In today’s scientifically advanced world, determining whether or not a nursing home resident displays symptoms of depression can be done quite simply and accurately. A more prevalent issue relating to depression involves the quality of treatment in nursing homes. A recent study titled “Antidepressant Prescribing Patterns in the Nursing Home: Second-Generation Issues Revisited” conducted by the Journal of American Medical Directors Association takes data from ten different nursing homes and analyzes how different factors influence the use of antidepressants among nursing home residents. The results of the study show a significant correlation between quality of treatment and pertinent documentation provided for this treatment.
In order to provide your loved one with the best possible care, it is important first to know exactly what his or her rights are. The Omnibus Reconciliation Act of 1987 requires that nursing home staff provide detailed records and regular assessments regarding the use of psychoactive drugs, including documentation of reasons for use and periodic attempts at dose reduction. This law was enacted for a specific reason. It is a health risk for nursing home residents to be using antidepressants without proper documentation of the patient’s depressive symptoms, the original reason for the prescription, as well as the reason for continued use of antidepressant drugs, and any side effects that these drugs may have.
In their study, the American Medical Directors Association found that 33% of nursing home residents who used antidepressant drugs had no documentation of actually being diagnosed with depression. Although in some of these cases antidepressant drugs were being used to treat other illnesses, many lacked any reason for the prescription of these drugs in the first place.
In the charts of those patients who were documented with a diagnosis of depression, the specific symptoms that led to this diagnosis and the subsequent prescription of antidepressants was missing. There were many patients who were diagnosed with depression and prescribed antidepressants, but later discontinued their treatment and 85.7% of such charts did report the reason. However, these reasons were found by the American Medical Directors Association to be vague, with “little explicit information…provided regarding the reason behind treatment changes.” While documentation is generally a sign of sufficient monitoring of a patient, the quality of this documentation is even more important. Documentation must be substantial and patient-specific in order to really be of any use to the patient and his or her future caretakers.
The accuracy of documentation is another area of concern. Although 65% of patient charts claimed that they were being monitored by psychiatrists, their quarterly reviews did not include documentation of any monitoring for depression symptoms. It is important to extensively investigate your loved one’s nursing home to ensure that his or her caretakers are actually following through on their documented promises.
The lack of monitoring and documentation of nursing homes is often a consequence of understaffing. In their study, the American Medical Directors Association discovered that nursing homes with low licensed nursing staff were less likely than those with higher licensed staff to document the presence or absence of depressive symptoms.
Although clear documentation does signify better organization and closer monitoring of patients, it may seem unimportant in comparison to other priorities of nursing homes. However, lack of documentation can lead to very serious consequences that often result in death. Nursing home residents often take multiple drugs for various reasons, putting them at risk of polypharmacy. In addition to the danger of simultaneously using more drugs than recommended by professionals, polypharmacy also places an emotional burden on elderly adults who have too many pills to take. Additionally, unless a patient is being closely monitored, it is impossible to determine whether or not he or she requires a change in drug dosage.
Because of the physical and psychological risks of using antidepressants without clear documentation or monitoring, it is very important to ensure that your loved one’s nursing home is properly documenting every aspect of your loved one’s health. If you feel that your loved one’s rights are being violated, contact us today to see how we can help obtain the care to which your loved one is entitled.