The US Senate’s Special Committee on Aging has introduced The Improving Dementia Care Treatment in Older Adults Act, S. 3604 to address what the Committee says is a growing concern about the overuse of antipsychotics in nursing homes and other long-term care facilities.

Professionals who are in the trenches actually working with dementia patients in care facilities experience the sad truth that it can sometimes become necessary to use antipsychotics to suppress behavior that cannot be otherwise managed and, left uncontrolled, likely would create risk to the safety of not only the patient being administered the antipsychotic but also the other patients and staff. This practice is informally but widely known as “snowing a patient.”

Federal laws prevent a nursing facility from releasing a dementia patient without consideration to what happens after release. In Pennsylvania, the legal requirement is found at 28 Pa. Code § 201.25 (2010) which says that: “There shall be a centralized coordinated discharge plan for each resident to ensure that the resident has a program of continuing care after discharge from the facility. The discharge plan shall be in accordance with each resident’s needs.” This requirement applies to licensed Skilled Nursing Facilities but not to hospitals, Assisted Living Residences or Personal Care Homes.

Because dementia is not a condition which necessarily qualifies a patient for care in a Skilled Nursing Facility, many dementia patients receive care in a Personal Care Home. Consequently, a Personal Care Home is within its legal rights to contact the family of a dementia resident and inform them that the resident is “too difficult” and will be discharged. Families in these instances need to make other arrangements quickly, and the sudden change of environment is detrimental the dementia patients.

Because of our staff’s experience with the practice of some Personal Care Homes being quicker than others to discharge difficult patients, we take this into consideration when we make placement recommendations to the caregivers of our clients. Other Personal Care Homes are more committed to do whatever they can to help the family of a dementia resident stabilize their loved one in the Personal Care Home as a final destination, even to the point of including hospice services to provide seem additional nursing care as needed in the final stage of the dementia patient’s life.

In difficult dementia cares, snowing can be the last alternative. This reality might not be a happy thought, but dementia caregivers understand it. Given the limited information of the following announcement, It is unclear if the US Senate’s Special Committee on Aging has a full understanding that snowing a patient can be an acceptable alternative to sudden discharge.

A September 21, 2012 press release from the Committee says the proposed legislation would require the Secretary of Health and Human Services “to develop a standardized protocol for obtaining informed consent prior to administering antipsychotics.” The bill also proposes education programs for physicians who prescribe the medications and require reporting of antipsychotic use by care facilities. The release does not distinguish between care facilities.

“An alarming number of dementia patients in nursing home and assisted living facilities are being prescribed antipsychotics off-label to deal with agitation or other behavioral issues,” according to Senators Herb Kohl, D-Wis, chairman of the Senate Special Committee on Aging.

“Alzheimer’s victims and older people with other dementia are particularly at risk for receiving these drugs inappropriately,” in the opinion of one of the legislation’s sponsors, Senator Chuck Grassley, R-Iowa, Grassley said.

A report last year from the Inspector General for the Department of Health and Human Services, found that 305,000, or 14 percent, of the nation’s 2.1 million elderly nursing home residents had at least one claim for antipsychotic drugs.

The Senate Committee’s press release did not propose any alternative treatment for facilities to use in response to agitation or other behavioral issues associated with dementia.

Dave Nesbit
Attorney

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