The New York Times hit one of its favorite punching bags again with an article titled “Phony Diagnoses Hide High Rates of Drugging at Nursing Homes.” In it, the Times alleges that a loophole not requiring nursing homes to report antipsychotic prescriptions for three uncommon conditions, including schizophrenia, has led doctors associated with the facilities to false diagnose schizophrenia in patients with dementia. Since these patients require much more time and attention from an already overworked and underpaid staff, the Times reasons that SNFs would rather drug them than provide real dementia care.
Some of the stats seemed damning. An analysis of Medicare data showed that schizophrenia diagnoses among nursing home patients rose from 7% in 2012, the year that the government began publicly disclosing antipsychotic drug prescriptions, to 11% now. And one in nine nursing home patients has received a schizophrenia diagnosis, compared with a general population rate for the disorder of 1 in 150.
The Times did attribute some of the rise to the closing of large psychiatric hospitals or institutions in the last few decades, leaving those patients with few options for long-term care. And the overall rate of antipsychotic drug use by nursing homes is down from 2012, even when including short-term patients and those with diagnoses with schizophrenia or other non-reported disorders.
But this is unfortunately yet another public black eye on an industry that has already been pummeled in the last year. If the hypothesis is that understaffing leads to overmedication of anti-psychotics, then maybe we will see an editorial or two in the Times on the negative impact that doubling the national minimum wage or mandating vaccines among staff will have on the labor crunch. Not holding our breath.
