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Senior Care Trends We’re Seeing in Southern California That You Should Know About Christy Rakoczy

January 15th, 2013

WhatToKnowAnti-psychotic medications are being abused in record numbers in nursing home settings as care providers dose patients to make them more docile and to make their behavior easier to control. This is an egregious form of senior abuse and a serious public health problem. In February 2012, the American Health Care Association announced a three-year plan for nursing homes and assisted living communities to improve their care, including reducing the use of off-label uses of antipsychotic medications.  Anyone interacting with senior patients, from hospital discharge planners to nursing home administrators, needs to be aware of the measures being taken.

Progress on this issue is just one important trend in senior care. Consider both the anti-psychotic drugs issue as well as some other key trends that are important to senior care providers.

Resources for Care Providers on Anti-psychotic Medications

Some basic resources and background on the use of antipsychotic medications in nursing homes is helpful as a first step to becoming educated about the problem. A number of resources can provide information on the nature of this issue, including the following:

  • On May 31, 2012, the California Department of Public Health issued a report addressing the use of antipsychotic drugs in California’s nursing homes. Background information, as well as the report, can be accessed at
  • Care facilities are being scrutinized in their use of antipsychotic medications with their patients.  Surveyors from the California Department of Public Health may enter a facility asking for documentation that patients have given informed consent to take such medications, and that plans are in place to attempt to reduce dosages.  It is imperative that facilities care plan and document any psychotropic medication use, including the reasons for starting or increasing medications.  Care plans should also include non-medication interventions.  Documentation notes on patient charts must be clear and consistent.
  • The website for the American Society of Consultant Pharmacists contains information about antipsychotic medication use in nursing facilities, and includes links to other resources.
  • A March 2012 article published by the American Society of Consultant Pharmacists answers questions about the use of antipsychotic medication in nursing home residents.

In addition to these resources, it is helpful to consider some other current trends when it comes to patient’s rights.

Advance Directives and Physician Orders for Life-Sustaining Treatment

Residents who are able must always have the chance to complete their own Physician Orders for Life-Sustaining Treatment (POLST) form, even though a family member might fill out the form more quickly.  Facilities who do not give residents this opportunity could face severe complications and legal liabilities.  Admission forms should have a place to acknowledge that residents with capacity were given the choice to complete an advance directive if one was not already in place.

According to California law, the signing of advance healthcare directives by residents must be witnessed by the Ombudsman, even if the signing takes place at a law office.  If a resident with capacity says that he or she wants another adult to make health decisions for him or her, this must be documented and is binding.

Blank POLST forms can be obtained from the Ombudsman’s office.

Dignity Violations

Avoid all potential violations of a resident’s dignity.  Be sure that residents in wheelchairs are pushed forward, not pulled or pushed backwards.  Residents should be fully covered on their way into and out of the shower.  Staff members should speak to residents and family members with respect.  If a resident likes to joke with staff members, that should be noted in the care plan. Such documentation of a resident’s preference can protect a facility by showing that such interaction is preferred by the resident, not imposed by the staff.

Information about violations at California nursing homes can be found at Member of the A short article on treating the elderly with dignity can be found at JD Supra.

Medicare Passes

Medicare rules allow for residents to leave facilities for certain reasons if they are healthy enough. They must be back by midnight so Medicare can be billed for the day (30.7.3 of Chapter 8 of the Medicare Benefit Policy Manual).  If your facility has a “four-hour rule,” this rule is incorrect.  To deal with this, when reviewing the policies with residents and families, facilities can state that they prefer that residents not be gone for that long; however, staff members may not tell residents that they will lose their Medicare benefits if they leave the facility on a pass.  If a resident is well enough to leave for a large part of the day, he or she might not need to stay in a skilled nursing facility.  More information about this and allowable reasons to leave a facility can be found at the website for the Center for Medicare Advocacy.


About the Author

Christy Rakoczy has a JD from UCLA School of Law and an undergraduate degree in English Media and Communications from University of Rochester. Her career background includes teaching at the college level as well as working in the insurance and legal industries. She is currently a full-time writer who specializes in the legal, financial and healthcare sectors. Ms. Rakoczy writes online content as well as textbooks for adult learners.



  1. Barbara, January 15, 2013

    Dignity guidelines is a good way to start. Let’s hope that by the time today’s 60- and 70-year-olds need longterm care, we’ll have more and better options open to us.

  2. Dennis , January 15, 2013

    Having been an RN, Board Certified In Psychiatry and a Director of Nursing in a skilled Nursing facility many years ago, I can appreciate the concern for our elderly and their safety. Psychotropics are the most dangerous class of drugs. Back in the 80′s we had interdisciplinary assessment meetings including the OT,PT, social worker and family members and only used chemical or physical restraints after significant discussion and documentation on an individual patient’s need. From a clinical stand point medication prescription is always weighted by benefit vs risk and with the use of psychotropics the desirable behavioral aspect may result in complete somnambulism or an untoward effect. Sure people abuse psychotropics everyday, somewhere, but for the most part I think Nurses can be trusted to do the right thing with these guidelines in place. I left skilled nursing and opened my own facility to take care of my own mother because I knew more about Nursing homes than I wanted to. Thank you for your article and refocusing our attention our loved ones, take care of them as if you loved them and no one can ever replace them.


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