Residents with a schizophrenia diagnosis have increased 70% since 2012 when the federal government began publicly disclosing the use of antipsychotics in nursing homes. One in nine residents in a nursing home now has a schizophrenia diagnosis. When a resident has a diagnosis of schizophrenia, that label excludes their use of antipsychotics from antipsychotic drug reporting.
A report by a federal oversight agency states that nearly one-third of long term nursing home residents with a schizophrenia diagnosis in 2018 had no Medicare record of being treated for schizophrenia. In the general population. schizophrenia affects one in 150 people. Schizophrenia is almost always diagnosed before the age of 40.
One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are receiving antipsychotic medications. According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia, Huntington’s, and Tourette’s diagnoses. The New York Times obtained unfiltered data via an open records request, and it showed that at least 21% of nursing home residents or about 225,000 residents are receiving antipsychotics.
Antipsychotic medications are dangerous for the geriatric patient with dementia. The use of antipsychotic medication for a person with dementia nearly doubles their chance of death from heart problems, infections, falls, and other ailments. The risk of giving these medications to the geriatric client is so high that nursing homes must report to the Federal government how many of the residents are receiving antipsychotic medications.
There have been reports that facilities who want a resident to get an antipsychotic medication will ask the doctor to write, “add dx of schizophrenia” even when a resident has no evidence of having schizophrenia. When schizophrenia is added as a diagnosis, it is excluding that resident’s use of an antipsychotic from the five star rating program. Nursing home residents are more likely to receive antipsychotic medications at facilities with poor staffing.
Serious problems within nursing homes can be hidden when the actual use of antipsychotic medications is under reported. Reports show that antipsychotic medications have been used when there is not enough staff to address behavioral health concerns.
Dr. David Gifford, the chief medical officer at the American Health Care Association, stated, “If physicians are improperly diagnosing individuals with serious mental health issues in order to continue an antipsychotic regimen, they should be reported and investigated.” Additional reports show that when the pandemic hit in 2020, antipsychotic drug use increased, while there was an overall drop in staffing in nursing homes.
Compliance Perspective
Issue
The use of any antipsychotic drug must be carefully evaluated prior to starting the medication. It is a concern that a geriatric resident would suddenly seem to develop schizophrenia after admission to a nursing home. The diagnosis of schizophrenia should never be used unless a qualified medical practitioner has assessed and evaluated the resident for a proper diagnosis of schizophrenia. Although antipsychotics can be effective in treating many conditions, this classification of drugs carries a risk to the geriatric resident and should be administered only when necessary. The use of antipsychotics should be monitored closely by medical and nursing staff who should communicate routinely about residents who are receiving antipsychotics, and a plan of care should be developed to gradually decrease or discontinue the use of antipsychotics when appropriate.
Discussion Points
- Review your policy and procedure for use and monitoring of psychotropic medications, to include antipsychotics, anti-depressants, anti-anxiety medications, and hypnotics. Update your policy and procedure if needed.
- Train all clinical staff on your psychotropic medication policy and procedure, including the risks and benefits of this classification of drug. Document that the trainings occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure that each psychotropic medication prescribed has a plan of care that addresses gradually decreasing or discontinuing the medication. IF decreasing or discontinuation of the psychotropic medication is not feasible, ensure that there is complete documentation of interventions that have been tried and were unsuccessful and a rationale for continuing use.
