Study: NY Nursing Homes Failed to Meet Federal Goal to Reduce Use of Antipsychotics

The Long Term Care Community Coalition (LTCCC), an advocacy group that promotes the improvement of nursing home care, released a report in April 2014 about the use of antipsychotic medications in New York nursing facilities. The study, titled “Antipsychotic Drug Use in NY State Nursing Homes: An Assessment of New York’s Progress in the National Campaign to Reduce Drugs and Improve Dementia Care,” revealed that NY nursing homes failed to meet a federal goal to reduce the use of antipsychotics. In March 2012, the Centers for Medicare and Medicaid Services (CMS) set a goal for all nursing homes to reduce antipsychotic medication use by 15 percent by the end of the year. Despite this goal, in December 2013 the CMS reported that NY nursing homes reduced antipsychotic use by only 14.6 percent, short of the target.

pills8.jpgAntipsychotic medications were developed to treat patients diagnosed with psychosis, such as schizophrenia. However, because such medications have a sedating effect, many nursing homes prescribe such antipsychotics to dementia patients with behavioral issues. In effect, the medication is being used as a chemical restraint to control agitated residents. Moreover, in 2005, the FDA issued a “black box” warning stating that antipsychotics can cause strokes, heart attacks and death in dementia patients.

Discussing the use of antipsychotics in nursing homes, U.S. Inspector General Daniel Levinson remarked, “Too may [nursing homes] fail to comply with federal regulations designed to prevent overmedication, giving nursing home patients antipsychotic drugs in ways that violate federal standards for unnecessary drug use. Government, taxpayers, nursing home residents, as well as their families and caregivers should be outraged–and seek solutions.”

Even though only one percent of nursing home residents are diagnosed with psychosis, the LTCCC’s report points out that nearly 20 percent of NY nursing home patients are taking an antipsychotic. In general, the study found that nursing homes in the NYC metropolitan area had the highest rate of antipsychotic use, while nursing facilities in the western region of the state had the lowest rate of antipsychotic use. The report concluded that the discrepancy was due to higher enforcement actions in western regions.

To address the problem of antipsychotic medications in nursing homes, the LTCCC has made several recommendations. First, the NYS Department of Health needs to address and enforce the issue when conducting nursing home inspections. The LTCCC study found that higher enforcement leads to more nursing homes complying with antipsychotic use. Second, NYS lawmakers need to pass a bill that will require nursing home residents to give their verbal and written consent before taking antipsychotics. The consent form would list potential side effects of such medications, including the FDA’s “black box” warning for dementia patients.

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