Many U.S. Nursing Homes Practice “Off-Label Use” of Antipsychotic Drugs

Medicaid spends more money on antipsychotic drugs than any other prescription drug. Physicians are prescribing these powerful drugs in record numbers to nursing home residents in order to control their behavior, not for the treatment of psychotic illness.

It is reported that nearly 30% of the total nursing home population is receiving medication in a practice that is known as “off label use” of prescription drugs. It’s no surprise to lawyers who practice this area that studies also reveal that nearly 21% of nursing facility residents being given these drugs do not have a psychosis diagnosis.

“You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they’re out of it, and that is unacceptable,” says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York’s nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. “These drugs are being given way too much to this frail elderly population,” Dr. Teigland says.

Here at Walton Law Firm we frequently get calls from families angry at nursing providers for over-medicating loved ones. It’s usually a similar story. The family stops by the facility for a visit, only to find their loved one non-communicative and listless, and sometimes incontinent.

The Centers for Medicare & Medicaid — the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor — has “initiated a more rigorous process to oversee appropriate use of medicine,” says Chief Medical Officer Barry Straube. He says the number of nursing home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.

Dr. Straube says CMS — which both funds and oversees nursing homes — “is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications.”

High use of antipsychotics in a nursing home can be an indicator of inadequate staffing or other negligent care, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. “We know the more staffing there is and the higher quality of care, the less the antipsychotic usage,” he says.

If you have concerns that someone you know is being over-medicated contact the resident’s primary physician immediately.