Texas nursing homes lead the nation in the prescribing of antipsychotic medications to seniors. That has watchdog organizations concerned that people with Alzheimer's disease and dementia are being prescribed such drugs, which can be heavily sedating, for reasons of convenience rather than necessity.
Amanda Frederickson: What we’re seeing over the last several years is that as nursing homes have moved away from using physical restraints for residents, we’re seeing that they’re replacing those physical restraints with chemical restraints.
Mark Haslett: When you hear the phrase “chemical restraint,” you might not know what that means. In the language of institutional care providers, a chemical restraint refers to a medication that reduces aggression. It’s a common practice to use chemical restraints in facilities for people with mental illness or developmental disabilities. Increasingly, chemical restraints are being used in nursing homes. This trend is most noticeable in Texas, which has the highest rate of nursing home residents taking antipsychotics.
Frederickson: Nursing homes are using anti-psychotic medications, mental health medications for people who don’t have a diagnosis of psychosis, and we’re seeing that using them primarily on folks with Alzheimer’s and dementia often for convenience of staff, because they don’t know how to manage outbursts or emotional behaviors of residents that are struggling with these diseases. So they’re using these anti-psychotics, prescribing these anti-psychotics off-label and inappropriately.
Haslett: That’s Amanda Frederickson with the AARP of Texas. There could be many reasons why someone suffering from Alzheimer’s or dementia might physically struggle with nursing home staff or other residents. Frederickson says that physical restraints used to be more common in nursing homes. Residents or staff were sometimes injured.
Frederickson: Nursing homes, the federal government, the states, groups like AARP have been working for years to get away from physical restraints in nursing homes, and together everyone’s done a really quite a good job there. The trick is now we seem to be replacing them with chemical restraints, and we think it’s a result of a number of issues. One of them clearly staff turnover. Texas has among the highest staff turnover in nursing homes.
Haslett: Actually worst in the country, according the newest numbers from a study published by AARP. Texas nursing homes have a staff turnover ratio of 72 percent. That means from one year to the next, 72 percent of an average Texas nursing home’s staff are new. The national average is 38 percent. When you have people with challenging illnesses like Alzheimer’s and dementia, put them in a situation where the people taking care of them don’t know them or might be new trainees – it’s really easy for things to go wrong. Of course someone’s going to suggest just medicating them so they don’t act out. Case managers are supposed to watch out for this sort of thing, but Frederickson says, it’s really important for families to pay attention and ask questions.
Frederickson: Ask why a specific medication is being prescribed, particularly if you’re seeing a change in behavior or personality from your loved one. We hear from members periodically, they go in and all of a sudden their personality is dramatically different. They may be very withdrawn, and they may see other changes, and what they find when they dig in is that something has been prescribed and they’re not quite sure what that’s being prescribed. And folks really need to be comfortable pushing and asking for what’s going on. And if they’re not getting the right answers, to kind of work themselves up the chain.
Haslett: You can find a link to the study that I mentioned - as well as a link to a federal report card ranking nursing homes by performance - at our website, ketr.org. For KETR News, this is Mark Haslett.