Texas Ranks Among Nation's Worst Offenders in Prescribing Antipsychotic Medications

According to a press release sent by the AARP, nursing homes in Texas rank among the nation’s worst offenders in improperly prescribing antipsychotic medications, according to new data that sheds light on the state’s inadequate attempts to deal with the problem of chemical restraint of vulnerable people in long-term care facilities.

In the latest report on the issue from the Centers for Medicare & Medicaid Services, Texas ranks 48th in the nation in the prevalence of antipsychotic use for long-stay nursing home residents. The report shows that roughly 1 in 5 residents, or about 19,000 people each month, in Texas’ 1,200-plus nursing homes are being inappropriately given the powerful drugs, which can result in serious harm.

“The misuse of antipsychotic drugs as chemical restraints is an all-too-common but preventable practice,” said AARP Texas Director Bob Jackson. “It’s time for the industry, state regulators and legislators to end this harmful tactic.”

Antipsychotics are approved mainly to treat serious mental illnesses like schizophrenia and bipolar disorder; however, federal and state reports show that nursing home residents are receiving antipsychotic drugs for off-label uses, sometimes to suppress the anxiety or aggression that can go with Alzheimer’s disease and other dementia.

For elderly residents who have dementia, medical experts and government officials say antipsychotics are only appropriate in a small number of instances. Significant morbidity, including higher blood sugar and cholesterol levels, weight gain, increased risk of falls, and decreased cognition, are also associated with the use of antipsychotics. These complications can lead to or cause a worsening of heart disease, cancers and other diagnoses known to affect older adults.

In 2015, the Texas Sunset Advisory Commission found serious flaws in the oversight of nursing homes in Texas. It called on the Legislature to enact a slate of reforms to clamp down on bad actors in the nursing home field. Though widely supported in the Legislature, most of the recommendations have not been enacted into law.

“When the Legislature reconvenes in January 2017, AARP Texas will again urge lawmakers and other state officials to prioritize and pass legislation to improve nursing home quality in Texas,” said Jackson.

Several years ago, in response to concerns that nursing homes were routinely administering antipsychotic medications inappropriately, federal officials established a public-private alliance to promote changes. In Texas, there are several state-led initiatives to help nursing homes reduce the unnecessary use of the medications, including programs for patients with dementia that work to help residents reconnect with the world through specific, music-triggered memories.

For information about the Texas initiatives, visit the Texas Department of Aging and Disability Services site at http://www.dads.state.tx.us/providers/qmp/evidence-based-best-practices/nursing-facilities/antipsychotics.html.

To see the latest report from CMS about antipsychotics in nursing homes, go to http://states.aarp.org/wp-content/uploads/2016/06/data-re-antipsychotic-drug-use-in-nursing-homes.pdf.