by U.S. Senator Chuck Grassley
Family members in Iowa are among the legions of caregivers across the country who sacrifice time, careers and money to provide care for loved ones who no longer are able to live independently or care for themselves.
The family safety net for generations has helped loved ones stay longer in their own homes and helped to enhance the quality of life for aging parents and grandparents.
Sometimes, it becomes impossible for these laborers of love to provide the 24-hour care and medical attention that America's most vulnerable population requires.
In communities across Iowa, trusted long-term care facilities provide a valuable service close to home for families who are no longer able to provide the level of care an aging or disabled loved one requires.
To be sure, America's aging population is creating increased demand for long-term care services. Nearly 1.7 million elderly and disabled Americans live in 17,000 nursing home facilities. The percentage of the U.S. population living in a nursing home is on the rise as Americans continue to defy life expectancy estimates from even a generation ago.
The two giant government health programs, Medicare and Medicaid, spend an estimated $70 billion each year for nursing home services. As a senior member of the Senate Finance Committee, which has jurisdiction over the Medicare and Medicaid programs, I've conducted extensive oversight of these programs to strengthen patient safety, track accountability within the U.S. health care system, and protect the integrity of tax dollars.
A recent federal report I requested to analyze how anti-psychotic drugs are being prescribed in nursing homes raises important questions in these areas. The audit shows an increase in the use of anti-psychotic drugs, such as Risperdal, Seroquel and Zyprexa, for so-called "off-label" use for patients suffering from dementia. The Food and Drug Administration requires makers of this class of drugs to put a "black box" warning on the product label (the FDA's strongest patient safety warning) about using these drugs for patients with dementia. In this way, the FDA warns that elderly patients with dementia who take these drugs have an increased risk of death.
Most Americans have grown accustomed to the risk of side effects when taking medication. Do nursing home residents, who are receiving powerful drugs not intended for their underlying condition, understand the risks? Are these drugs being prescribed in the best interest of the patient? Also, to what extent are Medicare and Medicaid paying for drugs that may not be in the best interest of the patient? Separately, I've examined the link between payments that pharmaceutical companies make to physicians. Some reports suggest some health care practitioners might be unduly influenced by drug companies to prescribe drugs "off label."
As more elderly patients are diagnosed with Alzheimer's disease and other forms of dementia, policymakers, patient safety advocates and health care professionals have a responsibility to protect this vulnerable population. The rising use of anti-psychotic medicines - which are FDA-approved to treat schizophrenia and bipolar disorder - may not be the best treatment for a nursing home patient exhibiting symptoms of age-onset dementia.
My list of credentials does not include a medical license. I'm not telling physicians what to prescribe to their patients. However, we all have a moral obligation to try to make sure the most vulnerable among us, the frail elderly, are not victims of medication misuse. And, as I serve Iowans in the U.S. Senate, I have a legislative license to hold to account those who receive payments from taxpayer-financed public health programs.
Friday, June 3, 2011