Getting older is a part of life. The best-case scenario for aging may be “aging in place” with family around to provide care. Modern medicine has made it possible for people to live longer, healthier lives, but in some cases, a nursing home or assisted living facility is the best choice for an aged loved one. Some conditions such as dementia or Alzheimer’s require around-the-clock monitoring and care. In other cases, families are not able to protect their loved ones against falls or provide all of the transportation or other assistance they need.
Making the choice to move an elderly parent to a nursing home is a difficult one, but once it’s made, the expectation is that your aging relative will be given the best care available. This care includes monitoring and dispensing medications as directed by a doctor and with the patient’s best interest in mind.
Unfortunately, statistics have revealed a disturbing practice: overmedication of the elderly.
Nearly 300,000 elderly patients take antipsychotic drugs such as Haldol, Risperdol, and Seroquel. Patients with Alzheimer’s or dementia may benefit from their calming effects, but in other cases these drugs are being used as “chemical restraints” to blunt behavior that staff might find difficult. Changing or adding prescriptions to an elderly person’s care requires a signed informed consent either from the patient or the patient’s decision maker. Many times patients are not able to read the forms, or the facility does not contact the decision maker. Patients may sign the forms, thinking the prescription is temporary and end up with serious side effects from long-term use. Prescribing medication without following these patient protections is illegal and unethical.
Some reports indicate unbelievable numbers of patients receiving antipsychotic medication, from 25% of patients in California to 71% in Florida. In 2014, an average of 19% of nursing home patients received antipsychotic medications, not all of them prescribed for Alzheimer’s or dementia. While useful for helping patients with memory issues and schizophrenia, the side effects are serous enough to warrant the FDA changing the label to a more serious “black box” warning.
Often patients will start taking antipsychotic medications as a response to some health emergency such as a fall or a heart attack. Once on the drugs, they stay on them, even after the crisis has passed. This extended use has been linked to increased mortality, even for patients with Alzheimer’s or schizophrenia.
Carole Herman founded the Foundation Aiding the Elderly (FATE) after her aunt was overmedicated and fell, breaking a hip and requiring rehabilitation. The rehabilitative nursing home instead prescribed the antipsychotic Haldol, and Herman’s aunt never made it out of bed, much less rehabilitation, dying of an infection from a bedsore. Herman formed her group to protect some of our most vulnerable members of society. Herman stated:
“Our [elderly] in long-term care facilities do not have a voice and FATE has been able to fill that void by speaking loud and clear for them and their families about abuses in long-term care facilities and, in particular, the overmedication of the patients in those places.”
There are other people leading the revolution in long-term elder care that does not include antipsychotic drugs. Pathstone Living’s program Awakenings in Mankato, Minnesota implemented a program of carefully selected activities, music, counseling, and other interventions with the goal of reducing antipsychotic prescriptions by 20%.
In the first year, prescriptions dropped 97%.
The key to their success? Finding out the source of the problem instead of medicating the symptoms. Staff at Awakenings gets up close and personal with patients, learning their life stories and digging into their likes and dislikes. Other therapies at Awakenings include aromatherapy, pet therapy, and anything else from other programs that successfully address the issues that arise when caring for patients with memory conditions.
Programs like Awakenings focus on treating each patient holistically instead of treating their condition. Nursing homes with high rates of antipsychotic prescriptions are often focused on maintaining order or keeping things quiet and calm. There is no excuse for overmedication, but often nursing homes who practice this unethical care are struggling to operate with very little money and staff. They may have a rotating group of physicians who are donating time, or they may have inexperienced young doctors. Private healthcare facilities can cost upwards of $75,000 a year, and most insurance plans do not cover this expense.
If your loved one is in a nursing facility or you are looking for care, there are several ways to find a quality facility.
Get a list of local facilities
Visit Eldercare Locator to find a list of facilities and services in your community.
Use social media
Post what you are looking for on your Facebook page. Ask for local recommendations or opinions on elder care facilities nearby.
Visit several times
Drop in unannounced around 9:30 or 10:00 to see how many residents are still in bed. Visit during dinner to see who is in the dining hall and what they are eating. Look at posted activity schedules to see what is being offered.
Ask to see the home’s 2567 form
This is the state inspection form that is required and must be made available to the public.
Talk to the staff
Chat with everyone from the director of the facility to the people who serve dinner. Ask how long the director has been in place and inquire about high turnover rates among staff at all levels. Unhappy staff do not generally give excellent care.
If you have a loved one in a medical facility, look for signs of overmedication or improper use of antipsychotic medications by watching for the following symptoms:
- Sudden changes in behavior
- Changes in sleeping and eating
- Withdrawal from family members or activities that they love
If any of these changes occur, request the log of medications given to your loved one. If there are unauthorized changes or medications that are new, discuss the changes with the prescribing doctor or your loved one’s physician. You are the best advocate your family member has. Don’t hesitate to speak up if you see something suspicious.
Read about the nine warning signs of bad care in a nursing facility, then tell us: have you or a loved elderly family member experienced overprescribing in a nursing facility? How did you handle it?