BOSTON (STATE HOUSE) – Nursing homes and long-term care facilities in Massachusetts would be required to receive informed written consent from a patient’s family, guardian or health care proxy if doctors prescribe psychotropic medications to a patient, under an amendment added to the Senate budget last week.
Family members of those with dementia and Alzheimer’s have pushed for years to have legislators strengthen laws around informed consent of anti-psychotic drugs for patients in nursing homes and long-term care facilities, arguing the drugs have unwanted side effects in dementia patients, including seizures. The drugs are overprescribed, often without a family’s consent, as a way for nursing care staff to quell unwanted behavior among patients, they say.
Alzheimer’s Association of Massachusetts spokeswoman Betsy Campbell said the organization has been watching the use of these medications for years, and advocating for families to be informed when they are prescribed.
Banker White, whose mother was diagnosed with early onset Alzheimer’s disease at 61-years-old, said having discussions with his mother’s doctor about her medication made all the difference. His mother, who lives in Dedham and is cared for by his father, was prescribed Risperadone, a psychotropic drug that was used to control violent episodes. White would like to see informed written consent be required.
“There needs to be a real understanding of why they are being used; how they are being used, and there is a game plan in place,” he said.
Psychiatrists and nursing home operators say singling out anti-psychotic drugs for increased regulation would tie their hands in caring for patients. Doctors and caregivers say some patients need the drugs for depression, anxiety and other mental health problems that often coincide with dementia.
Dr. James Ellison, the director of the geriatric psychiatry at McLean Hospital in Belmont, said psychiatrists have concerns about consent requirements.
Managing behavioral and psychiatric symptoms for patients with dementia is critical to caring for them and optimizing their quality of life, Ellison said. “It is problematic if that process becomes very cumbersome,” he said.
He added, “If the care of cognitively impaired patients, if it is made more cumbersome, there is a concern that long-term care facilities will be resistant to be admitting them.”
The amendment requiring informed written consent, sponsored by Sen. Kathleen O’Connor Ives (D-Newburyport), was among a bundle of amendments the Senate quickly and quietly approved as part of the fiscal year 2015 budget.
Top Senate aides could not say last week how many amendments had been crammed into “yes” and “no” bundles that were adopted and rejected on single votes and without debate. On Tuesday, five days after the Senate had wrapped up its budget debate, a Senate Ways and Means Committee aide told the News Service that 287 proposals were included in the rejected bundle and 120 were added to the budget in the “yes” bundle.
The House-controlled Committee on Mental Health and Substance Abuse considered similar legislation and sent it to a study, which usually means the bill won’t pass. The bill (H 1804), filed by Rep. Shaunna O’Connell (R-Taunton), called for standardized protocols for written authorization from a patient’s family member or representative before psychotropic drugs are given. The legislation would have required patients and their families to be educated on the side effects and any alternatives.
Lawmakers thought requiring informed consent for everyone could create a problem for those without family, or guardians, according to an aide for the committee. In addition, the state Department of Public Health has a program called Oasis that attempts to address the problem of overprescribing the medications through staff training, according to legislative staff.
O’Connell said she did not try to get the legislation passed as an amendment to the House budget, but instead was continuing to work with the committee to address concerns expressed by caregivers.
“Our bill just tightens up the rules a little bit. It requires it to be in writing, to include families when possible, and further protect the individuals,” she said.
The Senate amendment now becomes part of larger talks six lawmakers who will ultimately recommend which proposals to include in an annual budget that’s likely to top $36.3 billion.