Regulators Release New Guidelines to Reduce Antipsychotic Use for Residents Living with Dementia

Antipsychotic drugs are sometimes given to patients living in nursing homes to calm behaviors associated with dementia and Alzheimer’s. But for decades, staff have been wrongfully using the powerful medications as a crutch-to-caregiving to make these patients easier to handle. Antipsychotic drugs can be especially dangerous when used without the patient’s physician or family’s knowledge or consent, a haphazard tactic given that the mismanagement and misuse of these drugs have been known to cause sudden death and drastically decline a person’s well-being.

Some of the most widely used antipsychotic drugs used in nursing homes today include:

  • aripiprazole (Abilify)
  • clozapine (Clozaril)
  • haloperidol (Haldol)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)

The misuse of these dangerous drugs is also known as chemical restraint. After several attempts to resolute the issue through programs, regulations, reviews, education and awareness, the problem continues to be revisited.

Fact: Nursing Homes Should Avoid Antipsychotic Drug Use

Just this month, the Substance Abuse and Mental Health Services Administration (SAMHSA) along with the Centers for Medicare & Medicaid Services (CMS), the Health Resources & Services Administration (HRSA), and the Administration for Community Living (ACL) released guidance on the inappropriate use of antipsychotics for older adults and individuals living in nursing homes and other care facilities. This guidance is intended primarily for physicians as well as support staff, administrators, and caregivers working with people with dementia and persons with intellectual and developmental disabilities in community settings.

The new publication mimics similar guidelines released in 2016, by the American Psychiatric Association. This comprehensive “Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia” documented evidence that antipsychotics use can be harmful to people with dementia and concluded that:

  1. Antipsychotic medications should be avoided when possible.
  2. Dosages should be started as low as possible with modest increases only when necessary.
  3. Second generation antipsychotics are preferable over first-generation antipsychotics due to more favorable side effect profiles.
  4. Medications should be discontinued if no clinical benefit is observed.
  5. Discontinuation may need to be considered for those who experience side effects even if there is an improvement in behavioral symptoms.

These types of drugs have a heavily sedating effect and are also known to have severe side effects, including in some cases causing potentially lethal cardiac issues, increase risks of stroke, diabetes, wandering and fatal falls.

History Showcases Concerns of Antipsychotic Drug Abuse

Since at least the mid-80s, consumer interest groups have pushed to curtail the use of antipsychotic drugs in nursing home residents with dementia. But the issue has continued to grow rampant, especially with such a drastic increase in a large aging population relying on understaffed and underfunded nursing homes to manage and care for their memory type diseases.

More recent highlighted movements in the fight against the problem start in 2008, when the Food and Drug Administration (FDA) issued an advisory and black box warning that “the treatment of behavioral disorders in elderly patients with dementia through the use of antipsychotic medications is associated with increased mortality.”

Just four years later, The Centers for Medicare & Medicaid Services (CMS) announced a partnership to improve dementia care after CMS data showed that in 2010 more than 17 percent of nursing home patients had daily doses of the mind-altering medications exceeding recommended levels and that almost 40 percent of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point, even though there was no diagnosis of psychosis.

Advocates were excited but still skeptical about the initiative which focused on three areas of improvement.

  1. Enhanced training: CMS has developed Hand in Hand, a training series for nursing homes that emphasizes person-centered care, prevention of abuse, and high-quality care for residents. CMS is also providing training focused on behavioral health to state and federal surveyors;
  2. Increased transparency: CMS is making data on each nursing home’s antipsychotic drug use available on Nursing Home Compare starting in July of this year, and will update this data;
  3. Alternatives to antipsychotic medication: CMS is emphasizing non-pharmacological alternatives for nursing home residents, including potential approaches such as consistent staff assignments, increased exercise or time outdoors, monitoring and managing acute and chronic pain, and planning individualized activities.

The partnership goal was to achieve a 15 percent reduction in the use of antipsychotic drugs in nursing home residents by the end of the same year. Although many of the program’s initiatives influenced conversations with nursing home leaders and prescribing physicians, unfortunately, the goal was not successfully met and an estimated 250,000 vulnerable individuals are still being given the drugs, according to a report published by the Long Term Care Community Coalition (LTCCC).

Will 2019 Be the Year for Heavier Regulation and Change?

Latest moves to battle the issue came from CMS and erupted with a more formal announcement from Administrator Seema Verma. In April of 2019, CMS began a review of regulations and processes governing safety and quality of care in the nation’s nursing homes, including the misuse of sedative type drugs.

“Too often, residents with dementia-related psychosis have been deemed to be unruly or difficult, and have been given antipsychotic sedative drugs in contravention of FDA guidelines.” Verma said in a released statement. “We’ve begun imposing stricter sanctions like denying payment for new admissions and per-day Civil Money Penalties on late adopters that have a history of noncompliance with our rules related to chemical restraints, dementia care, and psychotropic drugs, and have been determined in a current survey to be out of substantial compliance with those requirements.”

But until nursing home funding is strengthened and enforcements stick with regulators, facility administrators, and owners, and the issues related to understaffed, overworked, underpaid and sometimes undertrained dementia care workers is truly addressed, the nursing home abuse and neglect attorneys at Levin & Perconti are more committed than ever to seek justice on behalf of your loved one who is being abused by the use of antipsychotic medications.

In the meantime, caregivers should be sure to ask questions about how these drugs are being used to manage their loved ones conditions and contact an Illinois Long-Term Care Ombudsman and an attorney with any concerns.

Levin & Perconti: Attorneys for Nursing Home Residents with Dementia

If someone you love is being given, or has been given, antipsychotic drugs and has been injured as a result, please contact the Chicago nursing home abuse and neglect attorneys of Levin & Perconti. For nearly three decades we have successfully defended the rights of the elderly against nursing homes that feel drugging a resident to make their job easier is a best practice.

Let us help you and your loved one receive the justice deserved. Call us now (312) 332-2872 or complete our online case evaluation form for a FREE consultation with one of our nursing home abuse attorneys.

Also read: Nursing Home Workers Steal From Dementia Patient