Groups Agree Overuse Of Antipsychotic Drugs An Issue In Kansas Nursing Homes

Oct 23, 2014

The Kansas Health Care Association and Kansas Advocates for Better Care don’t usually see eye to eye on much.

KHCA, which represents the state’s for-profit nursing homes, is quick to argue against passing laws that might increase their costs or add to their regulatory burden.

KABC typically says the state doesn’t do enough to improve conditions in poor-performing nursing homes and advocates for tighter regulation.

But on Wednesday, the directors of both organizations said far too many nursing homes have come to rely on using antipsychotic drugs to control residents’ dementia-driven behaviors.

“We don’t want to see a bunch of drugged-up people in our facilities,” said KHCA President and CEO Cindy Luxem, addressing a meeting of the Kansas Mental Health Coalition. “You can’t do person-centered care, you can’t do ‘culture of change’ if people are highly drugged. They can’t participate in things.”

“Kansas ranks very high in terms of older adults who are receiving antipsychotic medications,” said KABC Executive Director Mitzi McFatrich. “A few years ago, we were 45th in the nation; now we’re 47th. Our performance, compared to 49 other states, is getting worse, not better.”

Luxem and McFatrich each said it would be unrealistic to expect nursing homes to address the issue on their own.

“I just want to make one thing clear,” Luxem said. “Nursing home (nurses) are not the prescribers of these drugs. This is a societal issue that’s not going to change until folks (residents and their family members) come to us and say, ‘Hold on a minute, I don’t want to be like that (drugged).”

McFatrich agreed, saying use of antipsychotic drugs is a complicated, many-pronged issue that involves consumers, family members, doctors, medical directors, nurses and facility staffs.

“I don’t know that there needs to be more regulation,” she said. “The issue, I think, is one of oversight and lack of enforcement.”

Much of the discussion was driven by a U.S. Department of Health and Human Services report that raised concerns about elders often being prescribed “off-label” drugs that have harmful, sometimes fatal, side effects.

McFatrich said that roughly one-fourth of the state’s 18,000 nursing home residents are known to be taking at least one antipsychotic drug.

Luxem said KHCA did not plan to include the issue in its legislative agenda for 2015. KABC’s board, McFatrich said, was undecided.

“It looks like we’re going to be pushing for increased staffing levels to ensure a level of health and safety that we don’t have in Kansas now,” McFatrich said. “It’s an issue that we’ve been pushing for the last four years now.”

In August, McFatrich testified on the issue before the Legislature’s Joint Committee on Home- and Community-Based Services and KanCare Oversight.

Several members of the mental health coalition expressed support for adding the issue to the group’s list of topics to be discussed with lawmakers during next year’s legislative session.

Jim Brann, a coalition member whose adult son has a mental illness, said he favored urging state officials to do more to educate the public — elders in particular — about the risks associated with overuse of antipsychotic drugs in nursing homes.

“Consumer knowledge and awareness on this issue is abysmal,” Brann said.

Coalition members are expected to set their priorities for the 2015 legislative session during the group’s Nov. 19 meeting.