by Michael Connors, CANHR Advocate
This week, the HHS Office of Inspector General (OIG) issued another stunning report on the rampant misuse of antipsychotic drugs in our nation’s nursing homes. According to the OIG, nearly every nursing home record it reviewed involving antipsychotic drug use (99.5%) failed to meet federal requirements for resident assessments and/or care plans.
The OIG leaves no doubt about why it isn’t letting up on antipsychotic abuse. The report starts with this point: “Elderly nursing facility residents receiving atypical antipsychotic drugs are a particularly vulnerable population because of an increased risk of death associated with these drugs.”
The report might have been better titled Every Resident Left Behind. Its findings include:
- Overall, 373 of the 375 records reviewed for elderly nursing facility residents receiving atypical antipsychotic drugs lacked evidence to indicate that they met all federal requirements for nursing facility resident assessments and care plans.
- 99 percent of records did not contain evidence that federal requirements for care plans were met.
- Overall, 91 percent of records failed to indicate that the resident, the resident’s family, or the resident’s legal representative participated in the care plan process.
- A psychiatrist, geriatrician, or psychologist should be involved in developing care plans, given that they are the appropriate, qualified practitioners to assess the mental health conditions among residents receiving antipsychotics. However, only two care plans (out of 375!) involved such practitioners.
- Despite their responsibility to do so, physicians almost never participated in care plans related to antipsychotic use.
- Overall, of the records reviewed of elderly nursing facility residents receiving atypical antipsychotic drugs, 41 percent contained no indications that the residents received relevant interventions.
The OIG makes a few recommendations, and one of them is spot on. It says CMS must ensure that both the rate of detection and the sanctions for violations are significant enough to deter noncompliance. Unfortunately, as the report so clearly illustrates, the opposite is the case right now. Nursing homes are free to ignore the requirements because CMS almost never enforces them. Changing this reality is the number one challenge for the CMS initiative to reduce misuse of antipsychotics and improve dementia care.