As a Pennsylvania nursing home lawyer, I've written here several times before about the controversial practice of using psychiatric medications to control the behavior of dementia patients. Dementia can make patients argumentative or violent towards others, and it can also cause them to put themselves in danger. As a result, it's become a common practice to prescribe antipsychotic medications to these patients "off label," which means the drugs aren't approved for controlling dementia symptoms. I and many other Philadelphia medical malpractice lawyers have criticized the practice as unsafe, especially after studies began showing that certain atypical antipsychotics actually increased the rate of death in dementia patients. Now, a New York Times Well blog entry dated Feb. 15 suggests an alternative: a pilot project at Minnesota nursing homes that seeks to replace drugs whenever possible with behavioral interventions.
The Awakenings project trained the entire staff of one nursing home in how to calm and reassure patients, and talk to them without insisting on facts that the patients won't accept as true anymore. The home's director of nursing said just holding the patients' hands is sometimes enough to calm them down. When those steps were in place, the home began to reduce or eliminate psychiatric medications whenever possible and agreed to by the families. In the end, all of the residents taking antipsychotics and 30 to 50 percent of those taking antidepressants were able to stop the medications. The post said the behavioral interventions were expensive because they required two additional staff members, but the results were so strong that the program has been expanded to all of the homes owned by this home's parent company.
The experiment also uncovered the reasons for the outbursts from one patient, an unnamed woman in her 90s. The woman would grimace and cry out, had never spoken once since she entered the home and showed no clear signs of recognition when her children visited. At the beginning of the project, she was on the antipsychotic Risperdal, the anxiolytic Ativan and an antidepressant. But after Awakenings took her off most of her psychiatric medications, she was able to speak enough to tell caregivers that she was crying out in physical pain. She was also able to communicate with her family and even take part in games at the home before she eventually died of complications from the dementia.
As a Philadelphia injury lawyer, I'm pleased to see that nursing homes are considering alternatives to medicating dementia. As the post notes, medications are sometimes called "chemical restraints" because their purpose seems to be less to treat a medical problem than to make the caregiver's life easier. This essentially robs the patient of his or her ability to live fully so that nursing homes don't have to pay for the full amount of staff members they need (with Medicare, Medicaid or the family picking up the bill). As this blog post shows, it can also keep patients from communicating their actual medical or personal needs. And even worse, it's now well established that atypical antipsychotics increase patients' risk of stroke, diabetes and other serious health problems that are only exacerbated by age. Under these circumstances, using drugs as a substitute for adequate staffing could be considered a form of Pennsylvania nursing home abuse.