When it comes to dementia, many of us get to a point when we realize the people we love the most need more care than we can give them. As a result, we trust doctors and nursing home caregivers to do right by our fragile parents, grandparents or other loved ones. At most, we expect nursing home professionals to become surrogate sons and daughters. At the very least, we expect they will obey laws and governmental regulations involving elder care and the nursing home industry.
Unfortunately, they are not.
Recently the New York Times released results of an investigation on the misuse of antipsychotic drugs and other medications in nursing homes. The journalists found a staggering 21 percent of the nation’s nursing home residents are being given antipsychotics. Heavy sedatives, historically referred to as “chemical straitjackets” that come with a Food and Drug Administration (FDA) warning stressing that use by older dementia patients increases the risk of death.
The Times also reported nursing homes are covering up the use of the drugs by turning in misleading and false information on required government forms concerning patients’ needs for specific antipsychotics.
History of Drugs Being Misused in Nursing Homes
In 1987, under President Ronald Reagan, the Federal government banned medicines that serve the interests of nursing homes and staff rather than the patient. And, over the years, more regulations to protect seniors against the misuse of drugs have been put in place, including a decision in 2005 after studies determined that antipsychotic drugs like Seroquel, Zyprexa and Abilify made seniors drowsy and caused more of a likelihood of falling. The FDA required black box labels, warning that use by patients with dementia could be fatal.
Seven years later, in 2012, with antipsychotics still being overused by the nursing home industry, the government added more regulation, requiring facilities to report to Medicare how many residents were receiving such drugs. The collected information is added to a public database, showing a nursing home’s “quality of resident care” score, one of three major categories that contribute to a home’s star rating.
However, the Times has found a loophole in the 2012 requirements, making it possible for nursing homes to continue distributing the dangerous drugs to residents with dementia. The 2012 Medicare rule does not require nursing homes to report the use of the drugs when it comes to residents with either schizophrenia, Tourette’s syndrome or Huntington’s disease. These conditions can be treated with antipsychotics, so there was no reason for a nursing home score to decrease because of those cases.
The result – doctors are putting through “fake’’ diagnoses of schizophrenia. In the last seven years, ever since the Medicare requirements were set in motion, the number of nursing home residents with a schizophrenia diagnosis has increased to a startlingly 70 percent. In comparison, within the general population, the condition, which is almost always discovered before an individual is 40, is only found in one in 150 people.
The Times research also included figures from a May report by the inspector general of the Department of Health and Human Services finding 52 nursing homes, all with at least a four out of a five-star rating, included residents with an “unsupported diagnosis of schizophrenia,” in at least 20 percent of the patients.
Antipsychotics Are Not the Only Nursing Home Drug Issue
In recent years while the government has attempted to crack down on antipsychotics, the use of anti-seizure drugs on patients with dementia has been on the rise. One such drug is Depakote, a drug known to cause drowsiness and increase the risk of falls. It also is used to treat epilepsy or bipolar disorder.
According to information from the University of Michigan, between 2015-2018, Depakote use rose 15 percent in nursing home residents with dementia, despite the fact the government has not approved it for treatment of the condition, and studies show that it does not help with dementia. Depakote is also a drug that is easy to disperse in a “sprinkle” form, allowing nursing home staff to slip it into food undetected.
To illustrate the severity of the issue, the Times included the story of a South Carolina resident who became a tragic victim of a false diagnosis handed down by a nursing home doctor. When the resident entered the facility, he was diagnosed with high blood pressure, pneumonia and advanced dementia. However, as days went by, unbeknownst to his family, a doctor working for the facility added another diagnosis, schizophrenia, making it possible for the staff to administer the anti-psychotic Haldol. He was also prescribed Zyprexa, as well as the sleeping pill Ambien.
Medical staff, including a physical therapist and a dietician, expressed concern over his lethargy, and an outside pharmacist went so far as to fill out paperwork recommending the man’s medicine be reduced to “comply with federal guidelines that require nursing homes to gradually reduce doses of antipsychotics.”
However, an attending doctor at the facility disagreed with the pharmacist. The man continued to receive the blend of drugs. Finally, after more than seven months in the nursing home, his wife was able to move him to another facility. Unfortunately, by then, his struggle had become a downward spiral. He died soon after the move.
Nursing Home Staff Shortages Doesn’t Help the Issue
Even before the outbreak of COVID-19, America’s nursing homes had issues keeping the number of staff at acceptable levels, especially when it comes to caring for dementia patients.
However, the issue has gotten more severe during the pandemic. According to figures released by the Federal Reserve Economic Data (FRED), nursing home employment has been down since early 2020 and is at its lowest level since 1994.
With nursing home staff shortages, it becomes even more important to use extra caution when choosing a nursing home. Make sure to review a potential home’s certifications, learn the ratio of residents to staff members and interview the staff members while visiting the properties directly. You can also ready yourself with available information like Medicare’s nursing home comparison tool.
When To Seek Legal Help in Fighting Nursing Home Abuse
If you feel a loved one is being mistreated in a nursing home or suspect medical negligence, you should seek legal guidance from an attorney knowledgeable in nursing home abuse.
In the tragic case of the South Carolina victim, his wife told the Times that it was “…only after hiring a lawyer to sue’’ that she learned her husband had been on Haldol and other powerful drugs (although the nursing home denied the claims in court filings).
Sometimes you can not do it on your own.
If your family member has experienced or is experiencing nursing home abuse, there are legal ways to hold those responsible accountable while protecting your loved one. If you live in the Washington, D.C. or Charleston, West Virginia area and suspect the misuse of medication or other nursing home abuse, Paulson & Nace can help you determine the next steps. Call us at (202) 463-1999 or contact us online.
Both an Emory School of Law graduate and MBA graduate of Goizueta Business School at Emory, Chris Nace focuses his practice on areas of medical malpractice, drug and product liability, motor vehicle accidents, wrongful death, employment discrimination and other negligence and personal injury matters.