MISUSE AND OVERUSE OF ELDERS WITH DEMENTIA May 2018

Transcription

1 MISUSE AND OVERUSE OF ANTI-PSYCHOTIC DRUGS ON ELDERS WITH DEMENTIA May 2018 MITZI M CFATRICH, EXECUTIVE DIRECTOR LAURA MEYER PFEIFER, DIRECTOR OF DEVELOPMENT AND OUTREACH

2 Kansas Advocates for Better Care (KABC) Founded in 1975 by concerned Lawrence citizens, headed by Petey Cerf and Harriet Nehring, Executive Director. A team of 6 women began a grassroots movement and founded Kansans for Improvement of Nursing Homes. Worked closely with Douglas County League of Women Voters to investigate poor care in nursing homes, to increase public awareness and to pass laws to improve care.

3 Kansas Advocates for Better Care (KABC) In 1996, we became KABC. Nursing homes Assisted Living In-home care Funded by memberships, private donations, grants and corporate sponsorships. 650 members statewide

4 Our Mission Advocating for quality long-term care

5 How does KABC fulfill its Mission One-on-one support and guidance for older adults and families who are seeking quality long-term care, at home or in a facility Help and guidance for older adults and families to investigate and solve care problems they experience Training for caregivers on best care practices and quality, compassionate care We brought in a national expert this year to provide free training on best practices in providing comfort care to older adults with dementia. Advocacy with policy makers at the state and national levels to assure good quality long-term care

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7 What has been accomplished - Advocacy? Passage of 90 hour nurse aide training requirement prior to actual care of older adults KABC is one of a handful of advocacy organizations responsible for passage of national reforms governing nursing home care, including the 1987 Nursing Home Reform Act Passage of law which allows up to $10,000 in civil penalties against adult care homes who are seriously out of compliance with laws and regulations.

8 Fines against Kansas nursing homes up nearly 9,000 percent since 2012 B Y J O N A T H A N S H O R M A N J S H O R M A W I C H I T A E A G L E. C O M K A N S A S C I T Y S T A R, N O V E M B E R 2 9, : 2 6 PM TOPEKA - RESIDENTS IN NEARLY A THIRD OF KANSAS NURSING HOMES FACE POSSIBLE HARM OR ARE IN IMMEDIATE JEOPARDY, A CCORDING TO CITATIONS ISSUED THIS YEAR THE FOURTH HIGHEST PERCENTAGE A M ONG A LL STATES.

9 ADVOCACY Attack on nursing home inspections which assure health safety and protect from vulnerable elders from abuse KDADS not keeping up with required nursing home inspections (every months law requires 12 mo.) 23% OF Kansas Nursing Homes were in the Red Flag Zone as of December Red Flag Zone = 10 or more violations in three consecutive inspections. 20% - facilities cited for serious health safety violations 0-46 number of violations cited in a single facility As of Sept. 11, 2017, the Kansas Department for Aging and Disability Services (KDADS) had failed to obtain the nursing homes evidence of correction for 52% of the deficiencies identified during surveys in CY 2014.

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11 Key Priorities 2018 HB Video monitoring in nursing homes to prevent elder abuse. Law introduced in 2017, and passed in Effective July 1, 2018 SB 311/Adds Emergency Medical Services personnel as mandated reporters of abuse, neglect and exploitation of vulnerable adults. Passed in 2018

12 Key Priorities 2018 HB 2427 Background Check passed. Defines who cannot be employed by an adult care facility, hospital, or home health agency due to adverse findings on any State or national registry. A national database search is a safety improvement. The law s Provisional Employment puts older adults in harm s way. Allows a provider or facility to employ a person and allow them to work directly with vulnerable adults for 60 days without a completed, clean background check AND without eyes on supervision. Provider/facility is not required to tell the older adult about provisional employment, or identify any provisional employee. Providers/facilities are protected from civil lawsuits claims even if a provisional employee harms an older adult. Provisional employment transfers all the risk to the vulnerable older adult the person least able to protect her/himself from abuse or other wrong-doing. Provisional Employment presents serious, significant harm risks for older adults, without proper notice, and depriving them of civil legal remedies.

