Imagine if Uncle Sam permitted everyone who lives in Newport News, Va., or maybe Fort Lauderdale, Fla., to be chemically restrained, drugged with powerful medications so they fell, day and night, into a speechless stupor. Now, further envision the furor if these 180,000 souls and their families each were forced to pay as much as $100,000 annually to be reduced to a near vegetative state.
This real situation with over-medicated Americans, in this case seniors in nursing homes, is just one more cruelty happening against the aged. It’s also hard to see federal officials issuing faint praise on how regulations slowly — too painfully so — are reducing abuse of potent anti-psychotics in the nation’s care for the old, especially those with dementia.
The Centers for Medicare and Medicaid Services, aka CMS, has issued new data on its seven-year campaign to slash elder care facilities administering antipsychotics sold under brand names like Abilify, Risperdal, and Zyprexa. Questions also have been raised about a newer drug, the little red pill branded as Nudexta.
These drugs carry the federal Food and Drug Administration’s sternest safety warnings, so-called black label cautions against their use in the aged because they pack such a cognitive wallop and can worsen heart woes common in seniors. But nursing homes, to save money and to reduce staff, made the drugs’ use common, partly to ensure greater resident “compliance” — until senior advocates, including the powerful AARP, campaigned to get CMS to crack down on their use.
As the Associated Press reported:
Ten years ago, according to the Department of Health and Human Services, roughly 270,000 nursing home residents suffering from dementia were receiving antipsychotic drugs, even though such medications are not approved to treat that condition. The powerful class of drugs is intended, instead, to treat serious mental illnesses such as schizophrenia and bipolar disorder.
The AP quoted geriatrics experts who said that tough federal regulations against antipsychotic abuses had cut the drugs’ use to 16 percent last year from 24 percent in 2011 — what one doctor called the largest reduction he could recall.
Still, Human Rights Watch, the global advocacy group, rightly denounced CMS for failing to reduce antipsychotics’ use and abuse even more, estimating that almost 180,000 elderly Americans get dosed with the drugs, even though a doctor hasn’t formally diagnosed their need. (That’s the population, by the way, of Newport News or Fort Lauderdale.)
The organization pointed out that 1 in 6 U.S. nursing home residents effectively gets a drug that makes them easier for staff to handle but that also cuts them off from communication and anything but a sedated state. It is true that many patients given these powerful drugs suffer from dementia — a condition in which their cognitive decline may be acute, meaning they may wander aimlessly (and dangerously), talk to themselves, lose control of bodily functions, and require 24/7 care and supervision. Their care isn’t easy.
But nursing homes make residents and families pay dearly, with a single room in a standard facility — not one that charges more for the intensive dementia care — averaging around $100,000 annually.
Questions on assisted living, too
For seniors and their families, struggling to figure suitable living situations, there’s also little good news in another housing option: assisted living. These facilities— which tout themselves as a bridge between independent living and 24/7 care by offering increasing services as seniors decline and need them — are soaking in billions of dollars in state and federal aid to the aged.
But they’re also poorly regulated, with oversight so weak that the Government Accountability Office (GAO) warned that vulnerable seniors in assisted living may be subject to abuse, neglect, exploitation, and even death. As the New York Times reported about these facilities, which can cost residents and families on average roughly $50,000 annually:
Just 22 states were able to provide data on ‘critical incidents — cases of potential or actual harm’ [in them.] In one year, those states reported a total of more than 22,900 incidents, including the physical, emotional or sexual abuse of residents. Many of those people are ‘particularly vulnerable …like older adults and people with physical or intellectual disabilities. More than a third of residents are believed to have Alzheimer’s or other forms of dementia.
This is unacceptable. In my practice, I see the major harms that patients suffer while seeking medical services and the terrible toll that can be wreaked on them by abuses and neglect in nursing homes and other facilities caring for the aged. Uncle Sam needs to take a robust role in protecting the aged and helping millions of hard-working citizens get the best out of their lives. Seniors fare better if they and the world can see aging as an inevitable but positive aspect of life, studies suggest.
Safety net programs need support
Partisans, instead, seem to regard the old, chronically sick, children, and other vulnerable people among us with disdain, even just as drains on the treasury. They speak of social programs like Medicare, Medicaid, and Social Security as “entitlements” — though these efforts middle-class taxpayers, with popular support and deep commitment, pour billions of dollars into, because they recognize they and their loved ones benefit from them.
And with a Republican Administration and Congress, they have sought to cut them, bit by bit. Medicaid now covers a huge share of the cost for almost 6 in 10 Americans in nursing homes, and it has become the primary payer for long-term care for seniors. The Trump Administration wants to let states tweak Medicaid regulations, including proposals from Arizona, Kansas, Utah, Maine, and Wisconsin to impose the first-ever lifetime caps on program benefits.
These rules also might cap recipients from getting any Medicaid help after as little as 36 months. That could put a lot of Americans and their families in major financial straits, as lower-paid Arizonans, for example, might suffer with serious illness earlier in life and require Medicaid assistance only to find when older that they are out of luck because they long ago had exhausted their program eligibility.
Demographers estimate that 10,000 Baby Boomers retire each day and will do so for the next 19 years. The harsh and extreme policies for the aged, and the neglect, abuse, and poor oversight of facilities that purport to care for them, aren’t abstractions. They will touch tens of millions of lives, not only of seniors but also their loved ones and friends. Our government of the people and by the people needs to step up to do much more in this area.