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.