What factors are associated with high antipsychotic use in nursing homes? A recent study analyzed contributory factors by reviewing a number of prior studies. Here is a list of some of the factors associated with higher antipsychotic usage:
- Smaller facilities
- Not part of a chain
- Lower RN and CNA staffing [drugs in lieu of staff?]
- Higher LVN staffing [nurses who administer drugs]
- Presence of dementia or other special care unit
- High percentage of Medicaid residents
- High percentage of minority residents
- Low occupancy rate
- High number of deficiency citations
Of the factors examined in the study, the most troublesome is the presence of dementia or other special care units. One would hope the staff of such units would have special training in non-drugging interventions to deal with residents’ expressions of distress and discomfort. If these units are more prone to using antipsychotics, the residents and their families have to be wondering what they are paying (likely, a premium) for. Drugging residents is a sign of low quality, not specialized care. The fact that specialized units are more likely to drug residents indicates these units take advantage of poorly informed consumers, convincing them they are receiving better care when they really are receiving ugly, antiquated care.
While not part of this particular study, the greatest factor associated with high antipsychotic use is the culture of the facility; i.e., how management leads and how staff are trained to address unmet needs and create a comforting and vibrant environment. Antipsychotic use is driven up or down by a facility’s basic approach to how it treats people, anticipates their needs, and enriches their lives’ meaning.