13 Key Priorities 2018 HB Video monitoring in nursing homes to prevent elder abuse. Law introduced in 2017, and passed in Effective July 1, 2018 KanCare (Medicaid) - Has failed to process applications in a timely manner, denying thousands access to care. Has failed to provide legal advocacy for participants, including those with dementia, help when services are cut or eliminated. Has failed to require health improvement outcomes for older adult participants.

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15 Advocacy Key Priorities 2018 KanCare and KanCare 2.0 (Medicaid) Nursing facility inspections and deficiencies Protections for long-term care consumers Elder Abuse, Neglect and Exploitation Partnering with KS AG HB KABC for successful passage of legislation to enhance protections and enforce stiffer penalties related to elder abuse, neglect and exploitation (elder defined as age 60 +) KABC created training materials for law enforcement, bankers and social workers to better recognize and prevent elder abuse. Chemical Restraint of Older Adults Kansas ranks 50 th Worst in the U.S.! Used too often to restrain, instead of physical restraints (also illegal) Inappropriate and dangerous use of anti-psychotic drugs on older adults with dementia in nursing facilities.

16 Kansas nursing homes have become far too dependent on mind-altering meds BY ANDY MARSO AND KELSEY RYAN The Kansas City Star NOVEMBER 26, :00 AM UPDATED NOVEMBER 27, :36 AM A L L E N W A G N E R U S E D T O L I G H T U P W H E N H I S G R A N D D A U G H T E R E N T E R E D T H E R O O M, B U T W H E N S H E V I S I T S H I M A T H I S N U R S I N G H O M E I N O V E R L A N D P A R K N O W, H E H A R D L Y R E A C T S. H E S S L E E P Y A N D U N C O M M U N I C A T I V E. H E S S E D A T E D.

17 Anti-Psychotic Drugs Conventional Compazine (prochlorperazine) Haldol (haloperidol) Loxitane (loxapine) Mellaril (thioridazine) Moban (molindone) Navane (thiothixene) Orap (pimozide) Prolixin (fluphenazine) Stelazine (trifluoperazine) Thorazine (chlorpromazine) Trilafon (perphenazine) Atypical Abilify (aripiprazole) Clozaril (clozapine) FazaClo (clozapine) Geodon (ziprasidone) Invega (paliperidone) Risperdal (risperidone) Seroquel (quetiapine) Zyprexa (olanzapine) Symbyax (olanzapine and fluoxetine)

18 BLACK BOX WARNING WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; and SUICIDAL THOUGHTS AND BEHAVIORS See full prescribing information for complete boxed warning. Increased Mortality in Elderly Patients with Dementia- Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Anti- Psychotic medications are not approved for elderly patients with dementia-related psychosis. Geriatric Use: Consider a lower starting dose (50 mg/day), slower titration and careful monitoring during the initial dosing period in the elderly

19 Communication of Needs What facility staff who promote chemical restraints call or see as bad behaviors, research and best practice identifies as an older adult with dementia communicating a need pain, safety/fear, boredom, loneliness, companionship, anxiety, depression, etc.

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21 Protecting Against Chemical Restraint HB 2704 Informed Written Consent not passed Every person has the right to be fully informed and to accept or refuse medications Every prescriber has a standard of practice duty to fully inform Call your Long-Term Care Ombudsman (877) Toll Free Barbara.hickert@ks.gov Report to the elder abuse hotline at KS Dept. for Aging and Disability Services Complaint Unit am to 5 pm, Monday through Friday, excluding holidays

22 What Next? Create awareness Talk about it draw attention to the problem Partnerships (AARP, Alzheimers, Domestic Violence, Aging services, faith groups) Tour across Kansas (libraries, Rotary, Kiwanis, senior centers, etc.) Training Increased training for care providers in facilities across the state of Kansas Increased training and outreach to medical professionals Advocacy Alerts Sign up for alerts to know about action items in the legislature, new resources available and how you can get involved or volunteer Sign up for our monthly E-newsletter to stay up on the best news Financial Partnership Become a member, respond to appeals, host an event, and more. CHANGE = TRAINING, ADVOCACY, RESOURCES

23 CONTACT KABC website or Fireside Court, Suite B, Lawrence, KS 66049