Inspector General: Continued Use of Antipsychotics

The use of antipsychotic medications in nursing homes is not a new topic for us. Previously, we discussed the overuse of antipsychotics in nursing homes and how they cause more harm than good in most cases. The use of these drugs has been an ongoing issue in the nursing home industry as care facilities find themselves unfit to care for certain patients, or under prepared for patients with advanced dementia, Alzheimer’s, and other mental health issues. These conditions can have behavioral earmarks that  become frustrating for staff to deal with, leading to the use of chemical restraints in the form of antipsychotic drugs. 

Recently, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services conducted a study and released their findings. The study was meant to determine the results of a ten-year push for limiting the use of antipsychotic drugs in nursing homes, but the results were hardly encouraging.

The Results of the OIG Antipsychotics Study

Because of the harmful effects of antipsychotics, their overuse, and because antipsychotics can be a form of hidden abuse, the OIG teamed up with Centers for Medicare & Medicaid Services (CMS) to limit their use. The goal was to eliminate the inappropriate use of these drugs as a sedative in nursing home settings. Working with state agencies, facilities, professionals, and stakeholders, CMS sought to reduce the illegal, chemical restraint usage of antipsychotics. And they found some success. But this success was short-lived, and instead, the recent OIG report found that antipsychotics were simply replaced with “other psychotropic drugs, such as anticonvulsants and antidepressants.”

“While the use of one category of psychotropic drug-antipsychotics-decreased from 31 percent in 2011 to 22 percent in 2019 the use of another category of psychotropic drug -anticonvulsants- increased. Anticonvulsants showed an increase in use among nursing home residents from 28 percent to 40 percent during the same period.”

Additionally, while the use of antipsychotics may have seemingly dropped, there was an increase in schizophrenia diagnoses, resulting in the prescription of antipsychotics and possibly offsetting the perceived decline in antipsychotic usage

“From 2015-2019, there was a 194% increase in the number of residents diagnosed with schizophrenia without a corresponding diagnosis before their admission to the nursing home.”

Additionally, nursing homes with fewer staff and other general staffing issues were found to be the most frequent users of antipsychotics. This is just another justification for staffing regulations, or at the very least, better oversight of facilities and the industry as a whole. 

OIG Recommendations for CMS

The results of this study are shocking and confirm some of COnsumer Voice’s and industry leaders’ fears: that the issue of antipsychotics as chemical restraints were never actually addressed and continued to worsen. In light of these findings, the OIG has made the following recommendations to CMS, though CMS’s ability (financially and otherwise) to make these changes is yet to be seen.

  • Increase CMS effort to identify the illegal and inappropriate use of antipsychotics through accurate data collection.
  • Require a diagnosis code for all psychotropic medication prescriptions, especially from Medicare Part D prescribers which have not been tracked.

If you or a loved one has been the victim of neglect or abuse, call Gharibian Law (877-875-1119) today for a free consultation and the best legal representation.