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Anthony Cirillo

Despite Vow to Curb AntiPsychotics Industry Receives a Failing Grade

By October 5, 2012

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The Department of Health and Human Services Office of the Inspector General issued an updated report on the use of antipsychotic drugs in nursing homes. The news is abysmal. Virtually all nursing facilities were found not compliant with federal regulations governing residents who take atypical antipsychotic medications.

Nursing home standards require extra protections for nursing facility residents receiving antipsychotic drugs. Nursing facility staff are required to assess each resident's functional capacity upon admission to the facility and periodically thereafter. Staff must specify in a written care plan, based on these assessments, the services that each resident needs. The Centers for Medicare & Medicaid Services (CMS) contracts with State agencies to ensure that nursing facilities comply with the standards for resident assessments and care plans.

The study used a random sample of records from a previous Office of Inspector General (OIG) study of elderly nursing facility residents with Medicare claims for atypical antipsychotic drugs between January and June 2007. They reviewed the records for evidence of compliance with Federal requirements for resident assessments and documentation of decision making. They also reviewed the records for evidence of compliance with Federal requirements for care plan development and implementation.

What They Found

Nearly all records reviewed (99 percent) failed to meet one or more Federal requirements for resident assessments and/or care plans.

The resident assessment and care plan process involves four steps.

  • One-third of records reviewed did not contain evidence of compliance with Federal requirements regarding resident assessments, the first step.
  • For 4 percent of records, nursing facility staff did not document consideration of the Resident Assessment Protocol for psychotropic drug use as required, the second step.
  • Ninety-nine percent of records did not contain evidence of compliance with Federal requirements for care plan development, the third step.
  • Finally, 18 percent of records reviewed did not contain evidence to indicate that planned interventions for antipsychotic drug use--the fourth step--actually occurred.

What They Recommend

The OIG recommended that CMS:

  1. improve the detection of noncompliance with Federal requirements for resident assessments and care plans for residents receiving antipsychotic drugs.
  2. take appropriate action to address noncompliance with these requirements.
  3. provide methods for nursing facilities to enhance the development and usefulness of resident assessments and care plans.

What surprises me is that resident assessments and care plans are vital cogs in MDS 3.0 compliance so if assessments and care plans are not happening appropriately around anti-psychotics, what is taking place in the overall care of the resident/patient? This is disturbing and as the public picks up on these issues, it does nothing to help the bad image homes already have in the mind of consumers.

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