Antipsychotic use at five-star nursing homes

The Food and Drug Administration approved antipsychotics for the treatment of schizophrenia and bipolar disorders, but nursing homes nationwide are using them off label despite a warning that the drug can cause death in patients with dementia.

The Centers for Medicare and Medicaid Services (CMS) is taking action. It began considering the use of antipsychotics for its Nursing Home Compare five-star ratings in February in an effort to limit the use of the powerful drugs by nursing homes, according to an Al Jazeera America report.

More than 40 nursing homes with current five-star ratings — including the South Mountain Restoration Center in Pennsylvania — continue to use antipsychotics at almost twice the national average.

A Government Accountability Office report this year found one-third of nursing home residents with dementia receive antipsychotics. The national average for all nursing home residents is 18 percent.

The South Mountain Restoration Center, the 159-bed long-term care facility in Franklin County, recorded that nearly 53 percent of its residents received an antipsychotic medication, according to CMS.

Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform, told Al Jazeera that nursing homes see antipsychotics as a quick solution to calm down residents without considering the risk.

The story features Maria Guerrero’s mother who resides in Idle Acre Convalescent nursing home, which specializes in dementia care, outside of Los Angeles. Guerrero was unaware of the use of antipsychotics, and when she asked why her mother was tired and falling asleep during visits, nurses said that she was up late.

About 52 percent of Idle Care’s patients received antipsychotics from July 2014 through March 2015, according to Al Jazeera.

According to the report, Dr. Helen Kales, director of the University of Michigan’s Program for Positive Aging, examined nearly 100,000 patients from Veteran Affairs hospitals.

According to Dr. Kales data:  

Looking at the effect over a six-month period, she found the antipsychotic Haldol caused an additional death for every 26 patients with dementia receiving the drug. For Risperdal, the rate was one additional death for every 27 patients; Zyprexa, one additional death per 40 patients; and Seroquel, one per 50.

Kales and colleagues are working to find alternatives for caregivers who deal with behaviors associated with dementia.

Christine Manganas can be reached at

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