I've written here many times as a Pennsylvania nursing home lawyer about the dangers of overusing antipsychotic drugs in nursing homes. Sometimes called "chemical restraints" because the practice effectively prevents patients from being physically or mentally active, antipsychotics were once commonly used off-label in dementia patients. Their use has been curbed somewhat since 2005, when the FDA issued its strongest possible warning that studies have associated atypical antipsychotic use in the elderly with increased risk of death; the agency extended that warning in 2008 to all types of antipsychotics. Nonetheless, a federal report last year found the drugs are still used more widely in nursing homes than they should be, with numerous Medicare recipients getting the drugs for no medically accepted reason or in a way that violates federal standards.
Now, the Centers for Medicare and Medicaid Services has announced a campaign to stop unnecessary use of antipsychotics. According to McKnight's Long-Term Care News, CMS will promote alternatives to medication to control behaviors among dementia patients that are violent or otherwise difficult for caregivers to handle. These can include intervening in patients' behavior, better communication with patients when possible, and treating any problem that might be the real cause of an outburst, such as undiagnosed pain. Nursing home industry observers also called for homes to recheck whether there was ever a valid indication for the medication, and whether it's still valid today. McKnight's reported that this issue has been front and center partly because of interest from Sen. Chuck Grassley, R-IA, who may have driven the CMS initiative. That initiative will kick off March 29 with educational programs as well as increased regulatory oversight.
As a Philadelphia medical malpractice lawyer, I applaud Grassley and the no doubt many others who have been working to keep this issue front and center. Because of their illness, nursing home patients with dementia can rarely speak for themselves, so it's vital that we speak for them. That's particularly true for patients who are receiving antipsychotics unnecessarily, because a side effect of those drugs is sedation. (Indeed, it's possible that sedation is the goal of homes that overuse the drugs.) Like other powerful prescription drugs, however, antipsychotics carry even more serious side effects, including large weight gain, diabetes, sudden cardiac death, stroke and more. That's why knowingly misusing the drugs in elderly people, just to avoid taking the expensive staff time necessary to intervene in their behavior, is a form of Pennsylvania nursing home abuse.