Nursing homes are over-diagnosing patients with schizophrenia in order to conceal the high rates at which they’re prescribing antipsychotic medications, according to a recent report by the New York Times. Schizophrenia diagnoses among nursing home residents have “soared” as much as 70% since the federal government started making public disclosures of antipsychotic drug prescriptions in 2012. These prescriptions factor into nursing homes’ funding and ratings: nursing homes that prescribe them at high rates can receive lower ratings from the government, which in turn can affect their funding.
Because the government doesn’t disclose antipsychotic medication diagnoses for residents with schizophrenia, the Times’ analysis shows, these high diagnosis rates are “obscuring” the actual number of residents on potentially risky medications. Antipsychotic medications can be especially hazardous for nursing home residents suffering from dementia, increasing the odds they might experience “heart problems, infections, falls and other ailments.” According to the report, nursing homes rely on these medications’ sedative effects on dementia-stricken patients because otherwise they would need to hire more staff to handle the people under their care.
The Times describes one “restless and agitated” patient, 63 years old, who was given a schizophrenia diagnosis and an antipsychotic prescription even though he had no record of schizophrenia. Over the subsequent eight months of “round-the-clock sedation,” he suffered “devastating weight loss, pneumonia, and severe bedsores that required one of his feet to be amputated.” Then he died.
Among the broader population, according to the Times, approximately one out of every 150 people suffer from schizophrenia. Data analyzed by the newspaper shows that among the 1.1 million nursing home residents in the United States, that rate is one out of every nine people. This high rate is notable because people who suffer from schizophrenia typically receive a diagnosis before they reach 40. The Times based its analysis on “unfiltered” Medicare data and nursing home-specific data shared by an advocacy group that acquired the files via a public records request. In total, “at least 21%” of nursing home residents are currently using antipsychotic medications, a sum of approximately 225,000 residents.
The unnecessary use of antipsychotic medications can have tragic costs. As the Times notes, studies show that these medications can cause drowsiness in elderly people, which increases the odds they might fall and suffer injuries. Patients suffering from dementia, when on antipsychotic medications, can suffer heart problems and a “nearly doubled” risk of death. Partly in consideration of these risks, Medicare began requiring nursing homes to disclose their rates of antipsychotic prescriptions and factoring this information to its quality of care scores for nursing home. The exception to these reporting requirements, however, are patients with schizophrenia, Tourette’s syndrome, and Huntington’s disease, according to the Times.
Why would nursing homes make erroneous schizophrenia diagnoses and prescribe unnecessary, dangerous medications? Perhaps because patients with behavioral issues are easier to manage when they’re sedated. Studies cited by the Times show that “the worse a home’s staffing situation, the greater its use of antipsychotic drugs,” implying that “some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff.” An analysis of inspection records by the newspaper found “5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications,” though the vast majority of these citations were not assigned a level of severity that would affect the nursing home’s rating, and planned Medicare initiatives for “targeted inspections to examine the issue of false schizophrenia diagnoses” have been delayed by the coronavirus pandemic.
Another consequence of the government’s requirement that nursing homes report antipsychotic usage: the increase in prescriptions of non-antipsychotic medications that have similar effects. One such medication is Depakote, typically prescribed for bipolar disorder and epilepsy, which also has dangerous drowsiness-inducing effects. According to the Times, prescriptions of anti-seizure medications like Depakote increased 15% in nursing homes from 2015 to 2018, while antipsychotic prescriptions declined by roughly the same amount. One psychiatrist who conducted research into these figures told the Times, “The prescribing is far higher than you would expect based on the actual amount of epilepsy in the population.”
A lawsuit filed against Depakote’s manufacturer alleges that in the early 200s it “began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as ‘chemical restraints.'” The lawsuit was filed by a former saleswoman for the manufacturer; it was settled in 2012. There is still no requirement that nursing homes report drugs like Depakote, despite requirements that they report antidepressants, anti-anxiety medications, and other drugs with similar effects.
Questioned about the high diagnosis and prescription rates, a spokesperson for the Centers for Medicare and Medicaid Services said the agency is “concerned” about the trend and that “It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures.” A spokesperson for a for-profit nursing home group suggested nursing homes’ physicians are responsible for the improper diagnoses, though the Times noted these physicians “often work in partnership with the nursing homes.”
More information on the high rates of schizophrenia diagnoses and antipsychotic medication prescriptions in nursing homes is available via the New York Times.
The attorneys at the Law Offices of Thomas L. Gallivan, PLLC work diligently to protect the rights of nursing home residents. Please contact us to discuss in the event you have a potential case involving neglect or abuse.