Misuse of Antipsychotics Alleged in Nursing Homes Across U.S.

The Human Rights Watch report makes the claim that the overmedication of antipsychotics in nursing homes has become an epidemic.

The report quotes Walter L., a Texas nursing home patient who was given antipsychotics.  “Too many times I’m given too many pills…, I can’t even talk. I have a thick tongue when they do that. I ask them not to [give me the drugs]. When I say that, they threaten to remove me from the [nursing] home.”

In McKnights Long Term Care News, The American Health Care Association (AHCA) pushed back,

“Skilled nursing providers across the country have worked tirelessly to safely reduce the unnecessary use of antipsychotic medications over the last six years,” said David Gifford, M.D., senior vice president of quality and regulatory affairs for AHCA. “This report does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications, with more than half of our members achieving at least a 30 percent reduction.”

Gifford is referring to the association’s quality initiative and partnership with the Centers for Medicare and Medicaid’s National Partnership to Improve Dementia Care in Nursing Homes. The results were announced in an AHCA press release announcing half of its skilled nursing center members have reached or surpassed a nationwide goal in reducing antipsychotic usage by at least 30 percent.

The Human Rights Watch report estimated that weekly, 179,000 patients without correct diagnosis are given antipsychotics to subdue “disruptive” behavior. To make it easier for staff, the report alleges nursing homes will administer antipsychotics for seemingly “disruptive” behavior when the patient may be experiencing pain or discomfort instead.

Although CMS reported an eight percent drop in antipsychotic medications in nursing homes across the U.S. from 2011 to 2016, the agency’s recent report also confronts the issue.

“The potential overuse of antipsychotic agents is a symptom of a much larger problem – namely that many nursing home providers may not have a systematic plan to provide comprehensive behavioral health management to residents with diagnoses such as dementia and BPSD,” said CMS in its 2016/2017 action plan for nursing homes.

Dr. Jerry Gurwitz, chief of geriatric medicine at the University of Massachusetts Medical School told ABC News that he wonders if with the decrease, “some nursing homes might be finding other medications that sedate their patients into passivity without drawing the same level of scrutiny as antipsychotics.”

Patients receiving antipsychotics are to be fully aware of their medication and reserve the right to refuse per federal regulations, yet nursing homes often fail to get consent or even attempt to according to the Human Watch report.

Using drugs as chemical restraint to control patient behavior can be construed as abuse and inhumane, cruel treatment under domestic and international law.

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