The Long Term Care Community Coalition placed a big lump of coal in the Centers for Medicare and Medicaid Services’ (CMS) stocking this Christmas with its excellent review of the current state of chemical restraints and resident drugging in America’s nursing homes. Over ten years have passed since CMS launched a ballyhooed Partnership to Improve Dementia Care. The central goal of the Partnership was to reduce the misuse of antipsychotics and other drugs used on residents as chemical restraints. After a slow and modest reduction in antipsychotic use during its first few years, the Partnership has withered from inattention and now chemical restraint use is at horrific levels. A recent OIG study found that eighty percent (!) of long-stay nursing home residents are drugged with at least one psychotropic.
The LTCCC report finds the following:
- The reduction in antipsychotic use since the Partnership’s start in 2012 has been minimal.
- Much of the reduction in antipsychotic use is overblown because CMS uses an ill-advised measure that exempts residents with a diagnosis of schizophrenia. As a result of this loophole, the number of residents with phony schizophrenia diagnoses has exploded in recent years.
- Whatever reductions in antipsychotic use there have been are offset by a huge increase in the use of other harmful psychotropic drugs that CMS improvidently ignored in its Partnership work.
- Chemical restraints are disproportionately used on Black residents and low-income residents.
- Regulations to prohibit drug misuse are barely enforced
The CMS Partnership was doomed to fail because nursing homes were asked to reduce their use of chemical restraints, instead of being forced to. The good work performed in the name of the Partnership from 2011-2015 was undermined by CMS’s subsequent neglect ever since. A new campaign, with real teeth, is needed if resident drugging is going to be stopped.