Psychotropic Drug Use in a Nursing Home: A 6-Year Retrospective

Abstract

The Omnibus Budget Reconciliation Act of 1987 (OBRA) was a public policy initiative intended to improve nursing home residents'quality of life by providing strict guidelines for the prescription of psychotropic drugs (PD) and physical restraints. This study documents and explains the use of PDs in one nursing home at three points in time: well before (1988), immediately before (1990), and well after (1994) OBRA implementation. In 1994, 64.5% of residents in the nursing home had prescriptions for PDs compared with 71% in 1988 and 1990, but those with a PD prescription had more than one (mean = 2.19). After OBRA implementation, antipsychotic and antidepressant use was higher than at earlier data collection points, whereas anti-anxiety medication prescription was at its lowest. In addition, diagnoses of depression and cognitive impairment had increased dramatically by 1994. Explanations for these findings are provided, including possible aging of residents, change in staffing levels, caregiver anomie, the impact of another legislative bill, and the introduction of the minimum data set.

Effect of an Interdisciplinary Educational Program on Antipsychotic Prescribing Among Residents With Dementia in Two Long-Term Care Centers

“…In light of the high proportion of residents with restraints observed in Center B and the increased use during the program and postprogram periods, subsequent actions were taken by the center to reassess the needs for restraints. As discussed by Taylor et al (2003), the lower staffing level in Center B might explain, in part, the increased use of restraints during our study.…”

The role of regulation in the care of older people with depression living in long-term care: a systematic scoping review

“…The extent to which systems which are governed by regulation in the LTC sector make a difference to the quality of care that is delivered has been studied. In the USA, OBRA (1987) was enacted with the goal of helping improve LTC residents’ quality of life by mandating standardized assessments; by prescribing a policy of psychotropic drugs; and by enacting care planning requirements [ 52 ]. This act led to the use of the Pre-Admission Screening and Annual Resident Review Program (PASARR), which was designed to improve access to appropriate mental health care for long-term care residents [ 53 ].…”

“…This scoping review found that the program had mixed reviews. Taylor et al [52] explored prescribing patterns of psychotropic drug use before and after the implementation of the OBRA (1987) legislation in a not for profit LTC facility, using data retrieved from medical records. They found that before the enactment of the OBRA (1987) regulations, the use of anti-depressant medication was higher than after the introduction of OBRA (1987) legislation.…”

“…They suggest feasibility is a significant issue when treating LTC residents who have depression. Some barriers, such as funding, exist because of complex reimbursement schemes [30], where follow up assessment for depression may not be funded by the state, or where the funding of anxiolytics has been curtailed except for specific medical conditions [52]. Linkins et al [53] also suggest that regulation should be supported by the appropriate policies and financing to enhance the availability and integration of appropriate mental health services in nursing homes.…”

“…Taylor et al [52] suggests that nursing homes are subject to institutional and structural forces which can be challenging to staff, administrators, and policy makers, as they are faced with competing demands and priorities from funding constraints, inadequate staffing levels, care expectations and regulation. In a cross-sectional study of Medicare and Medicaid use in over 2000 nursing homes in 6 states in the USA, Lapane & Hughes [60] used MDS data from almost 88,000 residents to explore the relationship between nursing home characteristics and the management of depression.…”