Nursing Home Association Defends Drugging of Residents

By Mike Connors, CANHR Advocate

In a certain sign that nursing homes are beginning to worry about their indiscriminate drugging practices, a California nursing home association launched a new web page last week that denies residents are being inappropriately drugged. The California Association of Health Facilities (CAHF), a trade group that represents hundreds of California nursing homes, says its new web page will help consumers understand the use of psych drugs in nursing homes. If you find blind assurances helpful, this is the site for you.

Don’t worry, CAHF tells us, the frequent news stories about nursing home residents being drugged into submission are “misleading and exaggerated.” It appears unconcerned that 25,000 California nursing home residents are drugged each day with antipsychotics that nearly double their risk of death. CAHF says “Physicians who prescribe psychoactive medications carefully weigh the dangers against the individual benefits and try non-phamacological measures first whenever possible.”

CAHF offers no information or evidence for its blanket endorsement of doctors, and ignores voluminous studies that document nursing home misuse of antipsychotic drugs to chemically restrain residents. It also ignores a recent series of 11 investigations by the California Department of Public Health targeting nursing homes that were suspected of misusing antipsychotic drugs. Each investigation focused on a single resident who was being given multiple antipsychotics.

In January 2011, the Department of Public Health presented a webinar to CAHF on drugging with the following information about the 11 investigations:

  • On average, five drugging violations were cited per investigation;
  • 54 percent of the investigations found that residents were inappropriately drugged with multiple antipsychotics;
  • 54 percent of the investigations found that consultant pharmacists failed to identify that individual residents were inappropriately given multiple antipsychotics;
  • 64 percent of the investigations found care plan violations regarding the use of antipsychotics;
  • 27 percent of the investigations found violations of informed consent.

Although CAHF is always quick to claim it cares about nursing home residents, it apparently doesn’t care enough to actually confront the pervasive misuse of antipsychotic drugs to sedate and subdue them.

The CAHF site includes a page titled “What Physicians Have to Say.” It would be more accurately labeled “What One Physician Has to Say,” since it is a defense of nursing home drugging practices by a single doctor, Dr. Karl Steinberg.

Dr. Steinberg claims that most long-term care providers do not use antipsychotic drugs indiscriminately, but like CAHF, he offers no evidence to support his view. He acknowledges that “scientific evidence does not support the use of antipsychotics for the diagnosis of dementia with agitation on a large scale basis,” yet expresses no awareness or concern that California nursing homes are giving antipsychotic drugs to 25,000 residents a day, a virtual tidal wave of drugging. As we have noted before, some California nursing homes are giving antipsychotic drugs to 100 percent of their residents.

Contrary to CAHF’s website, Dr. Steinberg is not the voice for physicians on the drugging epidemic. Here is what leading physicians and psychologists have to say:

“There’s a bunch of problems, not least of which is those drugs (antipsychotics) can kill you. Whether you have Alzheimer’s or not, there’s a reason people get frustrated or upset — pain, urinary tract infections, hunger, fear of strangers or loud noises or strange settings, maybe drug interactions. If you figure that out, you likely can find a safer, nonpharmacologic treatment.” Dr. Mark Kunik, M.D., M.P.H., Baylor College of Medicine, Nursing Homes are Seeking to End the Stupor, Minneapolis Star Tribune, December 4, 2010.

“Doctors are just giving it (antipsychotics) out like candy and nurses are administering it without any knowledge of what to look out for. And they’re being prescribed for behavioral problems – things like ‘resisting care. It’s like they’re being drugged to quell the behavior instead of someone investigating why the behaviors are happening and coming up with a more humane approach. It really does boil down to what some believe is convenience.” Dr. Kathryn Locatell, M.D., Drugs Used at Kern Nursing Home Can be Deadly for Elderly, The Bakersfield Californian, February 20, 2009.

“There’s almost always a better way to control disruptive behavior in someone with dementia than with drugs.” John Brose, Minneapolis psychologist, People with dementia getting drugged rather than helped, Minneapolis-St. Paul Star Tribune, March 9, 2008.

“…you have probably got 15,000 elderly people in nursing homes dying each year from the off-label use of antipsychotic medications for an indication that the FDA knows the drug doesn’t work…With every pill that gets dispensed in a nursing home, the drug company is laughing all the way to the bank… We’ve got so many clinical trials that show these drugs don’t work … it is like malpractice to be using it.” Testimony of David Graham, M.D., M.P.H., FDA drug safety expert, at February 13, 2007 hearing of the House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations: The Adequacy of FDA Efforts to Assure the Safety of the Drug Supply.

“These antipsychotics can be overused and abused, and there’s a lot of abuse going on in a lot of these places.” Dr. Johnny Matson, professor of psychology, Louisiana State University, Doctors Say Medication is Overused in Dementia, The New York Times, June 24, 2008.

“Many physicians are absent without leave in the nursing home and don’t take an active role in the assessment of the patient.” Dr. William Smucker, M.D., member of the American Medical Directors Association. Doctors Say Medication is Overused in Dementia, The New York Times, June 24, 2008.

“You’ll always have doctors say there’s nothing else to use but atypicals (antipsychotics), and I agree there are a small minority of patients where you need to use these drugs. But not in the numbers we are using them.” Dr. Louis Mudannayake, M.D., Dementia Relief, with a Huge Side Effect: The Off-Label Use of Some Drugs is Helping Elderly Patients but May be Killing Thousands, St. Petersburg Times, November 18, 2007.

“We need to radically alter the way we look at the challenging behavioral expressions so commonly seen in people with dementia. As I will relate, our biomedical approach is inadequate to the needs of our rapidly increasing population living with dementia, and it compromises the well-being and personhood of millions of people around the world. It is only through a radical transformation of our system and approach to care that we can hope to turn the tide.” Dr. G. Allen Power, M.D., FACP, from his book, Dementia Beyond Drugs, Changing the Culture of Care, 2010, by Health Professions Press

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