In late February of this year, the Department of Health ran a routine certification survey at Rockaway Care Center, a nursing home in Queens. The DOH uncovered several deficiencies related to patient care at the facility. Among these areas of concern was the facility’s failure to keep its residents’ medication regimens free of unnecessary drugs. The two relevant residents detailed in the DOH survey were each prescribed daily “hypnotic” drugs. One of the residents was on this regimen for three years, the other for ten months. Nothing in the investigation showed that any type of reduction of dosage was attempted by the facility for the respective periods that the residents were prescribed these medications.
Both residents suffered from bipolar disorder, and as such were prescribed Ambien to assist with relaxation and sleeping at night. While this may in fact be an effective form of treatment for residents with such issues, federal regulations state that residents prescribed drugs such as these should receive gradual dose reductions, coupled with behavioral interventions, unless this is clinically contraindicated. Simply put, the goal of a facility is to wean residents off of anti-psychotic and hypnotic medications through other, non-pharmaceutical methods.
The DOH report indicates that the length of time of these prescriptions, on their own, was not the issue with either of these residents. Rather, it was the lack of exploration of alternative methods of behavior adjustment. Resident one was not monitored for the effectiveness of the Ambien in treating his issues. Further, although the resident had several psychiatric visits per year and psychotherapy sessions weekly, there were rarely annotations in the record of alternative methods of behavior modification or dosage reduction.
Like the first resident, there was little to no documentation in resident two’s chart that alternatives to Ambien were attempted. In an interview with the resident himself, he told the DOH that the medicine did not even work effectively. He also reportedly spends much of each day in bed.
All of this is not to say that the medication regimens were incorrect. The administration of the hypnotics may have been the correct diagnosis for each resident. Alternatives to hypnotics and anti-psychotics can allow a resident to lead a fuller, more active life. The facility has a duty to research and attempt alternative solutions, which it appears was not done in the cases of these residents.
The Department of Health report for Rockaway Care Center can be accessed here.