Trump Drug Prescription Policies Not Protecting Nursing Home Residents

According to a new study published in July 2020 by health researchers for Rep. Richard Neal (D-Mass.), citations for over-prescribing anti-psychotic drugs are down in the Trump administration.  The study’s lead author, Rachel Dolan, concluded that citations for prescribing unnecessary antipsychotic drugs to nursing home residents were shockingly low during the first half of the Trump administration, even for the most serious offenses which led to actual harm.

Nursing homes are required to limit the amount of anti-psychotic and psychotropic drugs being used for their patients, explains malpractice attorney Jeffrey J. Downey.  These drugs can have dangerous side effects and are sometimes abused as chemical restraints.  Under laws passed in the 1980s, skilled nursing facilities (“SNFs”) are required to provide monitoring and dose reduction of such medications, unless clinically contraindicated. 42 C.F.R. 483.l (unnecessary drugs). The use of such medications can cause or contribute to falls, bed sores (pressure sores) and other adverse outcomes, including deconditioning.

To ensure quality of care nursing homes are subject to annual inspections by state Departments of Health, applying federal regulatory standards. Aside from our civil justice system, these inspections remain one of the only quality-of-care checks on SNFs.  Between 2015 and 2017, citations for medication misuse in SNFs increased by 200%.   Under Trump’s reign, these citations have declined by 22%.  This decline in regulatory oversight, coincided with a number of Trump policies that put nursing home residents at risk.  The Trump Administration rolled back fines and changed the way fines were assessed, causing financial penalties to drop by about 33%.

In fact, before the Covid-19 pandemic, the Trump administration had rolled back regulations aimed at preventing the transmission of infectious diseases in SNFs. The Trump administration had also promised to be tough on Medicare fraud, but the Trump administration voluntarily dismissed one of the largest cases ever pursued against a nursing home chain, ManorCare, which was over $500 million. The case had been filed by the Obama Department of Justice (DOJ) and was set for trial when it was dismissed by the Trump DOJ.  ManorCare was owned by the Carlyle Group, who has close ties to the Administration.  The prosecution of nursing homes for Medicare fraud, while common in the Obama administration, has not been a priority for Trump.

When it comes to protecting the rights of abused nursing home seniors, the Trump Administration also withdrew an Obama regulation that prohibited nursing homes from requiring residents to sign mandatory arbitration provisions as a condition of admission. In other words, President Trump made it easier for SNFs to require elders to waive their rights to file a case in court, if they are abused, neglected or killed.

Nursing homes are so emboldened by their new protections that some facilities do not even respond to record requests from patients or their attorney, explains Downey.  This type of nonsense never happened in previous Administrations, even Republican Administrations.   Unfortunately, when it comes to President Trump’s priorities, while his Administration had given lip service to protecting our elders, his policies have had the opposite effect.   Large, for profit nursing home chains have been given carte blanche to ramp up their profits, while sacrificing the safety of our most vulnerable seniors.

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