April 18, 2012
Toby S. Edelman at
The Center for Medicare Advocacy knows that huge savings in nursing facility costs, and advances in resident care, could be achieved if facilities eliminated the inappropriate use of antipsychotic drugs and provided sufficient staff to meet resident needs. The Center commends the Senate Special Committee on Aging for holding a hearing on April 18, 2012 – The Future of Long-Term Care: Saving Money by Serving Seniors – to call attention to the connection between high quality of care and lower costs to the Medicare and Medicaid programs.
"Hundreds of thousands of residents receive antipsychotic drugs each day in nursing homes across the country," said Toby S. Edelman, Senior Policy Attorney with the Center's Washington, DC office, "even though these drugs are inappropriate and life-threatening for the vast majority of residents to whom they are given." In 2005 and 2008, the Food and Drug Administration issued Black Box warnings about atypical and conventional antipsychotic drugs, respectively, advising that these drugs can cause the death of older people who have dementia. Antipsychotic drugs are also included on the Beers List of drugs that are inappropriate for most older people. As the Office of Inspector General reported in May 2011, the Medicare program pays hundreds of millions of dollars for these drugs annually.
Staffing is a second critical issue. "More than a decade ago, the federal Medicare agency reported that more than 90% of nursing facilities did not have sufficient staff to prevent avoidable harm to nursing home residents or to meet their residents' needs. It is a national disgrace that such gross understaffing continues, when federal law since 1990 has required, and paid, facilities to have sufficient numbers of staff," said Ms. Edelman.
What are the consequences of insufficient numbers of professional nurses and paraprofessional nursing staff? Among other poor outcomes of inadequate staffing, with large financial consequences,
- Residents are sent to the emergency room and are otherwise hospitalized when there are not enough registered nurses, and virtually no doctors, to provide the high level of care that today's nursing home residents need; and
- Residents develop avoidable pressure sores that cause pain and cost hundreds of millions of dollars to treat.
The Center for Medicare Advocacy's statement for the record is available at: https://www.medicareadvocacy.org/2012/04/19/toby-edelman-testifies-regarding-antipsychotic-drugs-in-nursing-facilities/
- Management of Behavioral and Psychological Symptoms in People with Dementia Living in Care Homes: A UK Perspective, by Clive Ballard: https://www.medicareadvocacy.org/wp-content/uploads/2012/04/Antipsychotics-Clive-Ballard-powerpoint-04.2012.pps
- Lucette Lagnado, “Prescription Abuse Seen In U.S. Nursing Homes; Powerful Antipsychotics Used to Subdue Elderly; Huge Medicaid Expense,” Wall Street Journal (Dec. 4, 2007), https://www.medicareadvocacy.org/wp-content/uploads/2012/04/Antipsychotics-Wall-Street-Journal-Rx-and-nhs-12.04.07.pdf (article led Senator Grassley to request the OIG report, which came out in May 2011)
- Office of Inspector General, Department of Health and Human Services, Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents, OEI-07-08-00150 (May 2011), http://oig.hhs.gov/oei/reports/oei-07-08-00150.pdf.