In Louisiana, More Than a Third of Ex-Lawmakers Continue to Try to Influence Their Old Colleagues

Jim Tucker, former speaker of the Louisiana House of Representatives, is now CEO of the nonprofit nursing home conglomerate CommCare Corp. Tucker, shown above in 2011, pushed against legislation discouraging institutionalization of the elderly and disabled. (Travis Spradling/The Advocate)

Louisiana’s nursing homes are among the nation’s worst.

The state ranked 50th in patient quality of care in a recent AARP report, which noted high rates of pressure sores and antipsychotic medications.

Elderly citizens widely prefer staying in their homes with help as long as possible, studies show. And advocates for changing the system say that making institutionalization a last resort would save the state money.

But when legislation was introduced this year to address that imbalance, three prominent former lawmakers helped torpedo it before it could progress.

Former House Speaker Jim Tucker urged the House Appropriations Committee to kill the proposal. Joe McPherson, the former chair of the Senate Health and Welfare Committee, told his onetime colleagues the reform was impractical. And Sherri Buffington, the committee’s former vice chair, watched from the audience.

Each of them is deeply connected to the nursing home industry, which has strongly opposed the changes.

Tucker is the CEO of CommCare Corp., a nonprofit that runs 13 Louisiana nursing homes. McPherson is the administrator and part-owner of a nursing home in Lafayette. And Buffington, who as a legislator sponsored laws that helped nursing homes reap more money, now lobbies for the health care sector, including a Shreveport hospital system that owns a nursing home.

The muscular display from former lawmakers is not unusual in Louisiana, a state known for a pro-business climate, and in particular a lax regulatory environment. Former lawmakers, whose legislative jobs brought in $30,000 to $40,000 a year in combined salaries and per diems, frequently leverage the part-time jobs into much higher-paying roles in the private sector or in the upper ranks of government. The bills they sponsored and positions they espoused at the Capitol give them a launching pad for lucrative future opportunities.

Some work around the state ethics law requiring them to wait two years before lobbying the Legislature. Instead, they push industry positions before other government branches, or sign on as “consultants” rather than lobbyists. Others take on top jobs at state agencies or in the executive branch, working on behalf of interests they once championed from the floor.

“There’s a whole flock of them,” said State Sen. Conrad Appel, a Republican who sponsored the bill this year supporting more home- and community-based care. “Do they have any extra authority because they were a legislator? I’d say no. But they do have a leg up because they’re friends with people there, and they know how the system works, and they have contacts.”

To gauge the continuing influence of former lawmakers, The Advocate and ProPublica tracked the 99 former members who left the Legislature between 2010 and last month’s elections. Thirty-five went on to jobs in the spheres of lobbying, consulting, governmental affairs, state government, state boards or as legislative advocates for businesses they run. The group includes members of all political affiliations.

“They’ve proven their loyalty to the industry already, and they still have influence,” said Bruce Blaney, a former state health official, about lawmakers who advocate for nursing homes. As the head of an association of more than 300 in-home support providers, Blaney has often tangled with the nursing home industry. He has yet to prevail.  (Click to Continue)

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In Louisiana, More Than a Third of Ex-Lawmakers Continue to Try to Influence Their Old Colleagues

United States: Oversedation in Nursing Homes

Nursing homes across the United States routinely give antipsychotic drugs to residents with dementia to control their behavior, despite regulatory prohibitions on this misuse of drugs as “chemical restraints.” This abusive practice remains widespread even though the use of antipsychotics is associated with a nearly doubled risk of death in older people with dementia.

About every week in US nursing facilities, more than 179,000 people, mostly older and living with dementia, are given antipsychotic drugs without a diagnosis for which their use is approved. Often, nursing facilities use these drugs without obtaining or even seeking informed consent. Using antipsychotic medications as a “chemical restraint”—for the convenience of staff or to discipline residents— violates federal regulations and may amount to cruel, inhuman, or degrading treatment under international human rights law.

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United States: Oversedation in Nursing Homes

US care homes over-prescribing drugs for residents with dementia, report finds

Nursing homes in the US are inappropriately medicating an estimated 179,000 residents with dementia each week, in what amounts to use of “chemical restraints”, according to a new Human Rights Watch report.

The 157-page report, titled ‘They Want Docile’ claims thousands of long-term nursing-home patients with dementia are inappropriately given antipsychotic drugs not designed for them. In many cases, the report states, antipsychotics are prescribed because of their sedating effects, making dementia patients easier for staff to handle.

