Inappropriate Use of Antipsychotics at Nursing Homes Remains High as Citations Fall: House Report

Though about 2% of skilled nursing facility residents in the U.S. qualified for some form of antipsychotic drugs in the fourth quarter of 2019, about 20% of residents were receiving some form of antipsychotic medication, according to a new report from the House Ways and Means Committee Majority.

The report was released Tuesday and initially covered by NPR.

The new analysis gave an overview of citations related to inappropriate antipsychotic use, using data from the Centers for Medicare & Medicaid Services (CMS) and the Kaiser Family Foundation (KFF).

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Between 2015 and 2017, citations for the misuse of antipsychotics in SNFs rose by 200%, but dropped by 22% from 2017 to 2018, according to the report, as the Trump administration rolled back regulations implemented in the Obama administration designed to crack down on high rates of antipsychotic prescription in SNFs.

“The analysis presented in this report illustrates that, across the nation, antipsychotic citation rates have decreased dramatically since 2017,” the report said. “Nevertheless, use of antipsychotics remains high, particularly in the Northwest and Midwest, and the extent to which nursing home management may have falsified diagnoses to justify the inappropriate use of these drugs as a chemical restraint is relatively unknown.”

From 2017 to 2018, 10% of citations associated with “Actual Harm” or “Immediate Jeopardy” to resident health led to no fines, the report found. Almost a quarter of those 41 citations — out of a total of 5,704 antipsychotic citations — were associated with a fine of less than $20,000.

“The high rate of antipsychotics use across our nation’s nursing homes show that many facilities continue to resort to the use of these potentially dangerous drugs — in lieu of proper staffing — which has the potential to harm hundreds of thousands of patients,” the report concluded. “As the population continues to age and more Baby Boomers increasingly rely on institutional care provided in SNFs, it is critical that meaningful steps are taken to reduce the overuse of antipsychotics and ensure the nation adequately and appropriately addresses the needs of these vulnerable patient groups.”

The report was authored by health researchers for Rep. Richard Neal, the Massachusetts Democrat who chairs the powerful House Ways and Means Committee, NPR reported.

In 2018, the non-governmental organization Human Rights Watch issued a report estimating that more than 179,000 people in U.S. nursing facilities are inappropriately given antipsychotic drugs.

At the time, nursing home trade group the American Health Care Association noted that the SNF profession had launched an effort to reduce such medications in 2012 that led to more than half of its members reducing use by at least 30%.

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