by Anthony Chicotel, CANHR Staff Attorney
1. Inappropriate use of antipsychotic drugs is finally receiving its due regard as a common and insidious form of elder abuse. The “Least Medicating” movement has made it to the U.S. Senate!
2. Senator Kohl seems to have set a one-year deadline for some “significant” progress. Let’s hope he and the Committee hold CMS to this deadline.
3. Senator Grassley raised the idea that funds from federal lawsuit settlements with pharmaceutical companies for mismarketing psychotropic drugs be used to fund provider education about non-pharmacological dementia care. Sounds like justice to me.
4. All of the Senators in attendance appeared quite upset about the misuse of antipsychotics and the squandering of Medicare and Medicaid money.
5. Dr. Jonathan Evans, president-elect of the American Medical Directors’ Association says the “firm, fixed belief” among doctors that undesirable behaviors associated with dementia require medication “is false.” Dr. Evans could not be more clear: behavioral control drugs are the wrong treatment for nearly every person with dementia. Use should be “close to zero.” The use of drugs is often the result of caregiver and provider frustration, stress, and lack of information about more safe and effective alternatives.
6. Toby Edelman of the Center for Medicare Advocacy really set the hearing into context by displaying reports from similar hearing in 1975 and 1992. The talk has been going on for generations. What are we going to do now?
7. Cheryl Phillips of LeadingAge made some excellent points about the problem is much bigger than antipsychotics in nursing homes. The drugs used to chemically restrain the elderly include anti-anxiety drugs and hypnotics. Even pain medication can be used to inappropriately sedate and subdue. And drugging happens in all care contexts, from independent living to hospitals.
8. Inspector General Levinson – who found cause for “outrage” due to the misuse of antipsychotics in nursing homes back in May – showed little passion in his testimony. He called for some modest measures to improve drug prescribing and to prevent government payments for misprescribed drugs but seemed reserved and unwilling to bring the weight of his office to bear.
9. At the end of his testimony, General Levinson indicated that the drugging problem is due to “marginal” providers who cause health care fraud and waste. Most providers, he argued, are honest and trying to take good care of their patients. I agree that the vast majority of providers are honest and trying to do a good job. The problem is that, for at least 36 years, the federal government has known that even honest providers often overprescribe antipsychotic medications in nursing homes and yet has not remedied the problem. Honest providers often have no education about non-pharmacological dementia care options and no disincentives to carefully scrutinize their prescription practices.