On March 8th, 2008, a very disturbing article appeared on the website of the Minneapolis-St. Paul Star Tribune. The article, entitled “People With Dementia Getting Drugged Rather Than Helped ”, elucidates a very troubling trend in nursing home care across the country as it pertains to patients with dementia and behavior problems.

According to studies, antipsychotic drugs are now the number one pharmaceutical agent paid for by Medicaid. The federal agency is understandably alarmed by this statistic, and has demanded that state agencies overseeing long-term care facilities pay closer attention to a trend that is likely to be harming our vulnerable and institutionalized elders.

In Minnesota last year, 38% of nursing homes were cited for inappropriate use of antipsychotics. While 32% of Minnesota nursing home residents with dementia are receiving the drugs, 15% of patients without a diagnosis of dementia are also receiving them, a statistic that is apparently unsettling to regulators and bureaucrats alike.

Many websites offer advice and documentation vis-à-vis the use of chemical and physical restraints for elderly patients, and a great deal of information is available online regarding the 1987 Nursing Home Reform Act . Numerous articles---including this one published by The Wall Street Journal in December of 2007---highlight the ballooning costs of such medications. The Wall Street Journal article reported that Medicaid spent more than $5 billion on atypical antipsychotics in 2005, as compared to $1.58 billion on AIDS medications and $2.1 billion on cholesterol-lowering medications---an astounding disparity which could be partially explained by an aggressive ad campaign for the use of Risperdal in the elderly by pharmaceutical giant Johnson and Johnson, an ad campaign which the Arkansas Attorney General characterized as “false and misleading”.

The aforementioned 1987 Nursing Home Reform Act elucidates that “the resident (of a nursing home) has the right to be free from physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms.”  It is certain that many nursing home residents with behavior problems and dementia are being chemically or physically restrained more for the convenience of staff than for the actual safety of the patients themselves. It follows, therefore, that the staff-members of such facilities are legally bound to report such practices to regulatory agencies if attempts to change institutional policies are rebuffed by administrators, managers, or other staff. After all, such practices could be construed as elder abuse under various state and federal laws, and nurses and other licensed professionals who fail to report such abuses could potentially be held liable for failure to report them to the proper authorities.

Unwarranted and unnecessary chemical and physical restraint is an issue which will undoubtedly gain ground as the Baby Boom generation begins to retire in larger and larger numbers. As nursing home populations swell---an unavoidable and wholly expected demographic shift--- we must expect that such issues will continue to be explored as Medicare, Medicaid and other regulatory and advocacy groups pay closer and closer attention to the care being provided---and the money being spent---as this generation ages and its members become more vulnerable. Elder care is likely to become the majority of expenditures by both Medicare and Medicaid over the next 20 to 30 years, thus the attention paid to this aspect of medical and nursing care will likely increase exponentially in proportion to the dollars spent on its delivery.

So, if I were a nursing home administrator or nurse manager, I would take it upon myself to review the appropriate state and federal regulations, closely examine my facility’s practices, perform chart reviews of every patient (whether they are taking antipsychotics or not), and design appropriate and timely in-services for my staff. Inappropriate chemical restraint of the elderly is unconscionable, and, like it or not, as the population of elders grows, this issue will also grow in importance to clinicians, administrators and regulators alike.

-------------------

NurseKeith is a nurse, writer, blogger, and nurse consultant. Please feel free to visit his blog, Digital Doorway .

TrackBack URI for this entry

Comments (0)

Subscribe to this comment's feed

Title

Comment

smaller | bigger

Subscribe via email (Registered users only)

I have read and agree to the Terms of Usage.

Add Comment