Report: Nursing home patients over-medicated across U.S.

SAN RAMON, Calif. - When 93-year-old Celia Christian from San Ramon first settled into her new nursing home, she started taking medication that caused her to hallucinate and sleep all day. One day, her daughter even got a call that her mother was seeing lady bugs coming from the ceiling. 

“She was also seeing a kaleidoscope. Sounded like someone on an LSD trip!” said Lydia Gurgich. “I knew this was a side effect of the drugs.” 

Christian’s hallucinations caused by overmedication by her long-term care facility is just one story that make up a larger, troubling trend. According to a report released Monday by Human Rights Watch, in an average week, nursing facilities in the United State administer antipsychotic drugs to over 179,000 people who do not have a proper diagnoses for that medication. The drugs, according to the organization, are often given without consent from the resident or family members. Human Rights Watch said the reason behind this is a lack of caretaker training, convenience for the staff, discipline and, most of all, lack of enforcement by government regulators. 

Gugich said shortly after her mother started living at the facility, a caretaker called saying her mother was aggressive. The caretaker recommended she get a specific prescription, one that works for other patients. Gugich said her mother never exhibited aggressive behavior before, but the caretaker didn’t offer another option.

“Bottom line was we needed to fix this or find mother another place, and I’m in a manic at that point,” she said.

The results of cases like this one are not only dangerous, experts say, but they are in fact possible human rights violations.

“Studies find that on average, antipsychotic drugs almost double the risk of death in older people with dementia,” said lead researcher Hannah Flamm. “The drug’ use as a chemical restraint – for staff convenience or to discipline or punish a resident – could constitute as abuse under domestic law and cruel, inhumane, and degrading treatment under international law.”

“The problem is the government is failing to enforce the law and the industry is getting away with it,” Flamm added.

2 Investigate wanted to find out how California, including the Bay Area, fared in national report. State data shows California ranks fourth lowest in the nation for nursing home residents taking antipsychotic drugs even though they don’t have Schizophrenia, Huntington’s Disease or Tourette’s. Those are the three main conditions for which such drugs would be appropriate, said Flamm. 

Flamm surveyed 23 facilities in California. She says, although California is performing better than other states, overmedication of antipsychotic drugs on dementia residents is still a widespread, dangerous problem. Not only does California have the most nursing facilities and the most nursing facility residents in the country, it also has stronger regulations than other states in the country.

“And yet, enforcement is a problem and these abuses persist,” said Flamm. 

The Human Rights Watch report does not name any specific facilities, but 2 Investigates obtained a government list showing local long-term care homes with a high percentage of residents taking antipsychotic medications. Crestwood Behavior Health-run centers in Fremont and Modesto came in near the top of the list, showing 84%, 71% and more than 50% of their residents taking the drugs. Our team reached out to the business, but they declined to comment.

Still, a high percentage on the government list doesn't necessarily mean abuse is happening, according to the researchers who spoke to KTVU. Other care facilities on the list, like San Miguel Villa in Concord and Ashby Care Center in Berkeley explained there are legitimate reasons why their percentages are high. For instance, they have fewer residents and they specialize in treatment patients who need the drugs for approved diseases. 

Human Right Watch acknowledges there are many facilities administering the drugs for appropriate reasons, but the group believes the state isn’t investigating enough to make sure. 

Flamm told 2 Investigates state regulators failed to respond to her report. We reached out to the California Department of Public Health, which is responsible for regulating nursing facilities. Department officials said since 2012, the problem has improved. A spokesperson sent statement: 

“The inappropriate use of anti-psychotic medications with dementia patients is a critical issue. California has been taking concrete steps to ensure patient safety, and significantly reduce the misuse of prescription drugs. The California Department of Public Health has worked in partnership with skilled nursing facilities, patient advocate groups, federal regulators and other specialists. This collaboration, the California Partnership to Improve Dementia Care, has lowered antipsychotic drug use by 45 percent in California since 2012. The most recent national data from the Centers for Medicare and Medicaid Services place California as 4th lowest in the nation for anti-psychotic use with dementia patients, significant improvement from 2012 when California was ranked 22nd lowest. And the percentage of affected residents has dropped to 12 percent. We recognize there is more work to do, and will continue our strong efforts in the months and years ahead.” - CDPH spokesperson

On Monday, Flamm visited Sacramento to urge California law makers to fight for more government enforcement of antipsychotic drug-use at nursing facilities. 

Meanwhile, Celia Christian has moved to a new facility where she is off many of the mind-altering medications. She says the lady bugs and the kaleidoscope on the ceiling are gone. Christian is painting and plans to start sewing again.

“Now that we’re at a new facility and we see the difference. It’s night at day. My eyes have been opened,” said Gugich.

Sacramento - The California Association of Health Facilities issued the following statement today regarding a Human Rights Watch report on the use of antipsychotic medication in skilled nursing centers.

California Associates of Health Facilities (CAHF) responded to the Human Rights Watch report with the following statement:

"Skilled nursing providers across California have worked tirelessly to safely reduce the unnecessary use of antipsychotic medications over the last six years. This report does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications.

According to the federal Centers for Medicare & Medicaid Services, California ranks 4th best in the nation in reducing the unnecessary use of antipsychotic medication.  As of the second quarter of 2017, California had reduced the use of antipsychotics by 45 percent.

While our efforts are better than 46 other states, our providers remain focused on collaborating with families, regulators and other health care providers to find solutions to address this issue."