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The use of antipsy­chotic drugs in nursing homes is widespread. In 2010, CMS estimated that 39% of nursing home residents who had cognitive impair­ments and behav­ioral problems but no diagnosis of psychosis or related condi­tions received antipsy­chotic drugs. A smaller but signif­icant percentage, approx­i­mately 15% of residents without cognitive impair­ments or behavior problems still received antipsy­chotic drugs.

Antipsy­chotic drugs are now viewed as extremely dangerous for older persons who do not need them; the FDA has issued “black box” warnings against prescribing antipsy­chotic drugs to patients with dementia, cautioning that such drugs increased dementia patients’ mortality. The FDA now estimates that 15,000 elderly people in nursing homes die each year from the off-label use of antipsy­chotic drugs for an indication (typically dementia) that the FDA knows doesn’t work. 

Federal regula­tions explicitly limit the use of antipsy­chotic drugs and provide that nursing home residents should be free from “chemical restraints.”  However, because inspectors grade viola­tions of these regula­tions according to the severity of the offense, there are many “near misses” that are not graded as severe, so very few viola­tions result in penalties.

There have been calls for better training for federal and state inspectors, stressing the impor­tance of reviewing the use of antipsy­chotic drugs in nursing homes. It has also been suggested that nursing homes implement comput­erized order entry warning systems to inform prescribing physi­cians that antipsy­chotic drugs carry a black box warning for older persons who have dementia but no diagnosis of psychosis, so the physi­cians are better advised at the time they prescribe these drugs.

Ultimately, however, family members need to be on the lookout for the use of antipsy­chotic drugs by their loved ones in nursing homes. Antipsy­chotic drugs should only be prescribed for elderly patients with dementia only after medical, physical, functional, psycho­logical, emotional and environ­mental causes for their psychotic behaviors have been identified and addressed; even then, such drugs should be prescribed in the lowest doses for the shortest period of time subject to dose reduction and regular re-review. Concerns about the use of such drugs should be addressed during care plan meetings, with the prescribing physician and brought to the attention of the facility’s Director of Nursing.

The injuries and conse­quences that result from neglect in nursing homes can be devas­tating. If you or a loved one has experi­enced neglect while a resident of a nursing home, it is important to consult with an attorney experi­enced in nursing home cases and who has the resources to vigor­ously pursue justice on your behalf. For a free consul­tation, please contact attorney Albert Lechner at (904) 722‑2228 or lechner@terrellhogan.com