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Many U.S. nursing homes are creating phony schizophrenia diagnoses to hide their use of dangerous antipsychotic drugs to subdue dementia patients, a government watchdog report said Thursday in its sharpest finding yet over a persistent form of alleged abuse.
A diagnosis of schizophrenia allows nursing homes to avoid reporting use of the drugs and artificially improve quality-star ratings on the government's Medicare consumer website.
Most of the drugs are not approved for patients with Alzheimer's disease and other forms of dementia because they increase risk of falls, strokes and death. But doctors can prescribe them "off-label," and caregivers and families regularly resort to them if a patient is violent and poses a threat to themselves and others. Resident advocates have long warned they are overused.
The issue has been surfaced previously in recent years, but the new report from the Office of Inspector General for the Department of Health and Human Services is the agency's most direct accounting of the alleged deceptive practices thus far.
"We found that nursing homes inappropriately diagnosed schizophrenia to mask their misuse of antipsychotic drugs, artificially inflate their star rating, and skirt established safeguards meant to protect residents," the OIG report said. "As a result, nursing homes compromised residents' care."
In a companion report released Thursday, the OIG said nursing homes resorted to using the powerful medications without first trying non-pharmacological interventions to soothe emotional outbursts and other symptoms of dementia. It said staff admitted to inspectors that they were used to lighten the workload by quieting patients.
The agency cited an instance where an unnamed facility in Pennsylvania gave a woman who was more than 100 years old an antipsychotic because she enjoyed caring for dolls.
It cited instances in Virginia where a man was given the chemical restraints "to calm him down" because he preferred staying in bed to sitting his wheelchair, and where a woman was dosed because she would get upset and make noise when her call light was not answered quickly in the evenings.
"At times, residents with dementia received antipsychotic drugs for exhibiting behaviors that the nursing homes themselves acknowledged were not dangerous or distressing to the resident," the agency said. "These drugs were used to address harmless behaviors such as repeatedly asking for help or trying to calm themselves."
Its reports were based on a review of 40 inspection reports by state surveyors.
The OIG's findings come as the Centers for Medicare and Medicaid Services, which regulates nursing homes, is considering relaxing its reporting standards for antipsychotic use. The Washington Post first reported this month that the agency, under lobbying pressure from industry groups and Congress, is reviewing whether nursing homes can stop reporting the use of antipsychotics when the facilities can show they were used appropriately.
The American Health Care Association, the lobbying group that represents the nursing home industry in Washington, did not immediately respond Thursday morning to a request for comment.
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