- Tracking antipsychotic use in nursing homes
- http://www.boston.com/news/local/massachusetts/articles/2012/04/29/nursing_home_residents_with_dementia_often_given_antipsychotics_despite_health_warnings/?camp=aw&rico=1&zph=9avc
- http://www.boston.com/lifestyle/health/articles/2012/04/30/finding_alternatives_to_potent_sedatives/?camp=aw&rico=1&zph=9avc
- http://www.bostonglobe.com/lifestyle/health-wellness/2012/12/23/massachusetts-nursing-homes-seldom-penalized-for-overusing-antipsychotic-drugs-elderly/Yj1jI3XhjgLUHlLfqkzziM/story.html?camp=aw&rico=1&
Provide names of other journalists involved.
Kay Lazar & Matt Carroll
List date(s) this work was published or aired.
4/29/12, 4/30/12 & 12/23/12
Provide a brief synopsis of the story or stories, including any significant findings.
A Rampant Prescription, a hidden peril series investigated nursing homes’ use of antipsychotic medications on the elderly, a practice the US Food and Drug and Administration has long warned against because of potentially fatal side effects in people with dementia. The Boston Globe analyzed data from 15,600 nursing homes nationwide and found that about 185,000 residents received antipsychotics in 2010 alone, despite not having a medical condition that warranted such use. The series also revealed that Massachusetts nursing homes commonly use antipsychotics to control agitation and combative behavior in elderly residents who should not be receiving the powerful sedatives, yet state regulators seldom use their authority to reprimand or penalize facilities for this practice. Documents from the few state inspections that did result in citations highlighted instances in which residents were so over-medicated, they were unable to open their mouths to eat, or to do much of anything besides sleep.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
The Globe filed a Freedom of Information Act request in March 2010 with the Centers for Medicare & Medicaid Services for data on every nursing home in the country, including information on each facility’s use of antipsychotics on residents without a diagnosis that warranted such use. CMS denied the request, citing patient confidentiality. We persisted for 19 months — making our case during an April 2010 AHCJ Health Journalism session with CMS’ Edward Mortimore, numerous conversations and e-mails with Alice Bonner, the nation’s chief nursing home regulator, and finally a personal appeal to then-CMS Administrator Don Berwick. The agency finally relented in October, 2011. The data for every US nursing home were published on our website in a database searchable by facility name and state — allowing consumers to have this information on antipsychotic use for the first time. We also filed a public records request with Massachusetts regulators in early 2012 for copies of state inspection reports for each Massachusetts facility cited for unnecessary drug use from 2009 through 2011.
Explain types of human sources used.
Reporting for the series involved dozens of interviews with nursing home advocates, families with members in nursing homes, federal and state regulators, nursing home administrators and staff, nursing home industry executives, geriatricians, researchers, and elder law attorneys.
Results:
A month after we published the initial stories, the federal government announced an initiative aimed at reducing the use of antipsychotics in nursing homes by 15 percent by the end of 2012, and by more in future years. Massachusetts regulators supported expansion of a pilot program designed to lower antipsychotic use by teaching nursing home staff how to better communicate with residents who are unable to articulate their needs because of dementia.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
There have been no corrections or clarifications on the stories.
Advice to other journalists planning a similar story or project.
Don’t give up! Regulators often initially deny requests for documents, particularly if the information you are seeking pertains to sensitive health-related issues. That was what we faced when we filed our initial FOIA in March 2010 for the nursing home series. We started discussions early on with regulators about how the information might be released, while still ensuring patient confidentiality. Regulators were concerned that data about antipsychotic use released from smaller nursing homes, those with fewer than 30 residents, might be used to identify specific residents. We discussed these concerns over the course of more than a year — our FOIA was also misplaced by CMS for several months of this time — and when CMS eventually agreed to release the data, we received numbers for all nursing homes.