James M. Berklan, McKnight's Editor

If you were beginning to worry that some of long-term care’s most prominent needlers had forgotten to show up for work for most of the last year, you weren’t alone. Good news: They’re OK and feeling back to their old selves. And it looks like they’ve recruited a new crony.

U.S. Sens. Herb Kohl (D-WI) and Charles Grassley (R-IA) filed an amendment to an existing bill Tuesday and it could have significant implications for long-term care operators. The new measure takes on institutional caregivers’ apparently overzealous use of antipsychotic drugs on nursing home residents. Sen. Richard Blumenthal (D-CT) hopped along on the headline as a co-filer.

Kohl and Grassley, of course, are current and past chairmen of the Senate Special Committee on Aging, respectively. But it seems like eons since either of them has done anything too headline-worthy as far as long-term care goes. You notice when they make a big move. Each has stuck up for providers on occasion in the past. But those instances have been outpaced by the number of whacks they’ve taken at the piñata called the institutional caregiver.

It’s never too late to take out the stick again, as Tuesday’s announcement showed. It’s not necessarily a drastic or unexpected step. Last year, government reports showed that large numbers of providers were using antipsychotics for off-label uses or apparently to sedate too many residents with dementia. You knew it was only a matter of time before the vote-seekers became involved in a big way.

“We need a new policy that helps to ensure that these drugs are being appropriately used to treat people with mental illnesses, not used to curb behavioral symptoms of Alzheimer’s or other dementias,” said Kohl in an announcement publicizing Tuesday’s action. The overuse of psychotics puts residents at risk and costs taxpayers hundreds of millions of dollars each year, he added.

“Alarming” is how Grassley characterized reports about antipsychotic overuse. The amendment is designed to give residents and their family members more say in decisions about the prescribing of antipsychotics and other drugs.


The amendment was attached to S. 3187, the Food and Drug Administration Safety and Innovation Act. It would require the Health and Human Services Secretary “to issue standardized protocols for obtaining informed consent, or authorization from patients or their designated healthcare agents or legal representatives, acknowledging possible risks and side effects associated with the antipsychotic, as well as alternative treatment options, before administering the drug for off-label use.”

Last year, the Office of the Inspector General issued a report showing that over a six-month period, 14% (305,000) of the nation’s 2.1 million elderly nursing home residents had at least one Medicare or Medicaid claim for atypical antipsychotics.

The damning evidence piled up, as investigators also noted, among other eyebrow-raisers, that more than half of 1.4 million claims for atypical antipsychotic drugs didn’t comply with Medicare filing criteria.

Now that they’re back from the shadows (rescued from over-prescriptions of antipsychotics themselves?) the senior Senators are pushing for change. Kohl previously announced he will not run for re-election, so this might wind up being a good farewell shot.

Funds from settlements, penalties and damages awarded in cases involving off-label marketing of prescription drugs would pay for a prescriber-education program called for in the bill.

We’re not sure of the amendment’s chances of passage. But we do know it’s could be a lively run, now that the Honorable Sens. Kohl and Grassley are back in the picture.