One of our very insightful professional Infomail readers suggested that our comments about who the antipsychotic drug stakeholders (beneficiaries) are should be amplified.

Yesterday’s Infomail stated:

"The drugs’ beneficiaries are not those who ingest them: antipsychotic drug sales have enriched not only drug manufacturers, but psychiatry’s leadership, leading medical institutions, the mental health provider industry, and so-called patient advocacy groups—all of who have sold their integrity, serving as industry’s partners in a despicable crime."

The other very important, in fact, essential, group of beneficiaries:  THE CARETAKERS.  

In geriatric facilities, that group includes the attendants, nurses, and physicians, for whom feeding and toileting a zonked-out zombie is less unpleasant and less time-consuming than feeding, toileting, and coping with the demands of a disoriented, frightened, unhappy old woman. 

In children’s foster homes, the beneficiaries are the "parents," and in group homes and "shelters" for children the beneficiaries are the attendants.  Why deal with the tiresome, contentious, time-consuming struggles of parenting when, at the drop of a pill, the brats can be sent to la-la land?  Indeed this has been documented.

See, Texas Comptroller’s investigative reports : Strayhorn, CK. Forgotten children, Texas Comptroller, April 2004.  and a follow-up report (2006): http://www.window.state.tx.us/specialrpt/hccfoster06
https://ahrp.org/cms/content/view/505/108/

See: Florida Study by Florida Department of Children and Families :  and
http://www.palmbeachpost.com/localnews/content/state/epaper/2009/08/13/0813_kids_drugs.html

Both the old and new antipsychotics (neuroleptics) double the risk of sudden death in those who take them.
See: Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death by Wayne A. Ray, Ph.D., Cecilia P. Chung, M.D., M.P.H., Katherine T. Murray, M.D., Kathi Hall, B.S., and C. Michael Stein, M.B., Ch.B. New England Journal of Medicine, Volume 360:225-235, January 15, 2009   

Indeed, the risk of death in elderly patients taking an antipsychotic rises to threefold:
The FDA issued a Black Box label warning in 2005 after finding 60% increase in risk of sudden death in review of 17 trials in older patients receiving atypical antipsychotics for dementia–for which the drugs have shown NO CLINICAL BENEFIT.

Given the number of reported deaths of children prescribed antipsychotics, it is more than likely that were scientific studies conducted to document the risk for children, the Black Box would be expanded.
 
Despite the serious risks–including death–these two groups–institutionalized old people and children out-of-family-home–comprise the fastest growing population for whom antipsychotics and untested combinations of psychopharmacology are prescribed off-label, mostly by psychiatrists–despite Black Box warnings.

Children in foster care and the elderly in nursing homes comprise a high proportion of victims of polypsychopharmacy–which is the wonton prescribing of untested drug combinations that have been shown to result in sudden deaths.

Part of what is driving the off-label use of psychopharmacology in geriatric facilities is likely the profit motives of the facilities’ owners—and the fact that these very expensive drugs are mostly paid for by the government:

1.  Semi-somnolent inmates require fewer staff than fully conscious inmates.  Imagine the profit if a nursing home could be staffed 24/7 with the same skeleton crew that otherwise would work only the graveyard shift.  Use of psychopharmacology is a big step in the direction of staff reduction. 

And wouldn’t you know it, as Medicare and Medicaid foot most of the bills for nursing home residents—including psychotropic drugs for off-label uses–Wall Street investment firms have been acquiring thousands of nursing homes and reaping huge profits by cutting costs.

In 2007, The New York Times analyzed trends at nursing homes purchased by private investment groups by examining data (2000 to 2006) available from the Centers for Medicare and Medicaid Services. http://www.nytimes.com/2007/09/23/business/23nursing.html

Since 2000, more than 1,200 nursing homes purchased by large private investment groups, and more than 14,000 other homes. The analysis compared investor-owned homes against national averages:  including complaints received by regulators, health and safety violations cited by regulators, fines levied by state and federal authorities, the performance of homes as reported in a national database.

An example cited by The Times: "Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002. The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier.  Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration."

