Withering report on misuse of antipsychotics in nursing homes overlooks industry efforts to improve, advocates say

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AHCA vice president David Gifford, M.D., says Human Rights Watch ignored progress already being made
AHCA vice president David Gifford, M.D., says Human Rights Watch ignored progress already being made

Those who care for the nation's seniors have been leaders in reducing the inappropriate use of antipsychotic medications in skilled nursing settings, advocates said Monday in response to a scathing Human Rights Watch report on the drugs' misuse.

"Skilled nursing providers across the country have worked tirelessly to safely reduce the unnecessary use of antipsychotic medications over the last six years,” said David Gifford, M.D., senior vice president of quality and regulatory affairs for The American Health Care Association. “This report does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications, with more than half of our members achieving at least a 30 percent reduction.”

The 157-page Human Rights Watch report, “‘They Want Docile': How Nursing Homes in the United States Overmedicate People with Dementia,” accuses U.S. nursing homes of regularly using antipsychotic medications to control the behavior of residents with dementia.

The organization estimates more than 179,000 U.S. nursing home residents are given antipsychotic drugs without an appropriate diagnosis each week. Facilities often administer the drugs without the informed consent of residents or their families.

Human Rights Watch researchers visited more than 100 nursing facilities in six states and conducted more than 300 interviews with residents, their families, staff, long-term care and disability experts and government officials for the report.

LeadingAge was among the industry experts to respond in-depth and its full answers are available as part of the appendix

“We have been and continue to be an active supporter of the movement to improve dementia care in nursing homes, which includes reducing the use of antipsychotic medications as appropriate,” a spokeswoman told McKnight's. “Many of our members are leaders in the practice of non-med management of dementia."

Though using antipsychotic medications as a “chemical restraint” is against federal law, HRW found that nursing homes that break the rules are rarely punished. The Obama administration planned to strengthen regulations around their discretionary use — including the length of prescriptions — CMS has delayed enforcement for 18 months.

“People with dementia are often sedated to make life easier for overworked nursing home staff, and the government does little to protect vulnerable residents from such abuse,” wrote Hannah Flamm, NYU School of Law fellow at Human Rights Watch. “All too often, staff justify using antipsychotic drugs on people with dementia because they interpret urgent expressions of pain or distress as disruptive behavior that needs to be suppressed.”

But a study published last month in the Journal of the American Geriatrics Society found that 36% of nursing home residents who took antipsychotics were prescribed them by a hospital or an outpatient provider.

“Skilled nursing providers will continue to collaborate with families, regulators and other health care providers to find solutions to address this issue," AHCA's Gifford said.