A recent study conducted by the Center for Medicare Advocacy, a nonprofit consumer group, found that surveyors often have difficulty in challenging doctors who frequently prescribe antipsychotic drugs to dementia patients. Nursing home facilities often advocate prescribing these types of drugs to keep elderly residents in a sedative, and often times, a vegative state.
Because of such abuses in these types of drugs, the federal government’s Centers for Medicare and Medicaid Services set up a program in 2012 to attempt to prevent doctors prescribing antipsychotics to nursing home residents. Since the launching of this initiative, state surveyors have had mixed reviews on its effectiveness.
Often, nursing home facilities are found falsifying records and forcing residents to take drugs that are inappropriate. Doctors who are responsible for the care of these residents now create false diagnoses in attempts to justify the prescribing of these drugs. An elderly person who is prescribed antipsychotic drugs without reason can lead to dangerous changes in their health. This includes: choking, heart attacks, falls, bone fractures, infections, and pneumonia. See article at The Patriot Ledger.
Kaiser Health News and the Washington Post collaborated on a story about the overpayment of medications for Hospice patients. New Medicare guidance aims to stop the federal government from paying millions of dollars to hospice organizations and drug insurance plans for the same prescriptions for seniors. The new measures direct insurers not to pay for any prescriptions for hospice patients until they receive confirmation that the drugs are not covered instead by the hospice provider. The patient or doctor, with the hospice provider’s agreement, must explain to the insurer why the drug is not related to end-of-life care. The insurer may deny coverage for a number of reasons, including if the doctor or hospice did not explain sufficiently why the drug was unrelated to the terminal illness.
Medicines for Medicare patients receiving hospice care generally are paid in two ways. Drugs related to palliative and comfort care are supposed to be covered under the fixed-rate federal payments to the hospice. Drugs for diabetes, heart disease or other chronic conditions still used by these patients but not directly related to their terminal illness are covered by Medicare Part D prescription drug plans, which are heavily subsidized by Medicare, with beneficiaries picking up roughly 25 percent of the bill.
The new measures are a response to a 2012 investigation that found Part D prescription drug plans paid more than $33 million in 2009 that should have probably been covered by the hospice benefit. That was for analgesic, anti-nausea, laxative and antianxiety drugs, as well as prescription drugs used to treat pulmonary problems and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Beneficiaries paid nearly $4 million in copayments, the report by the Department of Health and Human Services’ inspector general found.
About 1.1 million Medicare beneficiaries received hospice care in 2009 and 437,121 filled prescriptions through their Medicare drug plan, according to the report.
McKnight’s reported that Omnicare has once again been accused of kickbacks. U.S. District Court Judge Robert M. Dow Jr. recently ruled a whistleblower can pursue allegations that long-term care pharmacy Omnicare funneled payments to nursing home owners through so-called charitable donations. Alan J. Litwiller, an Omnicare employee, filed the False Claims Act lawsuit in 2011. Among various charges, he said that a top Omnicare executive in Illinois directed the company’s nonprofit arm — the Omnicare Foundation — to make “indirect payments” to owners of client nursing homes, disguised as charitable contributions.
Other credible allegations include Omnicare giving illegal discounts and refunds to long-term care providers. A separate suit filed by whistleblower Susan Ruscher had accused the pharmacy of other infractions — namely, purposely failing to collect on certain bills to induce nursing homes to retain their business.
Andrew Sullivan’s blog The Daily Dish had an interesting article on the use of psychedelics to treat post-traumatic stress disorder and life-threatening illnesses. The first study in decades on the psychotherapeutic benefits of LSD found that it could help patients cope with life-threatening illnesses:
“The controlled, double-blind study, which was conducted in Switzerland under the direction of Swiss psychiatrist Peter Gasser, measured the impact of LSD-assisted psychotherapy on 12 people with life-threatening diseases (mainly terminal cancer). “The study was a success in the sense that we did not have any noteworthy adverse effects,” Gasser says. “All participants reported a personal benefit from the treatment, and the effects were stable over time.”
Initially eight subjects received a full 200-microgram dose of LSD while the other four got one-tenth as much. After two LSD-assisted therapy sessions two to three weeks apart, the subjects in the full-dose group experienced reductions in anxiety that averaged 20 percent, as measured by the State-Trait Anxiety Inventory, while the other subjects became more anxious. When the low-dose subjects were switched to the full dose, their anxiety levels went down too. The positive effects persisted a year later. “These results indicate that when administered safely in a methodologically rigorous medically supervised psychotherapeutic setting, LSD can reduce anxiety,” Gasser and his colleagues conclude, “suggesting that larger controlled studies are warranted.”
Tina Abassi was arrested at her home in Lancaster, KY and accused of using her job to steal pain pills from the residents at Golden Living Center in Stanford, KY. This is a common and serious problem in the nursing home industry. Abassi worked as an LPN for a year at Golden Living Center.
