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Nursing Home Residents Receive Psychotropic Medication

Those strategies appear to have worked, with antipsychotic drug use in nursing homes decreasing from 31 percent in 2011 to 22 percent in 2019, according to the new report.

But as antipsychotic use declined, another category of psychotropics — anticonvulsants, typically used to treat epileptic seizures — surged, with the proportion of residents prescribed them jumping from 28 percent in 2011 to 40 percent in 2019. This growth left overall use of psychotropic drugs unchanged.

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“Even though the government is taking action, the problem remains,” Brian Whitley, a regional inspector general for the Department of Health and Human Services and coauthor of the report, told AARP. “It’s just morphed, like a balloon — when you put pressure on one part of a balloon, the other part of the balloon gets bigger,” he added.

While antipsychotics have been its main focus, CMS has acknowledged that anticonvulsants and other psychotropic medications also carry major risks. It’s said that the use of other psychotropic medications “should not increase when efforts to decrease antipsychotic medications are being implemented.” And it stepped up penalties for nursing homes that needlessly prescribed psychotropic drugs, from 3,415 citations in 2011 to 4,321 citations in 2019, the report found. But overall use of all psychotropic drugs remained unchanged over that time.

“This report further indicates that nationwide efforts at provider education, along with current regulatory enforcement processes, have been largely ineffective in changing this dangerous practice,” said Jonathan Evans, a geriatrician and former head of Geriatric and Palliative Medicine at the University of Virginia, in a statement. “Clearly, a different approach is called for.”

Prescribing drugs to compensate for understaffing

Understaffed nursing homes have often been criticized for using psychotropic drugs as an alternative to hiring more staff to care for residents. The inspector general’s findings support that critique.

Analyzing data from 2019, the report found higher use of psychotropic drugs in nursing homes with lower levels of registered nurses (RNs). In facilities that had RNs on staff for 15 minutes or less per resident per day, 81 percent of residents had claims for psychotropic drugs. At nursing homes that had RNs on staff for more than one hour per resident per day, 75 percent of residents had claims for psychotropic drugs.

“Substituting inappropriate drugging for appropriate staffing is unacceptable,” Lori Smetanka, executive director for The National Consumer Voice for Quality Long-Term Care, said in a statement. “Sedation as a method of care management instead of investment in better pay and training to recruit and maintain safe staffing levels is further evidence many nursing home owners put profits over the well-being of residents in their care.”

CMS has proposed establishing a national minimum staffing requirement, which AARP supports, that could mandate certain amounts and types of care per resident in the nation’s nursing homes. But the specifics are not expected to be announced until spring, following a study to determine the level and type of staffing needed.

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