Did You Catch NPR’s “Old and Overmedicated?” (Links and Updates Here)
Mark Friedman, an elder law and special needs attorney from New Jersey, recently wrote to comment on the important series offered by National Public Radio on use and misuse of certain medications in long-term care settings. Here is what Mark said:
“NPR ran a story on ‘chemical restraints,’ – nursing homes using anti-psychotic drugs to make unruly residents more pliable. According to the article, the residents are usually Alzheimer’s or dementia patients, and anti-psychotics can make the residents easier for staff to manage. But the drugs can be dangerous, increasing a resident’s risk of falls and exacerbating health problems. At high doses, anti-psychotics can also sap away emotions and personality and put the resident into a ‘stupor.’
Administering drugs in this manner, any drugs, including anti-psychotics, without medical need and for the convenience of staff, is contrary to federal regulations. Unfortunately, it may also be widespread.
The NPR story includes a tool drawn from CMS data that shows the rate of residents on anti-psychotics at nursing homes across the country. You can look up the facility in which your loved one resides.
The news coverage shows that this issue is getting increased attention, and that’s a good thing. I think that as Americans age and more people have spouses and parents in nursing homes, the use of anti-psychotics as chemical restraints will have to diminish or end. People won’t stand for their loved ones being drugged into a stupor.”
Thanks, Mark, for making sure we included this topic and the latest links for more coverage and your additional commentary. Along the same lines, I listened to an interesting follow-up conversation on AirTalk, a Los Angeles public radio affiliate’s program, discussing “How California is Doing in the National Fight to Curb Over-Medication of Nursing Home Patients.” That program, now available as a 23-minute podcast, included an articulate medical professional, Dr. Karl Steinberg, who described how he sees medication practices changing in long-term care, including better use of behavior health techniques, rather than medication, to help residents.
I also noted, with interest, that Dr. Steinberg said in some instances, so-called off-prescription use of medications can still be appropriate and helpful in dementia care, particularly for patients in clear “distress.” That mirrored some of my own observations (admittedly, as a lay person, without medical training, in a family setting).
It seems there could be good reasons for off-prescription use of medications, but apparently some believe that the costs or protocols for testing to meet current FDA standards are part of the issue for what is or is not deemed safe. For example, in the 2011 OIG report, linked above, on Medicare coverage claims made during the first six months of 2007 for medications used in nursing homes, “fifty-one percent of Medicare atypical antipsychotic drug claims for elderly nursing home residents were erroneous.”
But were they “erroneous” solely because they were off-prescription uses and therefore should not be billed to Medicare? Could they still be — in appropriately small doses — safe and helpful to the resident, particularly for relief from aggression or anxiety? Would it be useful to consider new institutional safeguards for study of “necessary and appropriate use” (i.e., choice of last resort) of off-label medications in long-term care setting? I keep wishing we used the fines imposed for improper Medicare drug billings to fund investigation of proper drug use. Caregivers in the home sometimes need effective (including cost-effective), safe medication alternatives, but the safer venue for testing would seem to be facility-based settings.