The original version of this story was corrected. The last time Life Care Center of Hilton Head was cited for unnecessary medications was 2015.
After years of criticism, nursing homes are working diligently to cut down on the administration of anti-psychotics, which historically have been used to calm patients.
But across the country, and in Beaufort County specifically, the use of anti-psychotic medications still remains high in some nursing homes.
At the beginning of 2017, South Carolina ranked 18 among U.S. states for lowest use of anti-psychotics in nursing homes.
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The prevalence of anti-psychotics among long-term nursing home residents was 14.6 percent statewide at the start of 2017, down from 20.7 percent in 2011.
The federal government started tracking the off-label use of such medications in nursing homes in 2011. Although South Carolina hasn’t ranked high on the list since then, data still suggest that hundreds of residents in the state’s certified nursing homes who do not have a diagnosis that supports taking anti-psychotics are given them anyway. These drugs can be both dangerous to residents and expensive for the Medicare program.
In Beaufort County, two of the six state-certified nursing homes gave a higher percentage of long-term residents anti-psychotic medications in 2016 than the statewide average.
At Bayview Manor in Beaufort, 28.6 percent of residents received anti-psychotic medications, ranking eighth highest in the state, according to data from the Centers for Medicare & Medicaid Services.
Christy Drinkard, who started as an administrator at Bayview Manor three weeks ago, said reducing the use of anti-psychotics is one of her main goals.
“We want to make sure they (the residents) have a better quality of life and that we don’t restrain any of them chemically,” Drinkard said. “Hopefully when the January numbers come out, we’ll have a much better outlook.”
The federal data of anti-psychotic use rates exclude residents who have a diagnosis of schizophrenia, Tourette syndrome or Huntington’s disease, because anti-psychotics are indicated for those conditions. Drinkard said Bayview’s pharmacy was including residents on an anti-psychotic medication for one of those conditions.
When those residents are taken out of the equation, Drinkard said she hopes Bayview’s rate is closer to 18 or 20 percent when new numbers are released in January, she said.
At Fraser Health Center on Hilton Head Island, 24.1 percent of residents were on anti-psychotic medications in 2016.
Unlike Bayview Manor, which has 170 certified beds, Fraser Health Center is a much smaller facility with only 33 certified beds. Peter Marshall, administrator of Fraser Health Center, said this makes it hard to compare different facilities.
Last year, the facility had about 14 long-term residents, which means only a couple were on anti-psychotics, according to Marshall. Currently, none of the facility’s long-term residents are on the medications, he said.
“Oftentimes a patient comes from a hospital on those medications,” Marshall said. “We review the medications upon admission and either discontinue them or try a less stringent type of intervention. ... We try to offer other activities and identify the cause rather than go to the use of anti-psychotics.”
Elsewhere in Beaufort County, 14.9 percent of long-term residents at NHC Healthcare Bluffton, 9.8 percent at The Preston Health Center, 9.1 percent at Life Care Center of Hilton Head and none at Broad Creek Care Center were give anti-psychotics in 2016.
About 17 percent of South Carolina nursing homes in 2016 were cited for administration of unnecessary medications under federal medication rules, which can include failing to document a clinical reason for the medication, inadequately monitoring the effects of medications or giving excessive dosages. Nationally, the rate was 22 percent.
In Beaufort County, Bayview Manor was cited in 2016. Life Care Center of Hilton Head was cited in 2015.
Cheryl Dye, director of Clemson University’s Institute for Engaged Aging, frequently works with dementia patients and believes other avenues should be explored before using medications on them.
“I believe that oftentimes anti-psychotic medications are used to treat symptoms of undesirable behaviors such as agitation, aggression or wandering, rather than using approaches to address the underlying reasons for undesirable behaviors such as social isolation, depression, boredom, sensory deprivation or lack of engagement,” Dye said in an email.
“If you get to the underlying cause, the undesirable behaviors won’t be as great. They (nursing home residents) will have a better quality of life and staff will be better off by not having to deal with those behaviors as much,” Dye said.
Between 2010 and 2016, the amount of adults 65 and older increased from 13.7 percent to 16.7 percent of the population in South Carolina, according to census data. By 2030, the aging population is expected to grow to almost 22 percent in the state, a census predication estimates.
“We’re dealing more and more with the needs of aging people,” Dye said. “And unfortunately rates of dementia are going up. We’re going to have to look at new models of dealing with this.”