Use of anti-psychotic drugs by Ohio nursing homes questioned

At a typical Ohio nursing home, about 15 percent of long-term residents are on anti-psychotic drugs, which puts some patients at risk for dangerous side effects and even death, according to the Federal Drug Administration.

Many nursing homes have relied too heavily on medications as the quickest and most direct way to address difficult behavior, said Erin Pettegrew, State Long-Term Care Ombudsman for Ohio.

For dementia patients, anti-psychotic drugs intended for serious mental illnesses can significantly affect quality of life and result in dangerous side effects.

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Pettegrew said families of patients on these drugs tell her office that their family members are not acting like themselves, are sleeping all the time or have lost interest in activities they once enjoyed.

“We need to keep people with dementia present as long as we have them … These drugs are not only physically very dangerous for people with dementia who don’t have the appropriate diagnoses to be using anti-psychotics, but they also take away that humanity that we’re looking to keep,” Pettegrew said.

To curb the use of these medications for dementia patients, up to 100 Ohio nursing homes could get training at a substantial discount that teaches how to take other approaches to addressing difficult behaviors besides medication. The grant money comes from fines nursing homes have paid over citations.

Medications can be a “quick fix” and the value of the training is that it helps nursing home workers have the knowledge base to take other approaches with residents besides medication, said Peter Van Runkle, executive director of Ohio Health Care Association, which represents nursing homes and other long-term care facilities.

“There’s no question that other kinds of approaches do take more time, do take more effort, do take more knowledge,”Van Runkle said.

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The set of training programs are with nonprofit Eden Alternative and the training teaches nursing home staff how to provide individual care that looks to understand the reason behind challenging behavior and find an individual non-medication approach.

About 15.2 percent of long-term residents are on anti-psychotics at the average Ohio nursing home, compared to the national average of 15 percent, according to U.S. Centers for Medicare & Medicaid. That’s down from closer to 25 percent at the start of 2012.

For short-term residents — those that stay less than 100 days — 2 percent of Ohio nursing home residents and 1.9 percent of U.S. nursing home residents are on anti-psychotics.

Pettegrew said Ohio has had great improvement in recent years in lowering the rate of anti-psychotics prescribed in nursing homes.

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The state also has the ability from an enforcement to issue citations and penalties to nursing homes for having residents with drug regimens with unnecessary prescriptions, and the FDA has not approved anti-psychotics to treat dementia symptoms.

“An enforcement approach isn’t bad of course. You want facilities to follow the regulations and offer the best quality of care,” Pettegrew said. “But we think by offering positive approaches and better staff training that the facilities can redirect their efforts into care in other ways as well.”

How to search anti-psychotic prescribing at your nursing home 

You can look up the percent of residents who are prescribed anti-psychotic medications at every Medicare or Medicaid certified nursing home in the U.S.

  • Go to
  • Under "Find a nursing home" type the location and then the name of a nursing home in the two search bars.
  • Click on the "Quality of resident care" tab.
  • Scroll down and click on "long-stay" or "short-stay" to see the percentage of residents of those two groups who got an anti-psychotic prescription. Lower percentages are better.

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