The Costs of Antipsychotics

There are lots of problems with the use of popular antipsychotics with nursing home residents. No medications have been approved by the FDA for behavioral symptoms of dementia. “Off-label” prescriptions of antipsychotics are common, however, with up to 60% of nursing home patients with dementia prescribed such drugs. And certainly most doctors would say that their use can be beneficial in the right circumstances. But the side effects of antipsychotics can be severe: CVA, anticholinergic effects, sedation, extrapyramidal side effects, urinary tract symptoms, falls and death.

There are multiple interventions nursing and CNA staff (who are sufficiently trained) can use in response to various behavior issues with residents in nursing facilities. Only after non-drug interventions have been exhausted should antipsychotics be considered.

Also, some common sense to just what constitutes a “behavior issue” in the first place. No, Mr. Jones’ constant wandering about the halls is not a behavior problem unless he is harming others.

My own experience from a couple of decades of nursing home advocacy work is that too often a nurse calls the doctor to say “Mr. Jones is causing us problems and we need to give him an antipsychotic.” The too-busy doctor, relying on the professional observations of the nursing home nurse, often obliges. One thing is clear: The use of antipsychotics for the convenience of the nursing home staff is called a “chemical restraint” and is illegal.

In 2011 Medicare (Part D) spent $15 billion on antipsychotics. In comparison, only $4 billion was paid to doctors for nursing home visits. Studies have shown that the more engaged physicians are with their nursing home patients, the less antipsychotics are prescribed.

So here’s an idea: Why don’t we double the reimbursement rates for doctors to see nursing home patients, and maybe the use of antipsychotics will drop in half? That way, maybe taxpayers could save a few billion dollars each year, and we could improve the quality of life for demented seniors in nursing homes to boot!

About H. Kennard Bennett

Ken Bennett is a partner in the elder law firm of Bennett & McClammer and is Founder & Team Leader at Scout Guardianship Services. He also founded and serves as Executive Director and Senior Counsel to the Center for At-Risk Elders, Inc., a public interest law firm that, among other things, operates the CARE Volunteer Advocates Program, providing guardianship services to low-income, unbefriended, incapacitated adults.

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