Nursing Homes Are Not Side-Stepping Restrictions on Use of Antipsychotics as Chemical Restraints: Study

Some had feared nursing homes would begin diagnosing dementia patients with mental health conditions they do not have to allow the continued use of antipsychotics to sedate residents.

Following the implementation of new federal restrictions on the unnecessary use of antipsychotic drugs to sedate nursing home dementia patients, there does not appear to be evidence that facilities are attempting to skirt the restrictions by diagnosing residents with mental health conditions to continue the practice, which is often referred to as “chemical restraint”.

The U.S. Centers for Medicare and Medicaid Services (CMS) began to crackdown on the use of antipsychotics among dementia residents in 2009, since unneccesary use of the drugs has been linked to an increased risk of nursing home falls, injuries and death. In addition, research has found that use of antipsychotic drugs by dementia patients increases the risk of blood clots, stroke, kidney injury, bone fractures, heart attack, heart failure and pneumonia.

Medicare began more closely monitoring which dementia patients were prescribed antipsychotics, like Seroquel and Risperdal, since they do not help with the condition. However, in 2015, a policy was established that allowed patients with certain excluded conditions from being held to the new stricter rules against using antipsychotics.

This led to concerns that some nursing homes would begin diagnosing more dementia patients with mental health conditions, such as schizophrenia. These so-called “exclusionary conditions” would allow them to justify chemically restraining patients, which is widely seen as a form of nursing home abuse.

In a study published in the Journal of the American Geriatrics Society on August 23, researchers from Brown University and the University of Michigan examined the impact of these restrictions, looking at data on new long-stay nursing home residents. However, they found no indication residents were later being diagnosed with exclusionary conditions that would have then qualify them for antidepressant use.

These exclusionary conditions include schizophrenia, Tourette’s syndrome and Huntington’s Disease, which are also excluded from being a part of the Star Rating Program that measures the quality of nursing home care in the U.S.

The new research was led by Dr. Theresa Shireman, of Brown University’s Center for Gerontology and Healthcare Research, who found that diagnosis rates for excluded conditions stayed relatively level among more than a quarter million patients monitored from 2009 to 2018, who were diagnosed with dementia.

The average percentage of people diagnosed with excluded conditions before the new regulations was 2.2%. The data from the study indicated that over time the percentage remained roughly the same but never exceeded 2.9%.

Before the new policy was established, the rates of diagnosis for the excluded conditions were increasing among non-profit nursing homes, compared to for-profit nursing homes. However, after the new policy was put into place, non-profit nursing homes saw a decrease in the rate at which excluded conditions were diagnosed and for-profit nursing homes saw an increase in those diagnoses.

Nursing Home Chemical Restraint Restrictions Effective

Researchers said the policy crackdown seems to be working and nursing homes are not using the loophole to diagnose more patients with excluded conditions and chemically restrain them.

The study authors emphasized the need to incentivize programs that encourage appropriate use of medications and not chemical restraint practices. Avoiding chemical restraints for dementia patients is crucial for improved care and fewer side effects among nursing home residents, the researchers concluded.

Last year, the White House called for CMS to continue to investigate the use of chemical restraints in nursing homes, given the serious health risks posed by exposing dementia patients to unnecessary drugs.