing and ordinary observation of behavior. In many nursing homes this can account for about 90% of the residents. They are terrible places to work and difficult to adequately staff.

    So half the residents might be drugged to stop them wandering, interfering, falling, shouting etc. No one can admit that that’s the reason they are being drugged. They generally go into a decline, lose weight, become bedridden and die, often within 12 months.

    This can work out well for the nursing home. They are funded for the amount of work that was required to supervise a difficult resident as assessed during the first few weeks after admission. The resident is then funded for activities, walks, OT etc that they never get. The care plans and nursing notes are deliberately not updated or are fraudulently updated, ie “Mrs Brown is in bed with the flu.” The nursing home is given warning of a visit by regulators. The regulators collude because they are the government and they don’t want the public to demand better care. It’s cheaper to turn a blind eye to dodgy (most) nursing homes and better to keep the public in the dark.

    Even some residents who would be no trouble at all are sometimes drugged because the relatives ask for it. The relatives have been told by the TV that it will be a kindness.

    • This is certainly not a localized problem, and it tends to be global problem. I think the attention given it has to be a good thing. People don’t want to see their loved ones and relatives dying unnecessarily. Giving senior citizens neuroleptic drugs for dementia is “off label” drugging. These neuroleptic drugs are notorious for increasing the risk of needless death.

      As I point out above, I’m hoping that doing something about the problem of “off label” drugging in nursing homes will lead to doing something about the “off label” drugging of poor children and adolescents. These youths are often given a neuroleptic drug for ADHD, or conduct issues, rather than for any ‘psychosis’ whatsoever. In these instances, not only is the young person’s health being put in jeopardy, but they are also being given a drug for which there are no real indications.

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