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Feds Target Antipsychotic Drug Use In Nursing Homes
San Diego News - Channel 10
Government Plans To Reduce Antipsychotic Use By 15 Percent By End of Year
SAN DIEGO -- The Centers for Medicare and Medicaid Services (CMS) is stepping in to stop the over-drugging of seniors by reducing antipsychotic use in nursing homes by 15 percent by the end of the end of 2012.
It's one way to attack a decades-old problem -- antipsychotic drugs given to seniors to make them more manageable.
"My first response was glory, glory, hallelujah -- that they're actually talking specific numbers," said Tony Chicotel, staff attorney for California Advocates For Nursing Home Reform (CANHR).
CANHR is one of the advocacy groups that have hounded CMS for solutions to stop the widespread misuse of antipsychotics. Chicotel was in San Diego this week, hosting a symposium on dementia care without drugs.
Antipsychotics were created to help people with schizophrenia and certain other mental illnesses, and they were not approved for treating dementia. However, studies have shown that it has been used extensively off-label to sedate seniors, even though the Food and Drug Administration warns that it can cause death in the elderly.
"Not just doctors and nurses, but everybody is accustomed to think that if we have a problem, there's a pill for that," said Jonathan Evans, M.D., president-elect of the American Medical Directors Association.
Evans specializes in long-term care, and he testified before the U.S. Senate Special Committee on Aging last November about what can be done to combat the over-drugging of seniors.
"The CMS plan is a very reasonable, albeit somewhat modest plan. But at heart, it's really an effort to try to educate people rather than to regulate," said Evans.
To reduce drugging, CMS said it will focus on three things -- enhanced training for nursing homes, alternatives to antipsychotic medication and increased transparency. In July, CMS will post each nursing home's antipsychotic drugging data online.
When 10News obtained drugging data for local facilities last year, the investigation revealed many residents taking antispychotics even though they did not have mental illness.
"The best way to predict whether or not a resident is going to get drugged is by looking at the facility's drugging rate," said Chicotel. "Some facilities have become reliant on this procedure where someone comes in, they present a certain way, and the first thing they're trained to do is to call a doctor and get an order for a drug to calm them down. Whereas in other facilities, the first response is going to be, 'What is the problem with this person? What are they communicating to us? How do we resolve that?'"
"The reason that these medicines continue is that people believe that they're doing the right thing," said Evans. "We need to show them a better way."
"I also think there's another component that's needed that hasn't been discussed a whole lot, which is increased enforcement," said Chicotel, "Increased survey and inspection with the focus being on looking at drug use."
Beside the health dangers of misusing antipsychotic drugs, there is also a financial problem. The U.S. spent $18.2 billion on antipsychotic drugs in 2011.
"Overall we're spending billions of dollars … on this one class of medicines mostly for purposes that these drugs were not intended for. And that money could be better used to provide a lot more health care for people of all ages or to do other things that are important to society," said Evans.