There Are Some Great “Nursing Homes,” But …


First, let’s get my disclaimer out of the way. My wife and I are  such a strong believers in aging in place, with home care assistance, as necessary, that we left senior positions at Intel Corporation to start Support For Home In-Home Care. I have written about our own families’ experiences, that contributed greatly to that decision, in prior articles.

That having been said, there are a number of good skilled nursing facilities out there, with some of which we actually work closely, here in the greater Sacramento region. I have a knee jerk reaction against calling them nursing “homes,” however, but that is what many folks call them, including the Journal of the American Medical Association, in the study I want to talk about.

That study describes a far too prevalent practice of prescribing  medication of quite dubious value to residents / patients with dementia. In fact, the title of the article is pretty clear, “Use of Medications of Questionable Benefit in Advanced Dementia“.

Per the study, “Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received at least 1 medication with questionable benefit …” That cost real money. “The mean (SD) 90-day expenditure for medications with questionable benefit was $816 ($553), accounting for 35.2% of the total average 90-day medication expenditures for residents with advanced dementia who were prescribed these medications.”

Why is this being done? I have had clinicians suggest that sometimes it is simply about control of the patients / residents. In other situations, it is probably a lack of up to date information on medications, which is not a good thing, but …

What is your experience on this problem?

Best wishes. Bert

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