Are you an advocate for someone living in a nursing home?

Are you an advocate for someone living in a nursing home? Are you a medical power of attorney for someone living in a nursing home? If so, please read this. You cannot advocate well for someone until you are well informed about standards of care. Of course this is true whether the nursing home is licensed or unlicensed, as is the case with many Sisters who receive skilled nursing care at "home."

Did you know that across our country almost one of every four nursing home residents is on an antipsychotic medication? In the majority of cases, these drugs are prescribed for elder residents who are living with dementia. These antipsychotic drugs given to persons living with dementia are being prescribed "off label." This means that the drug, approved for a particular use (psychosis, depression, etc) is being used for another purpose: to eliminate "problem behaviors."

All too often in retirement settings, persons living with dementia are seen as "having behavior problems, difficult, non-compliant, hostile, aggressive" and on and on all because staff is not trained to understand that all behavior is meaningful, and that the "problem" is not with the resident, but with the staff not yet able to understand the message or need the resident is attempting to convey. Such understanding takes time and a genuine knowledge of the resident. Thus the call for consistent assignment of those providing care.

The quick answer to "problems" in too many nursing homes is use of antipsychotic medications which, among other things, can so sedate a resident that the "problem" seems to be taken care of. Of course there are so many negative outcomes from such abusive use of powerful drugs. There are negative outcomes to every system in the body in addition to the side effects of these powerful drugs. I encourage you to Google the name of any drug below, for example, and learn its side effects.

Several years ago the Federal Drug Administration (FDA) issued a Black Box Warning in the case of several antipsychotic drugs when they are used off label for older adults with dementia. Those drugs include the following: Tinclude Compazine (prochlorperazine), Haldol (haloperidol), Loxitane (loxapine), Mellaril (thioridazine), Moban (molindrone), Navane (thithixene), Orap (pimozide), Prolixin (fluphenazine), Stelazine (trifluoperazine), Thorazine (chlorpromazine), and Trilafon (perphenazine).

Newer drugs that continue to carry the black-box warning include Abilify, Clozaril, FazaClo, Geodon, Invega, Risperdal, Seroquel, Zyprexa, and Symbyax. Source of information (accessed Oct. 9, 2012): http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/AntipsychoticMedicationQM.pdf
The Center for Medicare and Medicaid Services (CMS) reports that information covering March through December of 2011 reveal that the national average among nursing home residents who received at least one antipsychotic was 23.9%. CMS has begun an initiative to reduce this usage rate by December 31, 2012.

To emphasize the importance of correcting the abuse of overprescribing antipsychotics for nursing residents living with dementia, CMS has added this topic as one of its Quality Measures (QM). These Quality Measures are found on the CMS Nursing Home Compare website for consumers to do precisely that --- compare nursing homes based on certain quality measures. This measure will be show for nursing home inspection reports made beginning in July, 2012.
(Go to http://www.medicare.gov/NursingHomeCompare/)
As an advocate, ask questions if a doctor or nurse suggests that an antipsychotic drug is advised. What questions should you ask:

1. For what medical issue is this drug being prescribed?
   If the 'medical issue' is really what they call a 'behavior' such as agitation, restlessness, anxiety, etc. be very, very wary. This is the very abuse CMS is addressing in their new initiative to reduce the use of antipsychotics.

2.    Are there alternative ways to treat this medical issue?
3.    What are the benefits of this medicine?
4.    What are the risks of taking this medicine? (What are the side effects?)
5.    How long will the treatment last? (How long will the person be on this medicine?)
Only when you have all this information are you qualified to weight all the facts and then to give informed consent for the treatment to proceed, or informed refusal for that treatment too proceed. The resident, and you, on behalf of that resident if s/he cannot speak for him/herself, has the right to choose or to refuse treatment.