Antipsychotic drugs carry a serious warning from the US Food and Drug Administration called a “black box” because the drugs increase dementia patients’ risk of death. The drugs were developed to treat psychiatric conditions such as schizophrenia.

Hannah Flamm, an NYU law school fellow at Human Rights Watch: “People with dementia are often sedated to make life easier for overworked nursing home staff, and the government does little to protect vulnerable residents from such abuse.

“All too often, staff justify using antipsychotic drugs on people with dementia because they interpret urgent expressions of pain or distress as disruptive behavior that needs to be suppressed.”

The report comes as lawmakers and researchers are warning of a wave of aging baby boomers. Currently, more than 5 million Americans have Alzheimer’s, and one in three seniors dies with Alzheimer’s or another dementia. The number of people with Alzheimer’s could triple by 2050.

Researchers with Human Rights Watch interviewed 323 people and visited 109 nursing homes in California, Florida, Illinois, Kansas, New York and Texas between October 2016 and March 2017. They used federal data to estimate the percentage of patients nationally who inappropriately receive such drugs.

Researchers found instances where patients or their proxies (such as family members) were not told of the risks of antipsychotic drugs, or felt their loved ones would be removed from a facility if they were taken off the drugs.

“[It] knocks you out,” a 62-year-old woman from a nursing facility in Texas told HRW. She said she was given Seroquel, an antipsychotic drug, without her knowledge. “It’s a powerful, powerful drug. I sleep all the time. I have to ask people what the day is.”

In another instance, the director of a nursing facility in Kansas told HRW that, “antipsychotics are a go-to thing”.

Rates of nursing home residents on antipsychotic drugs have declined in recent years, but government reports have said there is more work to do.

The HRW report chimes with others, including a recent government report, which found high rates of antipsychotic drug use in US nursing homes.

For example, a federal government report found that in 2012, 33% of older adults with dementia who lived in nursing homes were prescribed antipsychotics, versus 14% who lived outside nursing homes.

The most common antipsychotics address conditions such as schizophrenia and bipolar disorder. However, the FDA has found the drugs are commonly prescribed for “off-label” disorders.

“The trend now is to reduce the use of antipsychotic medication, and to monitor and to use them as appropriate,” said a spokeswoman for LeadingAge, a lobbying group for nursing facilities.

The report follows the Trump administration relaxing regulations on nursing homes, which discouraged regulators from levying fines on violators.

HRW called on the government to step up efforts against antipsychotics use in nursing homes.The federal government pays for the majority of nursing home residents’ care through the public health program Medicaid.

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US care homes over-prescribing drugs for residents with dementia, report finds

Man wrongly taken into custody, forced to take antipsychotic drugs, attorney says

A Meadville man is suing over a case of mistaken identity.

Eugene Wright, 63, says he still has nightmares after what happened to him just six months ago.

Wright, now retired, said he was outside his home in June of last year when Meadville police and a representative with Stairways Behavioral Health confronted him.

"They explained to me earlier that day at 10 a.m. I was at an orthopedic office threatening people. I was at work," Wright said.

He said they never checked his identity, but instead police took him to Meadville Medical Center.
Wright kept insisting they had the wrong person.

According to a federal civil lawsuit filed Wednesday, doctors injected Wright with Haldol, an antipsychotic medication and Ativan, which is used to treat anxiety disorders.

"I was powerless. I had no control of what was going on down there," Wright said.

Doctors later realized they had the wrong Eugene Wright, apologized and gave him a $50 gift card to a steakhouse.

Now he suing the police department, the medical center and Stairways Behavioral Health to send a message.

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Man wrongly taken into custody, forced to take antipsychotic drugs, attorney says

Women with dementia receive less medical care than men, study shows

Female dementia patients are more likely to take potentially harmful medication and receive less health monitoring than their male counterparts, according to a new study.

Research published online on Sunday in Age and Ageing found that overall, people with dementia received less medical care than those without the condition. Only half of people with dementia had an annual primary care checkup.

Women with dementia were found to have lower rates of annual weight and blood pressure monitoring, as well as surgery consultations, from primary care physicians.

Women were more likely than men to take psychotropic medications, such as antipsychotics or sedatives, which may not always be prescribed appropriately and have been shown to have negative effects when used long-term. Female patients also stayed on the medications longer, likely due to having fewer checkups to gauge if their prescriptions were still appropriate.

The study's findings indicate a need for improved healthcare access and reduced antipsychotic use for people with dementia, especially women, in order to help them “live well ... for longer,” said lead researcher Claudia Cooper, MSc, with University College London.

