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Using Antipsychotic Drugs in Long-Term Care Is Too Common

Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.

Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans

Behavioral issues occur with frequency among residents in long-term care facilities. It is not uncommon for those afflicted by Alzheimer’s disease and other dementias to be restless, combative, and disruptive. They may hallucinate, be delusional, and act in ways that are even more difficult to handle than a loss of memory. Facilities have long relied on doctors to prescribe antipsychotic medications as an off-label treatment for these behavioral disorders, but studies have shown that “anti-psychotics usually don’t reduce disruptive behavior in older dementia patients” (ABIM, 2017). CMS is working with all stakeholders in the long-term care industry “to improve comprehensive dementia care” and “to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident” (CMS, 2020).

Use of antipsychotic medication can be accompanied by serious side effects. A concerted effort is being made to reduce their use because “nondrug interventions appeared to be more effective than medications in reducing agitation and aggression in people with dementia. Researchers found that three nonpharmacologic interventions were more effective than usual care: multidisciplinary care, massage and touch therapy, and music combined with massage and touch therapy” (Collier, 2020). At the same time, broad stroke efforts to reduce the use of these drugs may also pose hazards. One study found that limiting antipsychotics for behavioral use in long-term care settings may also pose challenges. It “may be correlated to a rise in risk factors for avoidable and non-avoidable hospitalization among residents with behavioral health issues, according to a recent study published in JAMDA, the journal for The Society for Post-Acute and Long-Term Care Medicine” (Yamshon, 2019). For example, the overregulation of medication use for this “population may have resulted in patients with bipolar disorders having their meds stopped or reduced, an unintended consequence of the National Partnership to Improve Dementia Care, which aims to reduce the use of antipsychotic meds” (Yamshon, 2019). Perhaps a balanced outlook and very resident-centered approach to behavioral interventions and therapies, pharmaceutical and non-pharmaceutical, is something the long-term care industry should explore in greater depth.

References

 

ABIM, “Treating Disruptive Behavior in People with Dementia,” 2017 , Retrieved at https://www.choosingwisely.org/patient-resources/antipsychotic-drugs-for-people-with-dementia/.
CMS, “National Partnership to Improve Dementia Care in Nursing Homes: Antipsychotic Medication Use Data Report (October 2019),” October 2019, Retrieved at https://www.cms.gov/files/document/antipsychotic-medication-use-data-report-updated-01242020.pdf.
Yamshon, L., “Push to Reduce Antipsychotic Drugs in Nursing Homes May Have Boosted Costly Hospitalizations,” Skilled Nursing News, October 27, 2019, Retrieved at https://skillednursingnews.com/2019/10/push-to-reduce-antipsychotic-drugs-in-nursing-homes-may-have-boosted-costly-hospitalizations/.

 

This blog post continues a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

  • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
  • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
  • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures.
  • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs.
  • Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences
  • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care.

There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.

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