As part of a broader push to deregulate the nursing home industry, the Trump administration has proposed rolling back regulations on antipsychotic use in nursing homes. Under current nursing home regulations, doctors who prescribe antipsychotics to the elderly on an “as needed” basis may only write a prescription for 14 days. At the end of 14 days, the physician must reexamine the nursing home patient and write another prescription, if necessary. The Centers for Medicare and Medicaid Services (CMS) is proposing new regulations that would change the 14-day window to 70 days.
Antipsychotic use in the elderly has remained unnecessarily high and controversial, with public health experts and elder care advocates describing the practice as elder abuse. According to these experts, nursing homes who put their residents on antipsychotics lack a valid medical reason and are simply drugging these patients. Antipsychotics, such as Seroquel and Zyprexa, commonly sedate patients, especially at higher doses. In addition to doping up the residents, these mind-altering drugs also have serious side effects. The medications commonly interact with other drugs and increase the risk of everything from slip and fall accidents to death.
Given the lack of a medical rationale for prescribing an antipsychotic on an ‘as needed’ basis, The Human Rights Watch describes the extended timeline between physician examinations as a policy likely to exacerbate the problem, not help it. Sadly, even the subject of unnecessarily drugging senior citizens has become a political issue down in Washington DC. In a 2018 report by the House Ways and Means Committee, They Want Docile: How the Nursing Homes in the United States Overmedicate People with Dementia, Democrats took CMS to task for failing to enforce antipsychotic regulations. Now, they say, the government is merely lowering the bar for nursing homes for the rules they refused to enforce on them.
In explaining the reason for changing the rule, CMS said that rural nursing homes reported difficulty complying with the frequent examinations because of limited nursing staff and overburdened doctors. In addition to describing the rule as a tedious compliance burden on nursing homes, the federal agency also described the rule as ineffective overall. With 20 percent of nursing home patients receiving antipsychotics and only 2 percent diagnosed with a “qualifying medical condition,” the federal agency’s priorities appear misplaced and likely to harm America’s nursing home patients.