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Women with dementia receive less medical care than men, study shows

Antipsychotics linked to increased fall risks for SNF residents, study confirms

Psychotropic drugs, including antipsychotics and antidepressants, can increase the risk of falls among nursing home residents, a recently published study asserts.

Previous research has shown a link between psychotropic prescriptions and falls in nursing home residents, but little was known of how as-needed prescriptions impacted fall rates. The study, published in the December issue of JAMDA - The Journal of Post-Acute and Long-Term Care Medicine by Dutch researchers, not only backed up earlier research, but found a relationship between falls and drugs taken on an as-needed basis as well.

Of the 2,368 nursing home residents in the study, nearly 70% had a prescription for at least one psychotropic drug per day. An additional 8.8% had an as-needed psychotropic prescription. The study's authors found that 33.5% of residents had at least one fall, which most often occurred on days when a psychotropic drug was prescribed on a scheduled basis.

Residents receiving the drugs on a scheduled basis had a nearly threefold increase in falls. An increase in fall incidence also was noted in residents prescribed the drugs on an as-needed basis. Results of the study also showed that male residents had a fall risk nearly two times higher than female residents.

Study results showed no link between fall incidence and the prescription of benzodiazepines, drugs commonly used to treat anxiety and insomnia, the authors noted.

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Antipsychotics linked to increased fall risks for SNF residents, study confirms

Dementia Antipsychotics Death Risk Higher Than Previously Thought: Study

Researchers from the University of Michigan indicate that use of antipsychotic medications like Risperdal and Seroquel among patients with dementia may be even more dangerous than previously believed, increasing the risk of death over the subsequent months. 

A study published this month in the medical journal JAMA Psychiatry indicates that the dementia antipsychotics death risk appears to increase with dose, particularly men newer medications and those that include the same active ingredient as the antiseizure drug Depakote are used.

Although there has been a known risk of death associated with antipsychotic use among the elderly, the medications continue to be used as a form of chemical restraint in nursing homes, sedating dementia residents that are difficult to manage.

In this latest study, researchers looked at data on nearly 91,000 veterans age 65 and older with dementia from October 1, 1998 to September 30, 2009. The study looked at the effects on subjects given the drugs Risperdal, Seroquel, Haldol, Zyprexa, and drugs that are based on valproic acid, such as Depakote, Depacon, Depakene and Stavzor.

Researchers examined the risk of death over the next 180 days after the elderly individuals were prescribed the drugs, finding that use of the medications were associated with an overall 3.5% increased risk of mortality. That risk was dose-specific, meaning the higher the dose, the higher the risk of death. Antidepressants also appeared to increase the risk of death, but not to as strong a degree as antidepressants and valproic acid.

The FDA has previously warned against the use of antipsychotics with dementia patients, indicating that the medications provide no benefits and may increase the risk of death. Given what is known about the potential side effects of antipsychotics, use of the medications is often considered a form of elderly abuse when the purpose is to sedate the individual, rather than treat.

The Department of Health and Human Services (HHS), in conjunction with other federal agencies and private groups, is already battling antipsychotic drug use in nursing homes through the National Partnership to Improve Dementia Care and other efforts.

In September 2014, the National Partnership to Improve Dementia Care announced that it has set a goal of reducing the use of antipsychotics in long-term care facilities by 25% before the end of 2015. The group hopes to see reductions of 30% by the end of 2016.

“The harms associated with using these drugs in dementia patients are clear, yet clinicians continue to use them,” lead study author Dr. Donovan Maust, a University of Michigan and Veterans Affairs psychiatrist said in a press release. “That’s likely because the symptoms are so distressing. These results should raise the threshold for prescribing further.”

Researchers called for clinicians to look at non-pharmacological strategies first when treating dementia symptoms. However, they said the approach takes more time than writing a prescription and that whether doctors go that route will depend on reimbursement strategies and the actions of policy-makers.

The findings come days after a report by the U.S. Government Accountability Office (GAO), which found that too many elderly patients both in nursing homes and being treated at home are still being prescribed antipsychotics despite the FDA’s warnings that they do little to help and increase the risk of death.

The GAO report found that patient agitation, delusions, and certain setting-specific characteristics led to the use of antipsychotics as chemical restraints. The report found that the lower nursing home staff levels are, the higher the likelihood of unnecessary antipsychotic prescriptions to dementia patients.

The Department of Justice (DOJ) has previously accused Johnson & Johnson of engaging in kickback schemes designed to convince doctors to prescribe their antipsychotic medication Risperdal to elderly nursing home patients, knowing that the drug was being used abusively and potentially placing patients’ at risk of death.

