My diagnosis with Parkinson's Disease in September 2009 at age 80 gave my life a new focus and challenge. Finding ways to meet this challenge helped make 2010 the best year of my life. I hope this blog will be a place where I can connect with others who also are dealing with aging and its afflictions and attractions so that we can share our "experience, strength and hope."
July 15, 2014
The Scourge of Antipsychotics in Nursing Homes
Every day I wake up in my house, I count my lucky stars I’m still
living here. Five years ago, when I first got my Parkinson’s disease diagnosis,
I started planning to sell my house and move into a senior living facility. I suspected
I’d experience a rapid decline, and that I’d need lots of help… and soon.
So I visited one particular place downtown I’d heard some good things
about. It’s close to our excellent Metro system, to the Kennedy Center, fine
restaurants, and the museums and theaters that make Washington such a great
place to live. As I walked around, the residents there seemed
pleasant, interesting, and active. The apartments I saw looked nice. I even
thought, “OK, I could live here.”
The past five years in my own home -- where I’ve lived for about half a
century – have been wonderful. Mostly, I’ve enjoyed a long and fortunate
Parkinson’s “honeymoon,” during which my symptoms have been manageable. I’ve
enjoyed my garden like never before. And easing into a “new” life with
Parkinson’s has been immeasurably more comfortable, more fun, and less worrisome for me because of
my two young Nepali housemates. The peace of mind I feel because they live here
Life is good.
Over the past weeks, I’ve seen more and more evidence that, for
seniors, staying in one’s own home – as
long as you’re safe, comfortable, and happy there – is an excellent predictor
of continuing wellness.
For a while, I’ve thought of posting a few thoughts about the positive impact of
staying in one’s home. Then a friend mailed me a copy of the July-August 2014
issue of the AARP Bulletin. One particular story caught my eye: “Prescription
for Abuse: Antipsychotics in Nursing Homes.” When I finished the article, I
breathed another sigh of relief – and gratitude – that I’ve eluded that grim
nursing home fate. Who knows what the future holds, but I hope I’ll never have
to see the inside of such a place.
Here are a few of the bullet points from that scary article.
It’s a Big Problem
Estimates suggest that 20 percent of patients in America’s 15,500
nursing homes are given unnecessary antipsychotic drugs, mostly to make those
patients more easy for staff to control. Said Todd Edelman, attorney at Center
for Medicare Advocacy here in DC, "The misuse of antipsychotic drugs as chemical restraints is one of the
most common and long-standing, but preventable, practices causing serious harm
to nursing home residents today."
The reasons for this abuse are various, and often work in combination. Two big problems are inadequate personnel training and chronic understaffing.
Aggressive, Persuasive, Improper Marketing by Big Pharma
Antipsychotic drugs are designed to treat people with severe mental
health problems, like schizophrenia or
bipolar disorder… NOT seniors in nursing homes because they complain too much or
need too much attention.
These potent drugs carry the FDA’s black-box warning that they are not
intended for frail, elderly people -- or people with Alzheimer’s or other dementias.
For these people, powerful antipsychotics can cause agitation, anxiety, confusion,
disorientation, even death. The California Advocates for Nursing Home Reform
issued this statement about those drugs: “They can dull a patient’s memory, sap
their personalities, and crush their spirits.”
The government is catching on and getting tougher. In 2009, Eli Lilly
paid $1.4 billion for marketing their antipsychotic Zyprexa to nursing home and
senior living residents, when the company knew their drug had not received FDA
approval as safe and effective for this elderly population.
At the time of that settlement, special agent Patrick Boyle – head of
the Office of Inspector General for the U.S. Department of Health and
Human Services – said: “This case should
serve as still another warning to all those who break the law in order to
improve their profits.”
Another Black Eye for Greedy Big Pharma
In November, 2013 – just over half a year ago – Johnson & Johnson
and its subsidiaries paid fines of $2.2 billion for aggressively marketing
inappropriate drugs – including antipsychotics – to nursing homes.
That case also alleged kickbacks from Johnson & Johnson to doctors
and to Omnicare -- the country’s largest long-term-care pharmacy provider -- for recommending
its drugs, including the antipsychotic Risperdal (risperidone), to nursing home residents.
The U.S. Department of Justice called that case “one of the largest health care
fraud cases in history.”
Consent” Often Not Happening
homes are required by law to secure informed consent from patients – or
designated family members – before powerful drugs like antipsychotics are
administered. But that legal requirement is typically overlooked. Why? There
are many possible explanations, probably (again) occurring in combination:
overworked nursing home assistants (NSAs)
turnover rate for NSAs
nursing homes are often woefully understaffed. Residents require lots of care.
Many are incontinent. One estimate suggests that 60-70 percent of all nursing home
residents have some type of dementia. In most of these places, the
patient-to-NCA ratio should be about 5 to 1. In fact, the ratio is often higher than 15 to 1.
Chicotel, staff attorney with the California Advocates for Nursing Home Reform,
cites another issue that exacerbates the problem: “These facilities are
highly medicalized, but doctors are rarely there.”
Centers for Medicare and Medicaid Services (CMS) – which oversees nursing homes that
receive federal money – has been working
to improve the situation. Over a recent two-year period, the CMS reduced
inappropriate use of antipsychotic drugs in its nursing homes by 15 percent.
Over the next few years, the CMS hopes to reduce unnecessary medication by 30
facilities are simply trying to address the problems they already know exist,
like inadequate staffing and training. Others – like the Beatitudes facility in
Phoenix – are changing the way they care for their patients with dementia based
on Tom Kitwood’s book Dementia Care Reconsidered: The Person Comes First.
example of the adjustments they’ve made there: Because people with
dementia typically have irregular, disturbed sleep/wake cycles, the staff at
Beatitudes lets these residents sleep and eat whenever they want. Patients can
do what they want to do whenever they like. Though the prescription may sound like an additional staff burden, managers there report that most patients no longer
resist care, and that the facility runs more smoothly because they have positioned patients’ wishes first.
<> <> <> <> <> <> <>
The issue of nursing home drug abuses – especially with antipsychotics – is just one
reason why staying in one’s own home is good for seniors’ health. In the days
ahead, I’ll share others.