According to the New York Times, the federal government will be implementing significant changes to the rating system of nursing homes in the United States. Currently, the ratings are based on a five star system that is scrutinized by the public. This five star rating system “has been criticized for its reliance on self-reported, unverified data.” The current system was implemented five years ago and evaluates staffing levels and quality of care, which is reported by the nursing homes and not audited by the federal government. This flawed rating system “relied heavily on unverified and incomplete information that even homes with a documented history of quality problems were earning top ratings.” In 2009 37% of nursing homes had ratings of four or five stars and by 2013 over 50% had exceedingly high ratings. With more than 15,000 nursing homes in the United States, it is crucial that the optimal quality of care is guaranteed by skilled nursing facilities. Continue Reading
Antipsychotic drugs are an increasingly common form of medication for elderly patients in health care facilities. Although these drugs treat a wide variety of health concerns, most prescribed are unnecessary, and have the potential to cause more harm than good. In an interview with the Wall Street Journal, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine states, “ Due to an influx of the geriatric population, coupled with increasing chronic health issues, antipsychotic medications will grow to be a severe problem that should not be ignored. Continue Reading
According to the American Association of Retired Persons, AARP, 1 in 5 elderly patients—in over 15,500 nursing homes—are administered powerful antipsychotic medications that have the ability to create detrimental, and possibly fatal, side effects. Antipsychotics are habitually distributed to subdue the patient and create a less chaotic work environment for the understaffed nurses in a skilled nurse facility. The over prescription of antipsychotics have left many families outraged at the mistreatment of their loved ones. The use of antipsychotic medications is a disregard to the patient’s quality of life in favor of higher profits.
Antipsychotics have inimical side effects, especially when given to Dementia patients. Dementia patients compose of about 70% of residents in a skilled nursing facility. With such a high percentage residing in facilities, their quality of care is fundamental to maintain an adequate quality of life. AARP continues this thought by stating, “In those populations, these drugs can trigger agitation, anxiety, confusion, disorientation and even death.”
Antipsychotics are over prescribed as a shortcut to create more submissive patients. AARP explains, “If one drug caused sleeplessness and anxiety, she was given a different medication to counteract those side effects. If yet another drug induced agitation or the urge to constantly move, she was medicated again for that.” The overuse of drugs has lead to the neglect and abuse of many elderly residents.
Omnicare Incorporated is required to pay $124 million to settle two slander lawsuits claiming Omnicare failed to comply with the federal Anti-Kickback Statute. Omnicare Inc., one of the largest distributors of drugs and other pharmaceutical products to various skilled nursing facilities across the United States, allegedly provided discounts to certain skilled nursing facilities in return for the continuous use of their drugs and pharmaceutical products. The Anti-Kickback Statute is a criminal statute that is intended to eliminate any exchange of value to generate the referral of federal health care program business. The allegations against Omnicare smear the legitimacy of the company and may negatively impact future sales of its products. Although Omnicare denies any wrongdoing, and has agreed to settle the case to “end litigation,” its actions are deemed reprehensible by many. Continue Reading
The Centers for Medicare and Medicaid Services (CMS) launched the initiative Partnership to Improve Dementia Care in Nursing Homes to lower the use of antipsychotic medication in nursing home facilities. The aim of this initiative was to reduce the inappropriate use of antipsychotic drugs by 15%. However, this goal was not met, and as of 2013, the rate of antipsychotic drug use for long-stay residents was reported to be about 21%, which was approximately a 9% reduction. This meant that more than 1-in-5 residents, or about 300,000 individuals, are still being administered antipsychotic medications.
The Center for Medicare Advocacy recently issued a report analyzing antipsychotic medication use in nursing home facilities. One aspect of the report delved into the perspectives of state surveyors and their process of citing facilities for antipsychotic drug deficiencies. Specifically, the report revealed whether or not the surveyors found any changes in the practices of nursing home facilities after CMS launched its antipsychotic medication initiative.
A recent study published by the Journal of American Medical Directors Association (JAMDA) provided insight as to the knowledge nursing home staff possessed regarding antipsychotic drugs, along with the beliefs they held regarding the appropriateness and effectiveness of such drugs. Antipsychotic medications are generally administered to dementia patients to address behavioral issues. However, administration of these drugs has raised significant patient safety issues. There has been evidence of increased mortality, morbidity, along with risks of serious side effects such as strokes and death. Furthermore, evidence revealed such drugs have limited efficacy in older adults who suffer from dementia. The Food and Drug Administration (FDA) even issued black box warnings to emphasize these risks. Despite such evidence, the use of antipsychotic medications is still high within such facilities.
The study’s survey revealed gaps in knowledge and awareness across all levels of nursing home staff regarding the negative effects of antipsychotic medication. Many believed these drugs were effective in managing the behaviors of dementia patients, and that managing the challenging behavior of such patients was not possible without these drugs. Specifically, only 37% of direct care staff felt they could handle difficult residents without the use of medications. An even more alarming finding exposed the lack of knowledge amongst prescribers such as medical directors, directors of nursing, and RNs/LPNs concerning the significant adverse effects of such medications. The study revealed that only 24% of nursing home leaders were able to identify at least 1 severe adverse effect of antipsychotics, while only 12% of RNs were able to list at least one adverse effect.
Many nursing homes often substitute individualized care with the use of psychotropic drugs to make up for the lack of adequate staffing in their facilities. As a result, nursing homes often misuse psychotropic drugs by administering them to residents in order to sedate or control them. This has the tragic result of reducing a resident’s quality of life, because many hazardous side effects accompany the use of these drugs, including death. There are several major classes of psychotropic drugs: antipsychotics such as Risperdal and Haldol, anti-depressants, and anti-anxiety medications. Due to the dangers associated with their use, the FDA issued a black-box warning for anti-psychotics, warning consumers of the increased risk of death for those with dementia, as such drugs have not been approved for this use. Dangerous side effects include, but are not limited to, excessive sedation, weight loss, heart attack, stroke, delirium, agitation, and increased risk of pneumonia.
