Examining Debate Over Use Of Antipsychotics To Calm Symptoms Of Dementia Patients

Dementia

The WallStreet Journal on Thursday examined how the "challenge of caringfor rising numbers of seniors who suffer from dementia and the behaviorproblems that can stem from it has provoked a wrenching debate" over theuse of atypical antipsychotics to calm symptoms in such patients.

Federal law discourages the use of physical restraints on dementia patients,but federal programs such as Medicaid cover the cost of medications used tocalm symptoms in such patients. In 2005, Medicaid spent $5.4 billion onatypical antipsychotics, more than any other class of medications. Labels foratypical antipsychotics include a "black box" warning about increasedrisk for death among elderly dementia patients.

Last year, CMS implemented new rules to limit the use ofantipsychotics, but currently "it's still easier for nursing homes to getreimbursed for giving patients extra pills than it is for hiring morestaff" to care for dementia patients.

Cynthia Rudder of the Long-Term Care Community Coalition said that nursing home employees"are basically quieting" dementia patients "against their will,"adding that "it is absolutely horrendous." Larry Minnix, president ofthe American Association of Homes and Services forthe Aging, said,"We cannot treat people by simply throwing antipsychotic drugs at them forour convenience."

Senate Finance Committee ranking member Chuck Grassley(R-Iowa) earlier this month asked several pharmaceutical companies to providedocuments about efforts to market the medications directly or indirectly foruse in nursing home patients.

According to Dennis Smith, director of the Center for Medicaid and StateOperations at CMS, nursing homes should seek a "different model" ofcare to ensure that "unlocking the drug cabinet" is not their onlyresponse to the symptoms of dementia patients. CMS also seeks to offer nursinghomes alternatives and inform them that they "will be open toscrutiny," Smith said (Lagnado, Wall Street Journal, 12/10).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.