Doctors at nursing homes across the U.S. have written up questionable diagnoses on elderly patients in order to prescribe antipsychotic drugs that have been referred to for decades as “chemical straitjackets,” according to a feature article in The New York Times.
The paper pointed out how many nursing homes across the country are facing a worker shortage, so turning to medications that can subdue patients is one way to deal with the problem.
The paper pointed to one instance at a nursing home in rural South Carolina where a 63-year-old patient with no history of schizophrenia was prescribed Haldol, which is an antipsychotic medicine used to treat the illness. The drug is considered to be dangerous for older patients and can double their chance of death when administered the drug.
“People don’t just wake up with schizophrenia when they are elderly,” Dr. Wasserman, a former nursing home director who is now critical of the industry. “It’s used to skirt the rules.”
The paper, citing a federal oversight agency, reported that in 2018, about one-third of nursing home residents who were diagnosed with the disease had no prior history.
The Times reported that the number of patients in nursing homes on antipsychotic drugs seems to be a murky area. Medicare does not track the number of patients taking these drugs who have been diagnosed with schizophrenia.
Out of the country’s 1.1 million nursing home residents, Medicare says fewer than 15 percent of these people are on these drugs. But The Times’ investigation found that at least 21 percent of these residents are on antipsychotics.
A spokeswoman from the Centers for Medicare and Medicaid Services told the paper that it is “unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures.”
Homes that have the smallest numbers of caregivers seem to be the quickest to prescribe these medications, presumably to keep the patients sluggish and “avoid having to hire extra staff.” The report pointed out that staffing at these facilities are at their lowest levels since 1994. The industry has shed about 200,000 jobs since the beginning of the pandemic.
The NYT said that these nursing homes have been using antipsychotic drugs to control dementia patients and loopholes mean that they don’t have to record these patients, which could hurt the facility’s “quality of resident care.”
The report pointed to the case of 63-year-old dementia patient, David Blakeney, who was given several drugs that included Haldol, Zyprexa, Ambien, and trazodone while a resident at South Carolina’s Dundee Manor. The lawyer for the family said there is no evidence that the facility ever conducted a psychiatric evaluation. The facility did not respond to the paper for comment.
Blakeney went from 205 pounds to 128 and his family said that he suffered from extreme lethargy. He eventually died despite an outside doctor saying the drugs should stop being administered.
Renee Rose Shield, a professor of health services, policy and practice at Brown University School of Public Health and the author of Uneasy Endings: Daily Life in an American Nursing Home, wrote to The Times that the deeper and “more disturbing story underlying possible misdiagnosis and mishandling of medications for nursing home populations is the blame our country must take for the worsening situation of nursing home care.”
She wrote, “Deinstitutionalization put thousands into the community who were mentally ill and unable to care for themselves decades ago; they are aging. Increasing numbers of individuals with opioid use disorder join the homeless without resources and recourse in today’s nursing homes. No longer are these institutions inhabited only by the frail elderly, frequently with dementia, though they are still there. Add COVID vaccine hesitancy among staff, and the flight of staff from these positions now that mandates are ordered and the situation is more dire than ever. Try caring for these populations given this situation.”
TRENDPOST: The Trends Journal has reported on some of the disastrous decisions politicians have made when it comes to nursing homes in the age of COVID-19. (See: “NY NURSING HOME COVID DEATHS ON THE RISE,” “NURSING HOME NEGLIGENCE,” and “CANADA LOCKDOWN: NURSING HOMES’ VICTIMS OF COVID.”)