Efforts to Reduce Antipsychotic Use in Nursing Homes Fail To Meet Goals

For two years, the government has been pushing nursing homes to decrease the use of dangerous antipsychotic drugs among elderly residents. While those efforts have resulted in some reductions, it is far below previous expectations.  

The Wall Street Journal reported last week that the U.S. Centers for Medicare and Medicaid Services (CMS) will soon release data showing that the percentage of nursing home patients prescribed antipsychotics dropped about 9% from 2011 to 2013. However, the agency had been hoping for a 15% decrease by the end of 2012.

The use of antipsychotics in nursing homes is of concern because in many cases they are being used to treat conditions that do not benefit from antipsychotics, and in some cases, as with dementia, the use of antipsychotics actually increases the risk of injury and death from nursing home falls and other problems.

Critics also say that in many cases, the facilities are trying to use the drugs as a form of chemical restraints to subdue hard-to-handle patients, which is considered by some a form of nursing home abuse.

Officials in the nursing home industry indicate that much of the problem is linked to inadequate staffing that leads some to take the easy way out and sedate their residents with drugs.

In May 2011, the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) issued a report on atypical antipsychotic misuse in nursing homes, which found off-label and dangerous use of the drugs was widespread.

The HHS-OIG report took data collected by the U.S. Centers for Medicare and Medicaid Services (CMS) in the first half of 2007 and found that 14% of the nation’s 2.1 million elderly nursing home residents were prescribed atypical antipsychotics at least once. Medical records indicate that 83% of those drugs were given for “off-label” reasons that were not approved by the FDA.

About 88% of the off-label uses were for conditions that the FDA cautioned against in black box warnings, the strongest label advisory the agency can give. The FDA warnings date back to 2005.

Not only are the antipsychotics dangerous, but they are expensive as well, according to CMS. They cost Medicare $7.6 billion in prescription reimbursements in 2011 alone.

Despite their failure to hit the 15% decrease goal, officials say they are satisfied with the progress made so far, which was achieved by working with the nursing home industry to treat problems with patients as much as possible without turning to the use of drugs.

However, critics say that CMS is going to easy on nursing homes which may be abusing their patients with drugs. They are calling for CMS to get tougher on facilities that use atypical antipsychotics like Seroquel, Risperdal and Abilify as chemical restraints on patients that they could place in danger.