Antipsychotic drugs are dangerous for older people with dementia. However, their use is rampant among nursing home residents with dementia because of a loophole allowing most of nursing homes' antipsychotic prescriptions to go undisclosed by the government, according to an investigation The New York Times published Sept. 11.
For older people with dementia, antipsychotics nearly double their chance of death from heart problems, infections, falls and other complications. Because of this, nursing homes must report to the government how many of their residents are taking these drugs.
There's an exception, though: nursing homes don't have to include antipsychotic prescriptions on their public records if they are prescribed to patients who have been diagnosed with schizophrenia, Tourette’s syndrome or Huntington’s disease. The rationale is that nursing homes shouldn't have to report antipsychotic prescriptions for these conditions since the drugs were approved to treat them.
The share of nursing home residents diagnosed with schizophrenia had increased by 70 percent since 2012, the year the government began requiring nursing homes to report antipsychotic prescriptions, according to Medicare data.
The investigation found that 1 in every 9 nursing home residents has been diagnosed with schizophrenia. It also found that at least 21 percent of nursing home residents are taking antipsychotics.
Geriatrician and former nursing home executive Michael Wasserman, MD, and other advocates for nursing home residents argue nursing homes, which are chronically understaffed, are using the sedatives as a stand-in for adequate staffing.
"People don’t just wake up with schizophrenia when they are elderly," Dr. Wasserman told The New York Times. "It's used to skirt the rules."
Studies have shown that the more understaffed a nursing home is, the more its residents receive antipsychotic drugs, suggesting the medication is being used to subdue patients who need frequent monitoring instead of hiring more staff.
A CMS spokesperson said the agency is "concerned about this practice as a way to circumvent the protections these regulations afford."
"It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures," the spokesperson said. "We will continue to identify facilities which do so and hold them accountable."