Donut hole dangers

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Mary Gustafson, McKnight's Staff Writer
Mary Gustafson, McKnight's Staff Writer

It's well established that nursing home residents frequently struggle with conditions such as heart failure and depression. It's also true that critics of nursing home care are quick to blame these conditions on substandard care.

However, a study published this week links the so-called Medicare Part D “donut hole” to high rates of seniors deciding to forego antidepressants and medications that treat heart failure.

Researchers from the University of Pittsburgh studied spending trends of 22,000 Medicare beneficiaries diagnosed with depression and found that beneficiaries' use of antidepressants dropped roughly 12% when they reached the donut hole — or gap — in their prescription drug benefits. (Click here for a quick definition of the “donut hole.”)

In this group, 3,000 people had supplemental plans that covered generic drugs only, and 11,500 had full drug coverage from other sources, such as low-income subsidies, according to Reuters. But beneficiaries who had no additional coverage ended up not filling their prescriptions. The number of heart failure medications filled by these beneficiaries fell 13%, while prescriptions for diabetes drugs fell 13.4%, according to study authors.

The researchers, led by Yuting Zhang, Ph.D., looked for consequences of foregoing such medications, but did not find higher hospitalization rates in this group. While withdrawal symptoms from stopping antidepressants might not result in a hospital admission, they can still take a toll on that individual's quality of life. If a patient's depression (or diabetes, or cardiovascular health) is not well managed, chances are the individual will face an uphill battle if he or she is eventually admitted to a long-term care facility.

Health policy analysts told Reuters that the Affordable Care Act is on track to close the donut hole by 2020 and that it's already providing some relief, but, “Right now what's happening is that some people say, 'I can't afford these drugs,' so they stop taking them. So they never really reach the threshold (to receive help) because they stop taking the drug," according to Georgetown University's Jack Hoadley, Ph.D.

Critics of nursing homes are quick to blame facilities for exacerbating chronic conditions such as depression and heart failure, but clearly, these illnesses can get out of hand long before admission to a facility. For this population, admission to a nursing home might be their best shot for getting relief from these chronic conditions, because one this is sure: 2020 is a long way off.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.


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