Maine nursing homes reducing use of antipsychotic drugs

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Maine nursing homes lead the nation in reducing the unapproved use of potentially deadly antipsychotic medications, a state advocacy program announced Tuesday.

As part of a federal campaign to limit prescribing of the drugs, Maine nursing homes slashed their reliance on antipsychotic medications by more than 33 percent from the end of 2011 to mid-2014, according to the Maine Long-Term Care Ombudsman Program. Maine far outpaced a national reduction goal of 15 percent and slashed use of the drugs more than any other state.

While Maine was most improved under the initiative, the state ranks in the middle of the pack, at 26th in the nation, for the total number of nursing home residents taking antipsychotic drugs.

Antipsychotics are approved to treat serious mental illnesses such as schizophrenia and bipolar disorder, and allow some patients to live more normal lives. But experts say nursing homes too often rely on the drugs for their staffs’ convenience, medicating dementia patients to stifle their anxiety, confusion and anger.

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Prescribing the drugs to dementia patients is not only an off-label use, but potentially dangerous. The U.S. Food and Drug Administration requires that the drugs — which include Seroquel, Haldol and Risperdal — carry a black box warningthat they increase the risk of death from heart attack and stroke in elderly patients with Alzheimer’s and other forms of dementia.

More than half of Maine’s roughly 6,800 nursing home residents are diagnosed with dementia, a relatively high percentage.

“Today’s news provides concrete proof that Maine’s long-term care providers are committed to this initiative to provide improved care for individuals living with dementia,” Brenda Gallant, the state’s long-term care ombudsman, said in a Tuesday news release. “Our nursing homes have set an example for the rest of the nation as to what person-centered care looks like.”

The U.S. Centers for Medicare and Medicaid Services launched the national Partnership to Improve Dementia Care in Nursing Homes in March 2012, after an inspector general’s report that found elderly nursing home residents too frequently are prescribed antipsychotic drugs in ways that violate government standards. Federal officials partnered with nursing home professionals, advocacy groups and others.

Maine improved its performance significantly. In the fourth quarter of 2011, 27.2 percent of long-stay nursing home residents — or those who remained for at least 101 days — received an antipsychotic. In the second quarter of 2014, 18.2 percent received one of the drugs. In other words, about 1,230 Maine nursing home residents take the drugs today, down from 1,860 in 2011.

The figures exclude residents diagnosed with schizophrenia, Huntington’s disease and Tourette’s syndrome.

Nationally, nursing homes reduced antipsychotic use by 18.8 percent, from 23.6 percent of long-stay residents in the fourth quarter of 2011 to 19.4 percent in the second quarter of 2014.

The national partnership aims to decrease the use of antipsychotic medications in nursing home residents by 30 percent over five years, a benchmark Maine already has met.

Stillwater Health Care in Bangor reduced its use of antipsychotic medications from 23 percent of long-stay residents in 2012 to 15 percent today, according to Kristy Thibodeau, administrator of the 63-bed facility. Rather than turning to the drugs when dementia patients grow confused or upset, staff now take them to a new “multi-sensory room” where calming music, soothing lighting and aromatherapy help to calm residents, she said.

“We, without medication, can make a difference in helping people through a really challenging time,” she said.

The drugs carry harmful side effects that rival the hardship of dementia itself, Thibodeau said. Elderly patients tend to suffer from conditions that may exacerbate the side effects of medication, potentially experiencing involuntary muscle movements, falls, irregular heartbeat, sedation and trouble thinking.

“If they don’t need to take medication, we certainly shouldn’t be giving it to them,” Thibodeau said.

Federal law prohibits the use of antipsychotics to control behavior, known as “chemical restraint.” Nursing home staff must document a medical need to administer the drugs.

Some patient safety groups have criticized the national initiative for failing to enforce the law, instead relying on the nursing home industry to improve voluntarily. In a July letter to CMS administrators, advocates for nursing home residents wrote that the campaign “promotes paltry, numerical goals that many nursing homes ignore with impunity.” The national goals still allow nursing homes to use antipsychotics on thousands of nursing home residents, with rampant misuse of the drugs amounting to abuse, they wrote.

A new analysis by NPR found that federal regulators rarely penalize nursing homes for misusing antipsychotic drugs.

Gallant said Maine’s coalition plans to further exceed the federal government’s goals, calling the state’s progress a “good first step” in reducing reliance on antipsychotic drugs in nursing homes.

“After seeing the strides long-term care professionals in Maine have already made to address this issue, we are confident we can continue to build upon our success,” Gallant said. “We have applied for a research grant to study patient outcomes and further improve the lives of Mainers living with dementia.”

Along with the ombudsman program, Maine’s partnership is led by Dr. Jabbar Fazeli, a geriatrician with a practice in southern Maine, the Maine Medical Directors Association, the Maine Culture Change Coalition and the Maine Health Care Association, a trade group for nursing homes and assisted-living facilities.

Maine nursing home providers also participate in another national effort to improve the quality of care, which aims to safely reduce the off-label use of antipsychotic medications.

To learn the rate of antipsychotic medication use at your local nursing home, visit the federal government’s Nursing Home Compare tool atmedicare.gov/nursinghomecompare.

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