Antipsychotic drugs are a dangerous treatment for dementia patients – they increase risks for heart failure, infections, and death. And they do absolutely nothing to improve dementia. Yet in 2011 nearly 88% of Medicare claims for antipsychotic drugs given in nursing homes were to treat dementia patients. Why?
The reason is disturbing and appalling. Doctors in nursing homes prescribe antipsychotic drugs to dementia patients to make them easier to handle. It is much simpler for nursing home staff to monitor and care for a person who is drugged into a stupor. They don’t get confused or agitated, wander away, or resist treatment. They simply sit without complaining. It is called chemical restraint, and it is against the law.
After the 2011 study, the government decided to crack down and stop this dangerous behavior. But the solution has no teeth. Take the example of Texas, whose nursing homes have the highest rate of antipsychotic drug use in the US. An independent analysis of Medicare claims and payments has shown that Texas nursing homes are actually less likely to be censured for their misuse of drugs than most other states. In fact, only 2% of infractions were rated at a level that incurred a fine when state inspectors made their visits. CMS’s approach is one of collaboration with states. The Chief Medical Officer said, “There are many near misses…where medication might be given that’s not needed and doesn’t cause permanent harm. We view that as a learning opportunity.” An alternative view: it is illegal and harmful to patients.
But Medicare keeps paying for it. In one six-month period, they paid $116 million, and they keep doing it. CMS would rather partner with states to reduce claims over time than put a halt to this unconscionable behavior right now. It’s not hard to imagine what would happen if Medicare started denying the claims. It is, however, very hard to imagine why they continue to approve them. My insurance company won’t pay for medicines that they believe I don’t need – since when does Medicare?