US Sen. Richard Blumenthal said Wednesday that while he is pleased that the state has cut its rate of antipsychotic prescribing in nursing homes, he wants to see more progress.
He made the comments after meeting with a group of elder care representatives to discuss a recent news report showing that nursing home residents in Connecticut – many with dementia — are still more likely to be given antipsychotics than their counterparts in 33 other states. On the positive side, the state’s usage rate has dropped 21.6 percent since 2011 – more than the national average.
“The challenge is, how do we do better?” Blumenthal said. “Better results are well within reach,” but they require training, adequate staffing and “a new mindset and outlook” that allows for alternative approaches to antipsychotic prescribing.
“Reducing the misuse and overuse of these drugs is absolutely critical, in terms of lives and costs,” he said.
Antipsychotic drugs are an important treatment for patients with certain mental health conditions, such as schizophrenia. But the Food and Drug Administration has warned that the drugs have potentially fatal side effects when used in elderly patients with dementia. Still, nursing homes use the drugs “off-label” to calm patients who are agitated or confused.
Blumenthal said he heard a number of alternative approaches to the drugs at the Wednesday meeting, held at Hughes Health & Rehabilitation nursing home in West Hartford, which has seen a significant reduction in antipsychotic prescribing. But he said stronger measures nationally may be needed to encourage alternative interventions, which are often more time-consuming and intensive than prescribing pills.
In late 2012, he and colleagues introduced in a bill that aimed to reduce off-label antipsychotic prescribing by requiring consent from family members, training staff in alternative treatments, and tightening reporting on the use of the drugs. Blumenthal said he is considering revising and re-introducing the proposal.
Federal regulators with the Centers for Medicare & Medicaid Services (CMS) in 2012 announced a national initiative to slash the drugs’ inappropriate use in nursing homes by 15 percent by the end of 2012. That goal wasn’t met until the end of 2013. Recently, CMS set new goals of a 25 percent reduction by the end of 2015, and a 30 percent reduction by the end of 2016, compared to the baseline 2011 rate. Some elder care advocates have criticized CMS’ approach and goals as too lax.
In Connecticut, health care groups have formed a coalition — coordinated by Qualidigm, the state’s Medicare quality-improvement organization — to improve dementia care and reduce antipsychotic use. The group is working to educate providers about the risks of using antipsychotics and the benefits of alternative, personalized interventions for dementia patients.
Wednesday’s gathering included representatives of the Connecticut Department of Public Heath, the long-term care ombudsman’s office, Qualidigm, and the Connecticut Association of Health Care Facilities, among other groups.