Senate hearing addresses misuse of antipsychotics in nursing homes

Medicare is wasting too much money on reimbursing inappropriately prescribed antipsychotic medications for nursing home residents with dementia, Health and Human Services officials said Wednesday.

At a Senate Special Committee on Aging hearing titled, “Overprescribed: The Human and Taxpayers’ Costs of Antipsychotics in Nursing Homes,” HHS Inspector General Daniel Levinson told lawmakers it is “imperative” to address the misuse of antipsychotics in nursing home residents.

Levinson said not only does the overuse of antipsychotics present health concerns for elderly people with dementia, it also contributes to wasteful spending. He pointed to recent audits that showed half of antipsychotic prescriptions in nursing homes were wrongly paid for during 2007, costing Medicare $230 million.

Antipsychotics are commonly prescribed to residents with dementia for behavioral reasons, despite the Food and Drug Administration’s “black box” warning. Other experts present during the hearing said the prescribing practice still exists due to nursing home understaffing and high turnover. They also emphasized non-pharmacological approaches to behavior management, including treating underlying conditions that may be agitating residents, such as urinary tract infections or arthritis.

“Behavior is not a disease. Behavior is communication,” said Jonathan Evans, MD, vice president of AMDA – Dedicated to Long Term Care Medicine, who spoke to the committee. “And in people who have lost the ability to communicate with words, the only way to communicate is through behavior.”

Regulators suggested greater penalties be placed on physicians and nursing homes who continue to prescribe and administer the drugs inappropriately.

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