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AARP Bulletin

Drug Abuse: Antipsychotics in Nursing Homes

These dangerous medications are prescribed at an alarming rate without the patient's consent

"There was a push by drug manufacturers, claiming these medications work for seniors when they knew, in fact, that it doubled their risk of death," Chicotel says.

CMS, which oversees the nursing homes that receive funding from federal programs, says it has been working to correct deficiencies in nursing facilities, including the inappropriate use of medications. The agency achieved the goal of reducing the inappropriate use of antipsychotic drugs by 15 percent over a recent two-year period, and hopes to get to a 30 percent reduction in the next few years, according to spokesman Thomas Hamilton. But Edelman points out that initial goal was reached more than a year late, and some 300,000 patients are still receiving the drugs inappropriately. Hamilton acknowledges that more needs to be done, but lack of funding from Congress is making even the most preliminary work difficult.

A better way

Fortunately, a growing number of nursing homes have begun to look for more effective — and more humane — ways to care for patients. Better training for caregivers is key: According to Cheryl Phillips, M.D., a geriatrician at LeadingAge, an organization representing nonprofit services for older people, nursing home staff can be trained to deal with behavior issues thoughtfully and creatively, without resorting to drugs.

She cites an example of a male patient who was spending his days in a noisy nursing home activity room. One day, he grew more and more agitated and tripped an aide with his cane. To calm him down, the staff took him to his private quarters. Over the following days, his behavior in the activity room became increasingly aggressive; he began randomly hitting caregivers and fellow patients. Each time, he was taken away to spend time in his room.

"The staff initially thought he had become violent and needed an antipsychotic," Phillips recalls. "But they ultimately realized that the cacophony in the activity room was stressing him out. Caregivers inadvertently rewarded him by giving him quiet time in his room, which is what he wanted. When they did it repetitively, they reinforced his aggressive behavior." Once the staff discussed the problem and began finding peaceful activities for the patient, the problem was solved — no drugs needed.

Putting patients first

Another success story is the Beatitudes facility in Phoenix, which dramatically changed its way of handling patients with dementia based on Tom Kitwood's book Dementia Care Reconsidered: The Person Comes First. "What happens here is not for our systems, our convenience, but for the people we care for," says Tena Alonzo, the director of education and research at Beatitudes. "People with dementia have disturbances in their sleep/wake cycle, so we let them be comfortable and decide when they want to sleep or eat, or not. Or how they want to spend their time," she says. As a result, patients stop resisting care, and the facility runs more smoothly.

The Beatitudes' philosophy is now being taught to a growing number of nursing homes around the country. "We've created a softer, gentler approach, acknowledging that we are not in charge of a person's life — they are. In allowing them to retain their dignity, and adopt a comfort level of care, we've had better outcomes," says Alonzo. That paradigm shift has not increased operating expenses, or required a higher staff-to-resident ratio. "We discovered that better care was better business," Alonzo says.

For Kathi Levine and her mother, these encouraging developments are coming too late. "I want our lawsuits to impact nursing homes all over the country," Levine says. "We need to protect our family members. They don't have a voice, they can't speak for themselves. So we need to speak out for them and help other people know what to look for. I want to make sure that what happened to my family doesn't happen to anyone else."

Jan Goodwin is an award-winning author and investigative journalist for national publications.

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