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Did you know that the share of nursing home residents with a schizophrenia diagnosis soared 70 percent between 2012 and 2021? Today, one in nine residents has a schizophrenia diagnosis, according to a New York Times investigative report. The disease’s prevalence in the general public stands at about one in 150 people.

How could this be? Schizophrenia is a lifelong condition that usually presents itself in one’s early twenties. It’s exceedingly rare for someone to be diagnosed past the age of 40. It is not believable that someone would develop this condition in old age or live without it undetected for so many years.

Dr. Michael Wasserman, a geriatrician and former nursing home executive, said, “People don’t just wake up with schizophrenia when they are elderly…it’s used to skirt the rules.”

The rules specifically ban the use of chemical straitjackets/restraints in nursing homes. Back in 1987, President Reagan banned the use of medicines that serve the interests of the staff or nursing home rather than the patient for this very reason.

Then in 2012, CMS began requiring nursing homes to report anti-psychotic drug use data, which then became part of each nursing home’s “quality of resident care” score that contributes to a facility’s CMS star rating.

However, here’s the fine print. Nursing homes were not required to report anti-psychotic prescriptions for patients who had any of three conditions: schizophrenia, Tourette’s syndrome, and Huntington’s disease.

Schizophrenia became the diagnosis d’jour. Since 2012, this diagnosis skyrocketed in nursing homes. It was found that at least one-fifth of nursing home residents have been taking such drugs as Seroquel, Zyprexa, and Abilify, many for schizophrenia. That translates into 225,000 nursing home patients. Is your loved one part of that group?

Medicare’s website states that fewer than 15% of nursing home patients are taking anti-psychotics, however, the Times found that the more accurate number is around 21%. Why? Because of the “no reporting” requirement for patients diagnosed with schizophrenia.

This is what Wasserman meant when he said, “skirting the rules.” We’ve all seen the idiom “rules are made to be broken.”

Nursing homes are notoriously understaffed and face daunting challenges when caring for the most vulnerable populations in our country. And adding insult to injury, nursing home staffing dropped by more than 200,000 last year alone due to Covid and is now at a 27-year low.

The Times found in its research that the more understaffed a nursing home is, the greater the use of anti-psychotics, likely to subdue patients and reduce the need to hire additional staffing, assuming that staffing can be found. But these drugs are a danger to patients, making older patients drowsier, more likely to fall, and nearly double dementia patients’ risk of death, the Times reports.

Some facilities moved away from anti-psychotics and turned to Depakote, an anti-seizure medication used to treat epilepsy and bipolar disorder. These drugs also make patients drowsy and increase their fall risk.

Not surprisingly, when the use of anti-psychotics began to drop there was a corresponding increase in the use of Depakote; in fact, a 15% increase among patients with dementia.  At the same time, prescriptions for anti-psychotic drugs dropped 16%.

A federal whistle-blower lawsuit against Abbott Laboratories, the former manufacturer of Depakote, resulted in a $1.5 billion settlement after Abbott representatives said the drug would “fly under the radar screen” of government regulations,

According to Anthony Chicotel, the top lawyer for California Advocates for Nursing Home Reform, around half the complaints they receive involve nursing home residents being inappropriately drugged with Depakote.

Chicotel said one of the appeals of Depakote is that it comes in a “sprinkle” form, making it easy to slip into a patient’s food.

“It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.

“It is like an arrow pointing to that class of medications, like ‘Use us, use us!'” Donovan Maust, a geriatric psychiatrist at University of Michigan said. “No one is keeping track of this.” (Thomas et. al., New York Times, 9/14)

Have you noticed when walking into a nursing home how lethargic and disengaged most patients are, as they sit in their rooms or hallways? Did you just write that off as depression or boredom or mental deterioration?

Have you ever given any thought that your loved one could be drugged without their consent or consent by their surrogate?  It is a violation of human rights, i.e., unethical for an individual to be given medical procedures or pharmaceuticals without their voluntary, informed consent. And there is unequivocally no informed consent for hundreds of thousands of dementia patients residing in nursing homes as reported by the Times.

In response to the Times‘ investigation, Catherine Howden, Director for Media Relations at CMS, said the agency is “concerned about this practice as a way to circumvent the protections these regulations afford.”… “We will continue to identify facilities which do so and hold them accountable.”

Does that response give you comfort? Not me. When was the last time you asked to see what medications your loved one was being given at the nursing home? It’s your right and it’s time to ask. Don’t wait for a bureaucracy to do the work.

 

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