In November 2013, Johnson & Johnson agreed to pay $2.2 billion to the federal government to settle its Risperdal illegal marketing claims.

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Dementia Antipsychotics Death Risk Higher Than Previously Thought: Study

Genesis sued for allegedly administering drugs to resident without consent

The family of a former resident of a Genesis Healthcare facility is suing the company, the facility and its medical director for allegedly administering risky medications to the resident without her consent.

The lawsuit, filed on Sept. 2., claims Milford Center, a Genesis facility located in Milford, DE, began administering antipsychotic medications to Sylvia Pierce after she was admitted in September 2014. 

Two of Pierce's children, her legally appointed medical decision-makers, said in the suit that they were not notified and did not give the facility consent to administer the drugs.

The drugs given to Pierce included the Zyprexa, an antipsychotic that can cause death in people with dementia, which Pierce had. She also received the antidepressants Remeron and Zyloft.

The lawsuits claim the facility's staff was negligent in their administering of the drugs to Pierce, which caused her condition to deteriorate. She died in November 2014.

"We believe that the drugs were not administered for any medical purpose. It was more of a restraint type of purpose," said Chase T. Brockstedt, legal counsel for the family, told the News Journal. The suit seeks compensatory and punitive damages.

Genesis cannot comment on pending litigation or the specifics of any patient's care due to HIPAA regulations, but the Milford facility remains “committed to providing quality care to each and every patient and resident,” the company said in a statement to McKnight's.

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Genesis sued for allegedly administering drugs to resident without consent

Overmedicated and Misinformed

Oldie but Goodie


The use of antipsychotic drugs on the elderly has sparked a series of lawsuits and criticism from reform groups and advocates fighting for better regulation and enforcement.

According to federal government statistics, 16 percent of residents in California nursing homes are on antipsychotic drugs. Although these drugs are often used to control and sedate residents, they also pose an increased risk of death in patients with dementia.

To blur the lines even more, the FDA has not approved the use of antipsychotic drugs on elderly patients diagnosed with dementia.

In this segment of "SoCal Connected," reporter Val Zavala reveals the story of retired preschool teacher Aleah Davis, who filed a lawsuit against a nursing home company, Country Villa.

"I always ask what I'm getting, and now I am able to tell when I get the medication what’s in the cup.  I've learned to ask and I have learned that I have rights," Davis told KCET's "SoCal Connected."

Current law requires doctors to obtain a patient's informed consent before prescribing antipsychotics.

A recent campaign to reduce antipsychotic use in nursing homes has been successful, but reformers say progress is not enough and thousands of nursing home residents are still being overmedicated.

What is being done to change the culture of overmedication within nursing home? Zavala investigates.

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Overmedicated and Misinformed

Chemical Restraints: Anti-psychotic meds given to elderly despite warnings

45 area nursing homes rate below average for the use of antipsychotic drugs

It's estimated one out of every three elderly nursing home residents diagnosed with dementia is prescribed antipsychotic medication. That's according to studies by the Centers for Medicare and Medicaid Services and the Government Accountability Office. The drugs continue to be given to older adults in the facilities despite FDA warnings over the past decade that certain types of the drugs can be deadly.

Marisa Conover, of Fair Oaks, said her mother Genine Zizzo was given antipsychotic medication at a nursing home in 2012, even though she was promised the drug would not be used to treat Zizzo.

As documented in a coroner's investigative report, Conover also said she thinks the drugs contributed to her mom's death just 12 days after she was admitted to Roseville Point Health and Wellness Center.

That investigative report, as well as medical records from Kaiser, said Zizzo went into Roseville Point needing physical therapy after she fell at her home. The report goes on to say Zizzio left less than two weeks later after slipping into a "vegetative state" and then a "coma." Zizzo's death certificate reports she had "multiple organ failures."


Fighting for Change

A Sacramento County elders rights watchdog group, largely funded by private donations, said its seen cases like this before. Carole Herman's Foundation Aiding the Elderly represents nursing home abuse and neglect victims.

Carole Herman 

Herman has accumulated a 20-foot by 20-foot storage room full of cases since she founded the non-profit in 1982. She said medicare and medicaid pay for a vast majority of all nursing home treatment for the elderly.

"Our tax dollars are what's paying for this shoddy care," Herman said. "And for making all of these nursing home operators very wealthy."

The antipsychotic drugs are classified as heavy tranquilizers and have been linked to heart failure, according to the FDA. The agency placed a warning label on the drug Haldol. That's the same medication that Roseville Point injected into Zizzo.  (Continue Reading)

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Chemical Restraints: Anti-psychotic meds given to elderly despite warnings