"The investors and operators were soon earning millions of dollars a year from their 49 homes. Residents fared less well…"

See:  At Many Homes, More Profit and Less Nursing By CHARLES DUHIGG, The New York Times, September 23, 2007.

The conscientious nursing home owner would soon become a bankrupt former owner, as investor owned competitors would beat him in the economic race to the bottom.

Curiously, the Times did not examine the unprecedented escalating use of antipsychotics at those homes during those years when services and resident-care were cut. 

Corporate greed and government subsidies define the nursing home industry as they do every facet of the healthcare industry.

Corporate business ethics and investors’ interests have swept aside the humanitarian foundation of American medicine and most of related healthcare, and caring service professions.

Without government subsidies, many, if not most, of America’s shameful healthcare malpractices would not be possible or profitable. 

See: At Many Homes, More Profit and Less Nursing By CHARLES DUHIGG. The New York Times, September 23, 2007

Posted by Vera Hassner Sharav

Medical News Today
Many Nursing Homes Being Acquired By Wall Street Investment Firms
26 Sep 2007

As Wall Street investment firms in recent years have acquired thousands of U.S. nursing homes, they have "often reduced costs, increased profits and quickly resold facilities for significant gains," but by "many regulatory benchmarks, residents at those nursing homes are worse off, on average, than they were under previous owners," the New York Times reports. In an analysis of data collected by CMS from 2000 to 2006, the Times found large private investors who have purchased nursing homes have increased their profits by cutting expenses and staff, sometimes below minimum legal requirements.

The analysis includes information from more than 1,200 nursing homes purchased by large private investment groups since 2000 and more than 14,000 other homes. In recent years, large private investment groups have agreed to purchase six of the nation’s 10 largest nursing home chains, containing over 141,000 beds — 9% of the nation’s total — in addition to owning at least another 60,000 beds at smaller chains. The Times reports that chains owned by private investment companies were 41% more profitable than the average facility in 2005, with privately owned homes earning $1,700 per resident, according to reports filed by the facilities.

The Times analysis shows that many nursing homes acquired by private investment groups before 2006 scored worse than national average rates for 12 of 14 indicators of care, including bedsores and preventable infections. Before they were taken over, those same facilities often scored at or above national averages.

According to the Times, the complexity of the corporate structures that are established when an investment firm acquires nursing home properties makes it difficult for family members to sue. About 70% of attorneys who once pursued lawsuits against nursing homes have stopped doing so because the cases have become too expensive or difficult, according to estimates from Nathan Carter, a Florida plaintiffs’ lawyer. Corporate complexity also makes it harder for regulators to know when one company controls several properties and to collect on fines levied. Advocates for industry reform say that "anyone who profits from a facility should be held accountable for its care," the Times reports.

Comments
Ronald Silva, president and CEO of Fillmore Capital Partners — which paid $1.8 billion last year to buy one of the nation’s largest nursing home chains — said nursing homes are "essentially unlimited consumer demand as the baby boomers age," adding, "I’ve never seen a surer bet."

Jack MacDonald, an executive with a company owned by Fillmore, said the Times analysis was incomplete, adding, "We are focused on becoming a better organization today than we were 18 months ago. We are confident that we will be an even better organization in the future."

In addition, investment groups say that they "deserve credit for rebuilding an industry on the edge of widespread insolvency," the Times reports. Arnold Whitman — a principal with Formation Properties I, a fund that has bought nursing home properties — said, "Legal and regulatory costs were killing this industry," adding, "We should be recognized for supporting this industry when almost everyone else was running away."

However, Charlene Harrington, a professor at the University of California-San Francisco who studies nursing homes, said, "The first thing owners do is lay off nurses and other staff that are essential to keeping patients safe." She added that the chains "have made a lot of money by cutting nurses, but it’s at the cost of human lives."

Toby Edelman, a nursing home expert with the Center for Medicare Advocacy — a not-for-profit group that counsels people on Medicare — said, "Private equity is buying up this industry and then hiding the assets. … And now residents are dying, and there is little the courts or regulators can do" (Duhigg, New York Times, 9/23).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.