Human Rights Group Alleges Rampant Unnecessary Drug Use in SNFs

Human Rights Watch (HRW), a non-governmental organization that publishes reports and briefings on human rights conditions in about 90 countries, on Monday released a report estimating that more than 179,000 people in U.S. nursing facilities are inappropriately given antipsychotic drugs.

“The drugs’ use as a chemical restraint — for staff convenience or to discipline or punish a resident — could constitute abuse under domestic law and cruel, inhuman, and degrading treatment under international law,” the report said.

The skilled nursing industry pushed back strongly against HRW’s characterization.


“This report does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications, with more than half of our members achieving at least a 30% reduction,” Dr. David Gifford, the American Health Care Association’s senior vice president of quality and regulatory affairs, said in a statement released by the long-term care association. “Of course there is more to be done.”

The Centers for Medicare & Medicaid Services (CMS) has reported a significant drop in the national prevalence of antipsychotic use, with a 34.1% decline from the start of the reduction initiative in the fourth quarter of 2011 to the end of the first quarter of 2017. In addition, skilled nursing facilities that still have high rates of use must achieve a 15% reduction by the end of 2019, using the baseline rate for the fourth quarter of 2011. But the recent efforts to curb nursing homes’ use of antipsychotic drugs have not halted the problem of forced and inappropriate use of the medications. the HRW report said.

The organization based its report on visits to 109 nursing facilities in six states. HRW  also used 323 interviews with people living in the facilities, their families, and staff, as well as government officials, experts, and advocates active in the long-term care and disability spaces.


In many cases, facilities administer the drugs without obtaining the informed consent of residents or their families, according to HRW.

“Antipsychotic drugs alter consciousness and can adversely affect an individual’s ability to interact with others,” the report said. “They can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there.”

The report highlighted several areas of concern, including:

-Failure to enforce the right to be fully informed, to refuse treatment, or to require free and informed consent

-Lack of minimum staffing regulations

-Weak enforcement of federal regulations that specifically ban unnecessary drugs or chemical restraints

“The practicalities of obtaining consent from an older person with dementia can be fraught,” the report said. “However, in many of the cases Human Rights Watch documented, nursing facilities made no effort to obtain meaningful, informed consent from the individual or a health proxy before administering the medications in cases where it clearly would have been possible to do so.”

The report called for CMS and other government agencies to use the regulatory and enforcement tools at hand to end routine violations of regulations on inappropriate drug use. HRW also recommended that CMS and others ensure adequate staffing levels; boost enforcement of care planning requirements; and require nursing facilities and resident doctors to seek free and informed consent before the administration of antipsychotics.

But nursing facilities aren’t the only place to focus on, at least one study has found. Researchers with the University of Iowa found that almost 20% of antipsychotic prescriptions were initiated in hospitals, while many others were continued from other settings.

“A critical next step is finding ways to engage hospitals and other health care providers in this effort, since a significant number of patients enter our facilities already on these medications,” Gifford said in AHCA’s statement.

Written by Maggie Flynn

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