Upon her arrest, she answered the door and stated that she was intoxicated. She handed the police marijuana and prescription pain killers. Her two year old daughter was alone in the living room. Abassi faces numerous drug charges and first-degree wanton endangerment and endangering the welfare of a minor.
With the charges she is facing, hopefully she will no longer be able to work in a place with access to medication. The nursing home has no idea how many residents have suffered inhumane amounts of pain due to the lack of receiving the proper medication. There is also no knowledge as to how long Abassi was stealing from the facility.
No statement had been issued by Golden Living Center regarding compensation for the residents that have suffered undue harm. See WKYT article.
Thanks to the American Medical Directors Association, prescribing antipsychotic drugs is no longer a justifiable part of a care plan when treating dementia patients. A free resource is now available to health care providers that focus on providing patients with activity programs, social engagement and mental stimulation. However, it is unlikely that this program will be utilized in the majority of nursing home facilities, because the program requires staff to take extra time with patients for behavioral therapies and strong care team communication. Most nursing homes are minimally staffed, with staff unable to provide even the most basic levels of care to residents.
Even though viable opportunities are available to maintain the vitality of the aging population, it is unlikely that the prescription of antipsychotics to dementia patients will have any sort of significant decrease. Antipsychotics tend to have very serious side effects that often interact negatively with an aging person’s body chemistry. These drugs essentially place dementia patients in what is known as a ‘chemical restraint,’ making the patient unable to function normally. Therefore, because of the costs associated with providing the proper care to dementia patients in long-term-care facilities, the owners of these facilities will continue to sacrifice the well being of their residents in order to continually increase their profits.
THV11 reported the guilty plea of Courtney Lynn Goodwin for stealing pain medication that had been prescribed to residents of the long-term care facility where she worked. Goodwin pleaded guilty to obtaining a controlled substance by fraud, a Class D felony. Goodwin, a licensed practical nurse, was a nurse supervisor at Pine Lane Therapy and Living Center in Mountain Home.
She was arrested in October 2013 after an internal investigation at the long-term care center and an investigation by the Attorney General’s Medicaid Fraud Control Unit. Investigators determined that Goodwin had taken for her personal use hydrocodone/acetaminophen pills that had been prescribed to three residents of the center.
NBC Chicago reported that medication errors in nursing homes are leading to hospitalizations for dangerously low blood sugar, visual hallucinations and labored breathing, according to information obtained by NBC 5 Investigates via a search of public records. Sometimes handwriting can cause errors in terms of dosage. The errors can result in a resident getting the wrong medication, too much medication or not enough medication.
State health inspectors documented 384 nursing home medication errors since 2011. The number of medication errors is likely much higher since nursing homes self-report and often cover-up medication errors. Illinois currently has a 9% facility citation rate for medication errors. However, the state’s goal is a 5% citation rate.
An elderly nursing home resident may have died as a result of a morphine overdose administered by a nurse at the facility. The daughters of the dead woman believe the nurses then covered up the incident by falsifying the nursing home’s drug register. The Coroner is investigating the size of the morphine doses and whether Ms Zimmerman had received "an appropriate standard of care". The resident was injected with 10 milligrams of morphine, a dose that the inquest heard was not appropriate for a woman of her age and in her condition. Michelle Zimmerman, the daughter who happens to be a RN, claims that the nurse Ms Chapman later told her she should only have given Mrs Zimmerman five miligrams of morphine.
Mrs Zimmerman was prescribed small doses of morphine for pain linked to various health problems. The inquest heard that a registered nurse, Rosemary Chapman, injected the 84-year-old with morphine a number of times over several days. When the elderly woman’s daughters visited her, they found her in a comatose state, with her eyes open but not responding.
Daughter Michelle Zimmerman claims the nurses refused to act at this point, stating Mrs Zimmerman was dying as a consequence of her pre-existing health problems and nothing could be done. Michelle Zimmerman called Crime Stoppers, who arranged for an ambulance to attend. Mrs Zimmerman was taken to the Blue Mountains District Hospital, where she died a few days later.
The Daily Journal reported that Christi Franklin, a 27-year-old nurse in Ellisville, Missouri was charged for stealing morphine from elderly patients at an elderly care facility. The facility is operated by Bethesda Health Group. The theft of medicine occurred for three months (April 6 – July 6) before being discovered. Franklin had been diluting patients’ medicine with water and mouthwash in order to try and conceal her wrongdoings. Bethesda says that they immediately fired Franklin as soon as her theft was discovered. They also claim that only one or two of the residents were affected.
The undue pain and suffering these patients suffered from April to July was not reported. Unfortunately, cases like these are all too common. The majority of medication thefts in elder care facilities go unreported. Even when cases are reported, it is rare that care facilities provide any sort of compensation for the harms that patients suffered while staff helped themselves to a patient’s medication.