It pays to use a long-term care social work consultant

Two recent articles in the Los Angeles Times have pointed out how important it is to listen to your consultant’s recommendations – if you have a social service consultant – and to use one if you don’t. Licensing and other regulatory agencies are focusing on the use of psychotropic medications in nursing homes and rightly so. Last week the LA Times told us all that three former nursing home employees in Kern County, CA were under federal prosecution for killing three residents (and those are just the ones we know about) by illegally prescribing and administering psychotropic medications to keep residents quiet. This is called Chemical Restraint and it is against the law – thank god! The Director of Nursing who requested the order is going to prison. Good!

A second article in January attempted to raise awareness of a new study published in Britain’s main medical journal, the Lance (Lancet Neurology), that commonly prescribed antipsychotics Zyprexa, Risperdal and Seroquel are “just as likely – and perhaps even more likely – to cause a fatal heart attack as the older antipsychotic drugs.” So while I have been suggesting to my LTC clients for several years that Haldol is contraindicated int he elderly, it seems now that any antipsychotic presents a higher risk than we thought. And yet theses are frequently prescribed for “behavior problems” in the nursing home.

Social service consultants in nursing homes are beneficial to creating and sustaining a successful behavior management program, which helps facilities avoid deficiencies for unnecessary drugs. I have maintained for many years that non-drug interventions must be tried first and then simultaneously with drug therapy for depression, anxiety, psychosis, and troubling behaviors in LTC. In addition, I strongly urge my facilities to comply with OBRA regulations that require any order for psychotropic medication to have an acceptable diagnosis, dosing instructions and a measurable behavior manifestation, followed by an order to measure it. I have also seen months and months go by without and attempted does reductions, also required by OBRA. Get it together, nursing homes! No one is a better advocate for LTC than I, but that only means that I hold you to a higher standard…and believe me, that’s a good thing!

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