As pressure mounts CMS (the Center for Medicare and Medicaid Services) announced a partnership to improve dementia care in the US. They are partnering with providers, caregivers, patients to ensure appropriate use of antipsychotic medications.
They say they want to “ensure appropriate care and use of antipsychotic medications for nursing home patients.” Their first goal is to reduce use of antipsychotic drugs in nursing home residents by 15 percent by the end of 2012.
How bad is the problem? On an national level “unnecessary antipsychotic drug use is a significant challenge in ensuring appropriate dementia care. CMS data show that in 2010 more than 17 percent of nursing home patients had daily doses exceeding recommended levels.” “A CMS nursing home resident report found that almost 40 percent of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point in 2010, even though there was no diagnosis of psychosis.
In Texas has been much, much worse. ”A 2003 DADS,” Texas Department of Aging and Disability Services, “review of the medication administration records of Texas nursing facility residents 65 years and older found that 28.9% of residents had taken an antipsychotic in the preceding week, 18.7% had taken an anti-anxiety medication, and 8.5% had taken a sedative/hypnotic. Texas residents were prescribed these medications at rates 1.2, 1.7 and 3.0 times greater than the corresponding national averages. Among residents taking antipsychotic medications, 37.5% had no clinical indication that met widely accepted criteria (e.g., OBRA-87) for appropriate use. In the absence of persuasive evidence that Texas nursing facility residents have greater needs for psychotropic medications than LTC residents elsewhere in the United States, there is reason for concern regarding the appropriateness of psychotropic medication use in Texas LTC. “
Companies have been fined. Abbott Labs was fined 1.6 billion dollars and Eli Lilly was fined 1.4 billion dollars for illegally marketing these drugs for use with dementia patients but in 2010 antipsychotic drugs racked up more than $16 billion in sales, according to IMS Health. In my opinion, a fine of 3 billion dollars compared to a 16 billion dollar annual sales is a drop in the bucket. A recent report by pharmacy benefits manager Medco estimated that the prevalence of the drugs’ use among adults ballooned more than 169 percent between 2001 and 2010.
The Boston Globe did a great series and have published data of antipsychotic use for every nursing home in the country that treats patients with these drugs. If you are looking for a nursing home I highly recommend paying the 99 cents for a one month subscription to the Boston Globe so you can have access to their database (access the database here).
What is CMS going to do about this problem?
CMS, industry and advocacy partners are taking several steps to achieve the goal of improved care:
- Enhanced training: CMS has developed Hand in Hand, a training series for nursing homes that emphasizes person-centered care, prevention of abuse, and high-quality care for residents. CMS is also providing training focused on behavioral health to state and federal surveyors;
- Increased transparency: CMS is making data on each nursing home’s antipsychotic drug use available on Nursing Home Compare starting in July of this year, and will update this data;
- Alternatives to antipsychotic medication: CMS is emphasizing non-pharmacological alternatives for nursing home residents, including potential approaches such as consistent staff assignments, increased exercise or time outdoors, monitoring and managing acute and chronic pain, and planning individualized activities.
These efforts will help achieve the 15 percent reduction goal by the end of this year. In addition, to address this challenge in the long-term CMS is conducting research to better understand the decision to use or not to use antipsychotic drugs in residents with dementia. A study is underway in 20 to 25 nursing homes, evaluating this decision-making process. Findings will be used to target and implement approaches to improve the overall management of residents with dementia, including reducing the use of antipsychotic drugs in this population.
The Big question is, can you or your loved one stay in at home and not move to an institution where these abuses occur? I have a blog that can help you look at many of the questions you will want to ask, here. Realize that Medicare only pays for some of the care that people need to stay in their homes and they are getting more restrictive on what they will cover. There are other resources to assist in keeping us in our homes as we age and that is private duty home care. BrightStar specializes in this kind of care and we would be honored to be able to help you or a loved one.
All of our services are personalized to fit the specific needs of the client. We work with clients and their families to design a customized care plan, and we match each client with a qualified, pre-screened caregiver.
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