Abusing Drugs in Nursing Homes

[Traveling_Home]

Abusing Drugs In Nursing Facilities - Information Bulletin #222 (0807)

Thirty one years after the federal government reported to Congress about
the widespread abuse of medication to residents in nursing homes with
dangerous drugs, it is apparent that not much has changed.

Before we review the extent of this abuse, it is important to remember
that psychoactive and other drugs frequently have very serious and
irreversible side effects. They should not be prescribed or used in a
wholesale manner, unless one cares more about easing the job of the staff
than about the well-being of the residents.

While we have only anecdotal information and do not know how widespread
the practice is, we have heard reports that doctors write these
prescriptions on an "as needed" basis, so that nurses or untrained aides
decide when to administer them.

When do nursing facilities think these drugs are "needed?" Answer : when
the facilities are short-staffed, when a resident's behavior is somewhat
aggressive or when a resident is very upset, acting out, agitated -- then
sedate them with drugs.

These drugs in nursing facilities are used primarily to control behavior;
not to treat medical or psychiatric illnesses.

Prescribing doctors may not be psychiatrists and may not even see the
patient on any regular basis, which could explain why the nursing home
industry fights so hard to limit malpractice litigation that could hold
them accountable for abusing these drugs.

Anyone who regularly visits nursing facilities, or even visits them only
occasionally, sees the "zombie" look of many patients. Psychoactive and
antidepressant drugs can have that effect, sedating residents to such an
extent they just sit around and "space out." It makes running the
institution so much easier.

Here is the CMS national breakdown as of 3/07:

Re antipsychotic medications, nearly 27% of nursing home residents
were receiving such drugs regularly.

Re antidepressant medications, a whopping 52.2% are prescribed
these drugs regularly.

When will disability and older American advocates stop this abuse in your
State? When will State health departments stop it?

Is it hopeless? Will we just pretend it does not exist?

Maybe this abuse does not matter because the people in these institutions
are disabled and old?

Will this abuse never stop as long as low-income people with disabilities,
regardless of their age, are warehoused and segregated in institutions and
are invisible to the populace at large.

Here is a breakdown by State for the % of people in nursing facilities who
regularly receive Antidepressants and Antipsychotics:

Antidepressants Antipsychotics
Alabama .....................55.3% ............28.1%
Alaska ..................... 56.5% ............20.8%
Arizona .................... 51.4%. ...........26.5%
Arkansas.................... 52.4%... .........29.4%
California.................. 40.9% .. ..........26.8%
Colorado.................... 53.5%... .........23.7%
Connecticut................. 54.2%.... ........30.2%
Delaware.................... 49.7% .. ..........26.1%
D. C........................ 27.5% . ...........23.6%
Florida..................... 53.0% . ...........25.5%
Georgia..................... 51.6%... .........31.2%
Hawaii...................... 34.1% ............14.0%

Idaho....................... 59.9% ............27.2%
Illinois.....................44.6% ............33.2%
Indiana..................... 54.9% ............25.6%
Iowa........................ 52.4% . ...........22.1%
Kansas...................... 56.4% ............28.3%
Kentucky.................... 55.7% .............27.5%
Louisiana....................49.8% ............34.4%
Maine....................... 59.6% .............26.3%
Maryland.................... 47.9%. ...........22.5%
Massachus.................. 60.0%... .........30.5%
Michigan.................... 52.4% . ...........18.7%
Minnesota................... 55.2% ............23.8%
Mississippi................. 51.7% ............ 30.7%
Missouri.....................57.6% ............27.7%
Montana..................... 53.8% ............23.9%
Nebraska.....................54.8% ............25.2%
Nevada.......................43.1% ............23.7%
New Hampshire.......... 49.4% ............28.7%
New Jersey................. 54.4% ............24.9%
New Mexico............... 49.2% ............24.1%
New York .................. 42.1% ............26.3%
North Carolina............ 54.1% ............24.1%
North Dakota.............. 57.6% ............22.9%
Ohio.........................56.7% ............28.3%
Oklahoma................... 54.6% ............30.8%
Oregon.......................57.7% ............22.9%
Pennsylvania.............. . 54.3% ............24.7%
Rhode Island............... 61.2% . ...........24.7%
South Carolina............ 48.5% ...........24.9%
South Dakota.............. 53.4% ...........23.5%
Tennessee................... 58.9% ...........31.6%
Texas........................50.2% ...........29.0%
Utah.........................57.9% ............29.6%
Vermont..................... 56.9% ............29.1%
Virginia.....................50.4% ...........25.8%
Washington ................ 54.5% ............22.6%
West Virginia.............. 53.9%. ............24.3%
Wisconsin .................. 53.1% . ...........21.8%
Wyoming ................... 54.1% ............22.2%

National ....................51.2% ............26.9%

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to [e-mail] or call
215-627-7100.

[Olney Blue]

1. Do you know where Steve Gold gets his data?

[Traveling_Home]

2. Found it after all

CMS referred to in the article is the Center for Medicare & Medicaid Services

http://www.cms.hhs.gov/

I havn't look through their site for the data

Edited from "Email Steve" - still a good idea

[Olney Blue]

4. Thanks!

[Just-plain-Kathy]

3. Thank you for posting this and thank you for caring.

K&R

[emilyg]

5. Thank you.

[KT2000]

6. Tell me about it

What I am learning about the "maintenance" of people in these places is frightening.

An elderly friend in a nursing home was drugged with vicodin - she does not have pain and it has the side effect of her not being able to wake up. I was told she was dying one day - her pulse and respiration were waning. Long story short - I believe she was overdosed on vicodin. They have since taken her off vicodin and she is more awake than she has been in months. Unfortunately, her memory is now pretty much gone.

A friend was put into a nursing home. She is sensitive to chemicals and that is a real bother for homes to deal with. She was forced to take anti-psychotics - if she did not take the pills they would inject them.

A friend's mother is in a nursing home and when she asked the doctor why her non-depressed mother was on anti-depressants, the doctor said it made it easier for the staff.


A disabled cousin has been in the hospital for many months. He was put on a new medication that caused him to become agitated and agressive. He kept trying to leave the hospital. He scared other patients. I was contacted and told they were making arrangements to have him moved to a lock down state hospital.
He was having an adverse reaction!!!
They finally changed the meds and he returned to his normal self so he was not sent away.

Prescription drugs - how many have died - how many have suffered brain damage - how many are locked away in state hospitals because of adverse reactions?

[lvx35]

7. It is scary, I've worked in them and the only sane ones refuse to take their meds.

They get legal help so they don't, otherwise they try to put them in the food, hidden.

[KT2000]

8. OMG - Is that true?

Who would be liable for doing this? - the prescribing doctor or the nursing home?

[lvx35]

9. It all happens with te staff, nurses and caregivers.

Generally the doctor will prescribe something PRN without bad intent, that knocks the patient out (so they can sleep or whatever, or for agitation) When the nurses or caregivers are really overworked, they will try to get a patient to "choose" to take a PRN, to calm them down and make them less work. With certain patients who don't have it together, the nurse or caregiver may "assist" the patient to choose to take a PRN, by doing backhanded things like putting it in food hidden, often under the auspices of the patient having "trouble swallowing". Denials on the part of the patient of this can be attributed to dementia.