By Peter Eisler
Mon., Nov. 17, 1997
WASHINGTON -- Ten years after Congress attacked improper drug
use by nursing homes in a sweeping set of reforms, federal
investigators say tougher rules are needed to combat lingering
In a report today that suggests thousands of nursing home
patients get "inappropriate" medicine, the Department of Health
and Human Services inspector general sees Congress' 1987 reforms
as largely successful. No longer are patients commonly drugged
The big problem now tends to be unwitting errors, the report
says, resulting in poor drug interactions, overmedication and bad
"Our recommendations will require doctors, nurses and
pharmacists to work together more effectively," says George
Grob, a deputy inspector general who worked on the report. "The
systems that were put in place 10 years ago clearly are beginning
to work, but more needs to be done."
On Capitol Hill, some were more critical.
"Neither the spirit nor the intent of the (1987 reforms)
relating to prescription-drug use are being fulfilled," says
Sen. Charles Grassley, R-Iowa, who chairs the Special Committee
on Aging. "These concerns merit prompt and definitive action."
Grassley wants a report next year on what has been done. The
report recommends that nursing homes be required to:
Keep better records on what drugs patients are taking and what
results are expected. Ensure pharmacists review drug use and see
that their concerns reach doctors and nurses. Better train staff
to recognize adverse drug reactions.
Industry groups concede some of the problems cited by the report
but reject the call for new rules.
"Some of the (studies') findings . . . could be helpful," the
American Association of Homes and Services for the Aging (AAHSA)
says in a letter to the inspector general. "However, we are
concerned with some of the methodologies used in the study, the
limited nature of the findings and the recommendations for new
program requirements that are not justified."
AAHSA and other industry groups note that the studies'
assumptions of inappropriate drug use are based largely on a
national survey of nursing home pharmacists, whose reporting may
be biased by a desire for more authority.
They also dispute the importance of findings from an audit of 254
patients in Texas that up to 17% of nursing home patients there
get improper drugs. What happens in Texas isn't necessarily what
happens nationwide, they say.
"What this (report) does is peel off another layer," says Sarah
Burger of the National Citizens Coalition for Nursing Home
Reform. "People aren't taking 15 or 20 different drugs anymore,
so there's progress. But even with fewer drugs, the ones they are
taking aren't being monitored in a way that prevents untoward