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Reducing Antipsychotics

Misused Antipsychotics

NPR helps the Reduce the Misuse Cause!!!

Our 2013 Consumer Protection Grant Project: Misused Antipsychotic Drugs in Dementia Care

The federal government, health care professionals and consumer advocates are taking action in curbing the misuse of antipsychotic drugs in long-term care facilities, especially in the management of dementia related symptoms and behaviors. Why? When used used incorrectly with elders, these drugs can be dangerous, and studies show they have caused significant harm.

All residents in long-term care have the right to receive quality care free of the use of chemical restraints.

Across the state, the Office of the Washington State Long-Term Care Ombudsman, together with local ombudsmen, are working to inform residents, their surrogate decision makers and the public about the adverse side effects of atypical antipsychotics (such as Risperdal and Risperidone). It is the goal of this initiative, funded by a grant from the Washington Attorney General’s Office, to reach those whose quality of life is most affected by these powerful drugs, assisting them in exercising their rights, and providing, when needed, advocacy on their behalf.

PRESS RELEASE:  Ombudsman Tackling Misuse of Anti-psychotic Drugs and Advocated for Elders, November 2013

For more information about this, contact the Long-term Care Ombudsman in your area. To find the location of your ombudsman, visit our Find an Ombudsman page.

Watch our News and Events Column to the left or visit our calendar for upcoming information sessions or community-based events in your area where you can learn more about misused antipsychotic drugs in dementia care, how to recognize it, and what to do about it.

An expected outcome of this initiative is that increased consumer awareness will result in increased accountability by those prescribing and providing these drugs inappropriately, and increase use of non-pharmacological interventions, which have been proven to be extremely successful in dementia care, while providing the highest quality of life possible.

We will continually be adding more resources in our resources section. Please visit this section to learn more about the work being done to promote the significant reduction of the use of these antipsychotic drugs.

Facts & Resources

Facts about the Misuse of Antipsychotic Drugs in Dementia Care

  • The largest study of the use of such antipsychotics, conducted by Harvard Medical School and published in early 2013, found that elderly dementia patients using these drugs are almost TWICE as likely to die as those on a placebo.
  • David Graham, associate director of the Food and Drug Administration’s Office of Drug Safety, has estimated that 15,000 elderly people die in nursing homes every year as a result of the off-label use of these antipsychotics. (“Off-label” is defined as “medications used for reasons other than their intended use.”)
  • 42% of residents are given antipsychotic drugs in direct violation of nursing home prescribing guidelines.
  • 83% of the atypical antipsychotic medications were used for reasons other than their intended use (“off-label”).
  • 22% of antipsychotic drugs were prescribed to nursing home residents in excessive amounts or for an excessive time period.
  • 51% of the claims for these medications did not meet the government’s Medicare reimbursement rules – but were paid anyway.  This means that the Medicare system is paying hundreds of millions of dollars a year for these drugs, with taxpayers footing the bill.

Resources

There’s a Better Way: Ending Anti-Psychotics in LTC Settings

Dementia Beyond Drugs: Changing the Culture of Care – by G. Allen Power, MD, FACP, April 20, 2017

Materials by Jonathan M. Evans, MD, MPH, CMD, FACP on April 20, 2017:

Advocating Against The Illegal and Excessive Use of Psychotropic Drugs with People with Dementia by Kelly Bagby, AARP Foundation Litigation

Computer engagement reduces antipsychotic usage, improves quality of life (6.26.16)
A Chesapeake Bay nursing home’s two-year pilot uses technology to improve social engagement and life quality for those with dementia.

CMS Operations Manuals. CMS is the Center for Medicare and Medicaid service, The Federal entity that regulates the provision of health care coverage. CMS also works to achieve a high quality health care system through quality assurance guidelines and regulations, including guidelines on the use of antipsychotic drugs:

On March 29, 2012, CMS launched a national partnership with the mission of improving the quality of care provided to individuals with dementia living in nursing homes. This partnership focuses on the delivery of health care that is person-centered, comprehensive and interdisciplinary, which includes protecting residents from being prescribed antipsychotic medications unless there is a valid, clinical indication, and a systematic process to evaluate each individual. Visit their site: https://www.nhqualitycampaign.org/dementiaCare.aspx

SCMS Survey and Certification Letter: Dementia Care in nursing homes, clarification of CMS Operations Manual Ftags 309 and 329, Quality of care and Unnecessary Drugs
Issue date: 05.24.2013

The National Consumer Voice for Quality Long-Term Care is actively fighting to end the misuse of antipsychotic drugs as chemical restraints. This campaign seeks to address this problem through legislation, regulation, guidance and education.
The Misuse of Antipsychotics Among Nursing Home Residents
The National Consumer Voice – Resource List

Toby Edelman and Dean Lerner Report on Antipsychotic Drug Deficiencies in Nursing Homes (11.4.13). Click here to read Part I, here for Part II, and here for Part III of this highly informative report. Click here to download Antipsychotic presentation.

Center for Medicare Advocacy Report: Examining Inappropriate Use of Antipsychotic Drugs in Nursing Facilities

American Health Care Association, Fast Facts: What you Need to Know About Anti-psychotic Drugs for Persons Living with Dementia Care

American Psychiatric Association videoChoosing Wisely video on managing dementia care with antipsychotic drugs

ProPublica (05.11.13) Medicare Drug Program Fails to Monitor Prescribers, Putting Seniors and Disabled at Risk

Health In Aging Identifying Medications that older Adult Should Avoid or Use with Caution: the 2012 American Geriatrics Society Updated Beers Criteria

The New York Times – Health (3.1.15): – Psychiatric Drug Overuse Is Cited by Federal Study

Brain Health Resources. Click here to read Dementia-capable States and Communities, here to read Responding to the Wandering Behavior of People with Dementia, and here for Responding to the Wandering Behavior of People with Dementia.

The American Geriatrics Society 2012 Beers Criteria Update Expert Panel:  American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

AARP BULLETIN (July/August 2014): Drug Abuse: Drug Abuse – Antipsychotics in Nursing Homes

AIMS Test (Abnormal Involuntary Movement Test)

Excerpts from the Dementia in the Long Term Care Setting Clinical Practice Guideline: American Medical Directors Association. Columbia, MD 2012

Download an Informational PDF

Download Reduce the Misuse Brochure

Resource List for providers of Dementia Care

Rules and Laws Related to Misuse of Antipsychotic Drugs

The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents. This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, and reduction in chemical and physical restraint use.

Residents Rights for Reasonable Accommodations:

  1. “The resident has the right to reside and receive services in the facility with reasonable accommodation of individual needs and preferences, except when the health or safety of the individual or other residents would be endangered.” WAC (Washington Administrative Code): 388-97-08010.
  2. OBRA Interpretive Guideline at F-253: “Reasonable Accommodations” requirement means those adaptations of the facility’s physical environment and staff behaviors to assist residents in maintaining independent functioning, dignity, well being and self-determination”.

Residents Rights about Discharges Admissions:

  1. “A resident should not be transferred or discharged on grounds that the facility cannot meet his or her needs unless the resident’s condition is so acute as to require hospitalization. A Medicaid or Medicare certified skilled nursing facility should be able to meet resident needs that are less intensive than hospitalization”.  56 Fed Regulations 48839.
  2. Under OBRA, the facility, “must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care”. 42 CFR 483.30.

Residents Rights about Chemical Restraints:

Residents have the right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms.

“Often the basis for a transfer or discharge can be eliminated by close attention to medical problems, changes in the environment or alterations in staff interventions.”

WAC 388-97-0620  42 CFR 483.13(a).