Compliance Perspective:
Deliberately ignoring or failing to obtain a resident’s or their legal representative’s consent with regard to care and medications is a violation of CMS compliance rules and can be considered abuse or negligence. It is the compliance officer’s responsibility to oversee periodic audits to ensure that residents or their legal representatives are being informed and are approving of the medications being prescribed.
The results of a class action lawsuit against a by a number of families on behalf of a nursing home’s residents raises the issue of the appropriateness in using antipsychotic medications to treat residents in nursing homes with dementia without proper consent. The amount of the settlement, $345,000, was not significant in terms of the high number of residents represented. However, the families insist that they had a higher goal in bringing this suit-to effect changes at the facility where the practice occurred.
One of the examples of the alleged abuse involved a resident whose son held her healthcare power of attorney. The son had been very detailed and specific with the nursing home and physicians regarding his mother’s desire not to have any antipsychotic medications and to restrict painkillers to simple aspirin. However, the woman’s wishes were ignored. The list of medications given consisted of: Restoril-an anti-anxiety medication, Norco-a highly addictive pain medication with respiratory distress as a side effect and Lexapro-an antidepressant for major depressive disorder.
The allegations of the residents and families was that the nursing home signed a form indicating that consent had been obtained and this was given to the doctor; however, no consent had been given. The suit alleged that the nursing home used what is termed “chemical restraints” to try and control dementia symptoms in the residents. These chemical restraints were antipsychotic medications and prohibited by federal law. These types of drugs are intended for the mentally ill and are not indicated for those with dementia and Alzheimer’s and can cause harm to the elderly and frail. The CMS has been advocating for the reduction of these type of drugs because it has been shown to “double a patient’s risk of death.”
