New York nursing homes give about one fifth of their residents antipsychotic drugs, according to the latest data from the Long Term Care Community Coalition, a figure that has stayed flat since last year.
Nursing homes give patients antipsychotic drugs to treat the behavioral and physical changes that can come with dementia, such as aggression and delusions. The drugs can cause serious side effects such as heart attack and stroke, and increase mortality and morbidity risks for already-vulnerable residents.
Administration rates in New York have declined in recent decades and are lower than the national average. However, the report, released Monday, shows that nursing homes around the state gave an average of 18% of residents these medications in the third quarter of 2023, the same as Q3 of 2022.
Some facilities around the state are home to a disproportionately high percentage of residents who are given the drugs, the report, which uses Centers for Medicare and Medicaid Services data, illustrates. This includes the West Lawrence Care Center in Far Rockaway, where nearly 48% of residents got antipsychotics, and the Eleanor Nursing Care Center in Dutchess County, where 38% of people living there received the medications. Many facilities such as Tarrytown Care Hall Center in Westchester and The Grand Rehabilitation and Nursing at South Point in Island Park gave the medications to more than 30% of patients, the data shows.
Richard Mollot, the executive director of the coalition, said the data is evidence that New York still has a ways to go in creating better oversight, particularly since some medications carry a “black box” warning from the Food and Drug Administration because of their mortality and morbidity risks. Antipsychotics can greatly increase patients’ risk of heart attack, stroke and symptoms of Parkinson’s disease, Mollot said. Additionally, the drugs can render patients unable to communicate what they need or feel.
“If someone is crying or scratching or punching, that’s a form of expression. All behavior is communication,” Mollot said. “So the danger of these drugs is that it doesn’t address the underlying issue. It just takes away the individual’s ability to express it.”
The data comes about one year after the federal government cracked down on nursing homes’ antipsychotic administration at the beginning of 2023 after a nationwide trend of inaccurately diagnosing residents with mental illness and administering the medications. Data that could show the result of the increased audits has not yet been released.
Mollot highlighted some solutions to the issue, like tracking nursing home ownership data to flag which networks give antipsychotics to a high percentage of patients and implementing more severe consequences for facilities that inappropriately drug and misdiagnose residents. Barring a facility from participating in Medicare or Medicaid could be a necessary consequence, Mollot added.
Dr. Zachary Palace, the medical director at the Hebrew Home at Riverdale, a Bronx long-term care community operated by RiverSpring Living, argued that there are appropriate uses for antipsychotics, including for dementia patients experiencing psychosis and delusions. Psychosis is a very specific diagnosis represented by a “constellation of symptoms,” he said, and medications can lessen patients’ discomfort and fear. His facility has kept usage rates down to about 11% by assessing whether each patient truly needs the medication and employing other techniques first to quiet distress, he added. He noted separating residents who are not responding well to each other and trying to snap patients out of an anxious moment can be effective.
“Dementia patients are living in the moment, so redirecting them is not as difficult as one might think,” he said.
Palace said better oversight hinges upon what happens within individual facilities. He encouraged nursing homes to ensure psychiatrists and physicians are assessing whether residents’ behaviors are truly psychotic in nature before administering medication to reduce excessive use.
“A patient can have an episode of psychosis that may just be temporary. And that’s why it’s so important for the gradual dose reductions to take place to try to see what’s the least dose we can give that’s effective,” he said.
The Long Term Care Community Coalition is a Midtown-based nonprofit that represents more than one dozen organizations around New York. It releases quarterly antipsychotic drug administration data.
Jacqueline Neber , 2024-03-19 10:33:03
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