The organization Human Rights Watch recently issued a disturbing report about the improper and illegal off-label use of antipsychotic medications in the nation's nursing homes and elder care facilities. According to the report, staff at these facilities are administering these drugs to patients with dementia, a condition for which they are not indicated.
The practice has been going on for several years. Although there are federal rules prohibiting the administration of medications for any reason other than those for which they are approved, enforcement has been lax. In December 2016, an 81-year-old male resident living in a Texas nursing facility said, “I've been given too many pills...I can't even talk. They get me so I can't think.” When he asked the staff to refrain from giving him the pills, they threatened to remove him from the home.
Anti-psychotic medications are being given to these patients primarily to control their behavior, particularly in facilities that are not sufficiently staffed. In most cases, anti-psychotics such as risperidone and aripiprazole are administered to residents without their knowledge or consent. Not only are these drugs contraindicated for dementia, they have been clinically demonstrated to increase the risk of death in such patients.
For many years, healthcare experts have been sounding the alarms about the over-medication of geriatric patients, particularly with prescription medications that are dangerous and/or of dubious efficacy (the practice is especially prevalent in the South). Since 2012, the U.S. Centers for Medicare and Medicaid Services (CMS) have been working with elder care facilities and geriatric specialists to reduce the usage of anti-psychotics. Unfortunately, warnings have been falling on deaf ears, and efforts to curtail such use has been falling short of their goals. Although laws exist to protect elderly patients, Human Rights Watch says they are not being enforced. An investigation by National Public Radio two years after the CMS program was started found that only 2% of nursing homes were being penalized for applying “chemical restraints.”
On the upside, a few nursing facilities are making progress in reducing their reliance on the off-label use of antipsychotics. Last year, the director of a nursing home in Kansas acknowledged that only 10 percent of the residents suffered from mental illness – and they managed to reduce the use of antipsychotic medication by half. In 2014, a non-profit organization that operates a chain of nursing homes in Minnesota reported that they were able to reduce the number of patients on antipsychotic medications by 97 percent through a program called Awakenings. The program employs a number of non-drug therapies, including music, aromatherapy, pet therapy and validation.
There is also some push back against the Human Rights Watch report. In a statement issued the same day, the American Health Care Association (AHCA) gave the following response:
“Skilled nursing providers across the country have worked tirelessly to safely reduce the unnecessary use of antipsychotic medications over the last six years. This report does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications, with more than half of our members achieving at least a 30 percent reduction.”
The AHCA acknowledges that much more needs to be done, pointing out that many elderly patients enter nursing homes already on such medication – indicating that family members, personal physicians, hospitals and other healthcare providers need to be involved in reducing the improper geriatric use of antipsychotics.