Despite knowing and understanding the dangers such drugs pose to residents, they are still administered to sedate residents, particularly in facilities that are understaffed or those that have caregivers who are not qualified or trained. Advocacy group CANHR compiled a database of the nursing homes located in California, and each facility’s rates of psychotropic drug use. Therefore, consumers and their loved ones may find such information particularly useful when conducting a search for nursing homes, as this data may help consumers find a facility without a drugging issue.
The Department of Health and Human Services Office of Inspector General (OIG) released a report in 2011 finding that antipsychotic drugs given to elderly residents of nursing homes were not administered in compliance with standards set forth by the Center for Medicare and Medicaid Services (CMS). Such medications, when used properly, can be effective in aiding a patient’s mental and physical well-being. However, unnecessary antipsychotic drug administration is dangerous and not appropriate in the care of the elderly. Unnecessary drug administration practices may include excessive dose administrations, drugs provided in excessive durations, lack of adequate monitoring, or the administration of drugs in the presence of adverse effects which show the dosage should be lowered or discontinued. It has been found that improper or excessive administration of antipsychotic drugs may not only result in death but may lead to unnecessary hospitalization, falls, heart attacks, strokes, and other complications.
Unfortunately, because many elderly nursing home residents currently suffer from dementia, there has been a growing concern that antipsychotic medication has been administered inappropriately to control behavioral problems related to dementia. To combat this issue, CMS launched a National Partnership to Improve Dementia Care in 2012 with the goal of protecting the elderly receiving dementia care in nursing homes and other healthcare settings. Specifically, the partnership sought to protect against unnecessary antipsychotic drug use unless there was a valid, clinical purpose. The partnership also sought to encourage nursing homes and others providing dementia care to consider non-pharmacological alternatives for the elderly.
Johnson & Johnson initiated a product recall of their antipsychotic drug, Risperdal Consta, on Wednesday due to mold contamination of their product. Risperdal Consta is an antipsychotic medication that has been approved for use in patients with bipolar 1 disorder and schizophrenia. It should be noted that this recall only impacts the injected drug Risperdal Consta, and not the oral pill medication Risperdal.
While the company has stated that the risks to patients are low, patients should be aware that the effects of using the contaminated product include reactions or infections at the injection site. Additionally, those who have compromised immune systems may also be at risk of developing a systematic infection. The elderly are a particularly vulnerable population, and caregivers must be cautious and vigilant in ensuring that the elderly patients taking Risperdal Consta are not administered a contaminated batch.
When nursing homes neglect to monitor medications properly due to a lack of time or a disruption in their communication, elderly residents suffer the consequences by having to be admitted to the hospital for an adverse drug reaction. Such has been the case in many nursing homes, and many residents have continuously been victimized. The attorneys at the Law Offices of Ben Yeroushalmi believe that your loved ones deserve attentive, high quality care. If you believe your loved one is a victim of elder abuse or neglect, call us immediately at (888) 606-3453 so that we may work together to put an end to elder abuse and neglect. With offices in both Northern and Southern California, we can help you regardless of what part of the state in which you reside.
It is not uncommon for the elderly to need the assistance of multiple medications to maintain their health. However, as the number of medications being taken increases, so does the risk involved. A study conducted by the Division of Geriatric Medicine at the Saint Louis University School of Medicine finds that incorporating more inter-professional education in nursing home caretakers’ training can help reduce polypharmacy in their facilities. Such discovery is significant when it is taken into account that up to 28 percent of nursing home residents are hospitalized due to adverse drug reactions (ADR). An ADR’s mortality rate is significantly increased when the patient is taking over six medications.
The need to decrease polypharmacy is not only evident in residents’ high rate of hospitalizations, but it is also reflected in the incredible cost created by it. The study cites a cost analysis which proves that for every dollar spent on medications in nursing homes, another dollar and thirty three cents are spent on treating adverse drug reactions. It is abundantly clear that nursing facilities should have a greater interest in reducing polypharmacy in order to increase the quality of care of their residents, and to decrease the cost of care for themselves.
Enhancing communication amongst nurses, doctors, resident’s families, and staff can help them track the resident’s medications, and detect any deterioration due to polypharmacy. This allows for all those involved in the resident’s care to be more fully informed about how they can best help him or her. The study also suggests that hand counting all medications prescribed to patients from the physician’s order sheet is a more reliable way to avoid any mistakes from using an electronic log. Although this may seem more time consuming for pharmacists, it reduces the time spent on having to solve adverse drug reactions resulting from negative drug interactions later. Additionally, minimizing the number of medications prescribed also reduces medication administration time, which allows staff more time to dedicate to providing proper care and attention to each resident. Furthermore, a resident that is less medicated has a decreased risk for falls, weight-loss, and even death.
This new information-based initiative is simple and can only be made possible through the cooperation of pharmacists and nursing home staff. The Omnibus Budget Reconciliation Act of 1987 (OBRA) included a clause which demands that all certified nursing homes have pharmacy services available on location at their facilities. Therefore, all certified nursing homes already have an infrastructure of professionals which facilitates the spread of knowledge in order to promote a decrease in polypharmacy. There is also an incentive present for nursing homes to decrease medication use in order to save money and time, and increase the quality of care for their residents. This need to increase the quality of care of their residents should outweigh their desire for convenience. Sedating patients so that fewer staff is needed to care for them is a common practice at many nursing homes that value convenience over their residents’ well-being, and it constitutes a form of elder abuse.