Antipsychotic Drugs in Nursing Homes

Does an elderly person with dementia benefit from a drug meant to treat schizophrenia?  Is a drug that’s safe for a 25-year-old person dangerous for a 95-year-old person whose physical condition is much different?   Despite serious warnings about using these powerful medications in dementia patients, nearly 9 out of 10 times these drugs are being given to dementia patients in nursing homes. Why are doctors prescribing these medicines in such big numbers?

These are just a few of the questions raised by a government audit conducted at my request and released this week. The report has disturbing conclusions and raises more questions than answers.

The audit found that 88 percent of the powerful antipsychotic drugs being prescribed to nursing home residents with dementia carry what are called black box warnings from the Food and Drug Administration.  The warnings cite an increased risk of death in elderly patients with dementia. 

Doctors are allowed to prescribe these drugs for dementia, despite the warnings, but the expectation is that they’ll weigh the risks and benefits very carefully before doing so. 

The widespread use of these drugs raises worries about how much due diligence is conducted, especially in light of the report’s other conclusions: 22 percent of the nursing homes failed to meet federal standards on unnecessary drug use in nursing homes.  More than half of the claims for atypical antipsychotic drugs were improperly paid by the taxpayers through Medicare.

“Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” the inspector general of the Department of Health and Human Services wrote in announcing the audit results.

He’s right.  With a fellow senator, I wrote to the administrator of the Centers for Medicare and Medicaid Services, seeking a description of the agency’s actions to protect nursing home residents from unnecessary antipsychotic prescriptions and to protect the taxpayers from improper payments for these drugs. 

Over the years, working through my committee leadership positions and pressuring federal agencies, in collaboration with nursing home patient advocates and families, I’ve had success in getting government nursing home inspectors to do a better job of enforcing quality standards.  There’s also more transparency about nursing home inspection reports and quality than there was before.  The right kind and right level of medication are critical to nursing home residents’ quality of care.