December 24, 2012

27 Bay State nursing homes cited over anti-psychotic use

The Associated Press

BOSTON - Massachusetts regulators rarely take action against nursing homes that use powerful anti-psychotic sedatives to control elderly residents, a newspaper has reported.

Twenty-seven homes were cited for unnecessary use of anti-psychotics between 2009 and 2011, The Boston Globe reported Sunday. Inspectors did not consider the incidents serious and the homes were not fined.

In cases citing homes, inspection reports described residents who were on anti-psychotics for months, and sometimes years, without evidence that staff tried to wean them off as required by federal law. A few reports detailed cases when residents were so overmedicated they were unable to open their mouths to eat or do much but sleep.

Federal guidelines say anti-psychotics are intended for patients with severe mental illness and a few other conditions. But many nursing homes administer the drugs more broadly to residents who punch, kick or shove others. That often includes residents with dementia, despite federal warnings about potentially fatal side effects in such patients.

Dr. Madeleine Biondolillo, Massachusetts' top nursing home regulator, said inspectors try to justify reprimands, but federal rules are ambiguous. Harm from inappropriate use of anti-psychotics can be subtle, indirect and be apparent weeks after drugs are administered, making it hard for penalties to stick if nursing homes appeal a reprimand, she said.

"I desperately want these overuse numbers to come down," Biondolillo said.

The Centers for Medicare & Medicaid Services, the federal agency that regulates nursing homes, said 425 Massachusetts facilities were cited for unnecessary drug use from 2009 to 2011. The Globe cited records it requested from the federal agency.

The most commonly cited overused medication was Seroquel, an anti-psychotic that was the subject of a 2005 U.S. Food and Drug Administration black-box warning, which is the agency's most serious medication alert, about potentially lethal side effects for patients with dementia.

Federal regulators are in the final stages of drafting guidelines that will more clearly define the approaches nursing homes must first try with agitated or combative residents, ruling out other reasons for their behavior such as infections, hunger, thirst, or pain before using anti-psychotics.

Biondolillo's agency is writing dementia care regulations, to go into effect by April 1, requiring improved training for Massachusetts nursing home staff to use alternative techniques to calm agitated residents without using anti-psychotics.


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