Pharmaceutical companies have encouraged the use of these medications in nursing homes, advocates said. In fact, 36 states filed suit against Johnson & Johnson contending the company improperly marketed the schizophrenia drug Risperdal for the treatment of Alzheimer’s disease and dementia. The company was also accused of providing lucrative agreements to physicians who prescribed the drug off-label.
J&J agreed last August to pay $181 million to resolve the claims. The company did not admit any wrongdoing in the case, said Teresa Mueller, a company spokeswoman, who declined to comment further.
One staff member with Buckingham at Norwood Care & Rehabilitation Center is all too familiar with the reasons some facilities turn to these medications. Colleen O’Keefe, assistant director of nursing at Buckingham, said patients would scream, spit on her and throw food across the room.
“We have a lot of residents with senile dementia with behavior disturbances. People that would hit you, fall a lot and didn’t want to eat,” O’Keefe said.
“I was old school — if you acted out, we fixed you with a pill,” she said.
But Buckingham has evolved as a leader in New Jersey in caring for the elderly, drastically reducing its use of antipsychotics. It has developed a personalized-care approach that centers on meeting each patient’s individual needs — for instance letting patients choose a shower or bath, and feeding themselves if they want, no matter how long it takes — rather than drugging them when they become frustrated and difficult.
“We went down from about 33 percent [of our patients given these drugs] to about 3 percent,” said Batsheva Katz, a vice president for Windsor Healthcare Communities, the parent company of Buckingham.
“This really isn’t a choice — this is the way we need to treat the elderly today,” she said. “Patients have a better quality of life.”
Buckingham, which started its personalized approach several years before federal officials addressed the problem, puts an emphasis on building a bond between caregivers and residents. Staffers learn a resident’s history, including longtime habits, career, hobbies and family members, as well as current needs. Permanent assignments, where the same caregivers tend to the same residents each day, have been instrumental in building trust, said Helene Ledany, an administrator at the home.
“We have a resident we’ll call ‘Bill’ who was a photographer, had done a lot of walking in his life and never got up before 10 or 11 a.m.,” she said. He was difficult to deal with when awakened at 7 a.m. — angry and anxious. He also walked throughout the building, setting off alarms and adding to his agitation, she said.
Under the new system, Bill sleeps until midmorning. He is allowed free rein in the building and staffers are instructed to gently guide him back to his floor instead of sounding alarms.
“He’s been fine ever since,” Ledany said. “He doesn’t try to leave — he just liked being able to walk around.”
Other changes at the home include allowing residents to shower at a time they prefer, such as in the evening instead of the morning. Residents are allowed time to feed themselves, even if the process is painstakingly slow. And the residents who long for the days they were once nurses or other types of caregivers are allowed to assist with minor tasks, such as pouring drinks.
O’Keefe said she resisted embracing the new system at first. “I didn’t think this new way could be done, but I have to admit, it works,” she said.
A major bonus — the new system didn’t cost the home more, Katz said.
“We just reallocated the money we had,” Katz said. “For example, we realized that no one was showing up for the entertainment on weeknights, so we used that money to pay staff members to offer recreational activities in the late afternoon, when some residents were a little agitated.”
Will other nursing homes follow? Even if they start immediately, the system Buckingham uses will not show immediate results.
Paul Langevin, president of the Health Care Association of New Jersey, noted that the continuing cuts to Medicare and Medicaid funding to nursing homes will exacerbate the overprescribing of antipsychotics. It’s no coincidence, he said, that as Medicare reimbursements for nursing home care have dropped, the use of these medications has exploded.
“It takes a significant amount of time to sit down with someone and read to them to help calm them,” Langevin said. “Is that as efficient as giving him medication? It’s definitely a better outcome for him, but nursing homes have fiscal restraints.”