Federal regulators announced Wednesday that they will begin penalizing nursing homes that falsely label residents as having schizophrenia, a practice that many facilities have used to avoid antipsychotic drug restrictions, which can be especially dangerous for the elderly.
Officials from the Centers for Medicare and Medicaid Services announced in the announcement that facilities that inflate the number of residents with schizophrenia may face a lower ranking in the federal ratings system used to evaluate the quality of nursing homes.
The move, part of the Biden administration’s broader effort to strengthen nursing home regulation, could close a loophole that some nursing homes have used to sedate dementia patients who would otherwise require expensive round-the-clock care.
According to the federal rating system, nursing homes are required to report the number of residents who are taking antipsychotic medications. Residents with certain other medical diagnoses, such as schizophrenia, may be excluded from facilities.
According to a 2021 investigation, the share of residents with a questionable schizophrenia diagnosis has increased by 70% since 2012, when nursing homes were first required to report how many residents had received such drugs. That year, one in every nine residents was diagnosed with schizophrenia; the disorder, which has strong genetic roots, affects roughly one in every 150 people in the general population.
“We support consumer transparency and ensuring that nursing home residents are properly diagnosed and receive the appropriate care,” said Dr. David Gifford, chief medical officer of the American Health Care Association, which represents nursing homes.
“Our members have been active partners in a national effort to reduce unnecessary use of antipsychotics in nursing homes, which has decreased by 40% in the last decade,” he added.
A federal oversight agency found that nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition, according to a 2021 report. The Medicare agency, which oversees nursing homes, stated that it would conduct an audit of nursing home medical records to determine whether the diagnoses were correct.
The increase in schizophrenia diagnoses has disproportionately impacted black nursing home residents. According to a 2021 study, Black Americans with dementia were 1.7 times more likely than white residents to be diagnosed with schizophrenia.
The Medicare agency stated in its most recent announcement that it has already conducted a handful of audits of nursing homes’ medical records and discovered instances of residents being saddled with phony diagnoses. Some nursing homes did not conduct psychiatric evaluations on their residents. Among those who did, some mislabeled dementia symptoms as signs of schizophrenia.
The agency also stated that it would begin publishing citations against nursing homes while the facilities appealed the charges. According to the New York Times, thousands of problems discovered by state health inspectors were hidden from public view because they were being appealed by nursing homes in a secretive process.
Inspectors found dangerous conditions that violated federal regulations in many cases, but nursing homes were allowed to keep their high ratings during the appeals, which sometimes lasted years.
According to the Medicare agency, while the number of hidden citations is small, the practice has obscured serious charges. According to the agency, over the last two years, 80 citations that put residents in “immediate jeopardy” went through the appeals process and were not published on the site.