NYT: Nursing Homes Use Loophole to Underreport Residents on Antipsychotics

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More than 21 percent of nursing home residents are on antipsychotic drugs, a recent investigation by the NY Times has revealed. Photo Credit: healthaffairs.org

By Hellen Zaboulani

More than 21 percent of nursing home residents are on antipsychotic drugs, a recent investigation by the NY Times has revealed.

For decades, antipsychotic drugs have been criticized, earning the derogatory nickname, ‘chemical straitjackets’.   For elders with dementia, the pills are identified as dangerous, close to doubling the possibility of death from heart problems, infections, and falls. This, however, has not stopped understaffed nursing homes from seeking out prescriptions for the sedatives to make their residents more manageable, and to keep from needing more staff to handle the elders.

Due to the risks the antipsychotic drugs pose for the elderly, the government requires nursing homes to report how many of their residents are being given the sedatives.  There is a loophole to the regulation, however.  As per the Times, nursing homes do not need to report the use of antipsychotics when administered to patients with schizophrenia or two other conditions.  The result has been that the number of residents with a diagnosis for schizophrenia has jumped 70 percent since 2012, as per an analysis of Medicare data.

In fact, today, one of every nine out of the country’s 1.1 million nursing home residents has a schizophrenia diagnosis.  In the general population, the disorder only affects about one out of 150 people.  “People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive. “It’s used to skirt the rules.”

The government designed the antipsychotic drug reporting regulation to be able to rank nursing homes and warn loved ones of which institutions may have low staffing or inferior medical care.  Unfortunately, many facilities, with money on their minds, have found a way to circumvent the reporting and retain a high ranking despite their use of the drugs on residents.  Medicare’s web page states that less than 15 percent of nursing home residents are on antipsychotics.  That number, however, is underestimated as it doesn’t include those with a diagnosis for schizophrenia.  The NY Times, using unfiltered date with the help of a patient advocacy group, estimates that actually 225,000 residents or 21 percent of nursing home residents, are on antipsychotics.  The trend for underestimating has reportedly worsened with the pandemic.

“It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” said Catherine Howden, a spokeswoman for Medicare and Medicaid Services. “We will continue to identify facilities which do so and hold them accountable.”