Pain Management and Psychotropic Drugs at Gracedale

Seth Vaughn 

Contrary to what Executive John Brown stated in his annual "State of the County" Address at Hotel Bethlehem, Medicare's actual rating at Gracedale is just three stars. One of the most troubling aspects of this rating is for "quality measures," which measures things like the use of psychotropic drugs, pain management, bed sores and infections. Gracedale has just one star in this category, which is considered "much below average."  This black eye has been ignored by Seth Vaughn's Human Services Committee, but was one of the first things Pete Melan noted in announcing his candidacy for a seat on County Council. "We should not only focus on revenue and expenses but want families to place their loved ones in a safe and comforting environment and maintain a home away from home feeling," he said.

Guess what? Seth Vaughn's Committee finally addressed these lousy ratings at their meeting last week. Before things got underway, Mat Benol and Vaughn spoke on a hot mike about where to send someone who needs medical care. They also spoke about an email that court administrator Jermaine Greene had sent about the Grace Packer case, with what Benol called "canned responses." Ken Kraft told Vaughn he was lucky I wasn't there, and Vaughn snapped. "I couldn't care less what he says."

Once the meeting finally started, Vaughn asked about Gracedale's terrible rating on quality measures. Administrator Raymond Soto said the nursing home is working with Kendal Outreach to reduce both pain and the psychotropic medications.

Nothing on h Kendal Outreach's webpage even mentions the use of these drugs.

The reality is that most nursing homes, including Gracedale, improperly use psychotropic drugs. At Gracedale, one of every four residents receives antipsychotic medications, and 35% of the facility's population are on anxiety or hypnotic drugs.

A 2011 study determined that 88% of Medicare claims for antipsychotics prescribed in nursing homes were for treating symptoms of dementia even though the drugs have never been approved for dementia. Federal law prohibits the use of psychoactive drugs when they are just for the convenience of staff. It's called a "chemical restraint." There has to be a documented medical need for the drugs. These are considered "chemical restraints."

In addition to the overuse of drugs, Gracedale gets a low score on quality measures for pain management. Soto stated that there is a "pain committee," but it is a subjective matter.

Council was much more concerned about overtime,and devotedmost of the meeting to that discussion.  In February, overtime for LPNs was up 24%. For CNAs, it was up 31%.

Soto pointed to one resident who requires one-on-one nursing care, 24 hours a day. He tried to ship her to NJ, but she is not Medicaid eligible under Jersey law. Once she is, she will be sent off. No one on Council seemed troubled in the slightest by this insensitivity to a fellow human being. They were focused on cost. "Are you saying that one person drive 1,000 hours of overtime?" demanded Glenn Geissinger. Soto responded that five people get one-to-one, but only one gets it a full 24/7.

Matt Dietz complained that Council voted on changes to bring OT down."When is that going to happen?" he wondered. Now Administrator Cathy Allen jumped up to say that the county is building up its staff of per diem RNs.

Soto also noted that the nursing home received a deficiency in February because a psychiatrist made a mistake in ordering drugs.

In other Gracedale business, Human Services Director Allison Frantz reported two pieces of good news.

First, here will be an intergovernmental transfer again this year. That's what helped Gracedale return a slight profit last year.

Second, the VA has conducted an onsite inspection of the facility for residents,and the county is waiting for a contract.

She had nothing to report about the Packer case, but spoke highly of foster parents. "They do the work of angels,." she said.

If Grace Packer were still alive, she might disagree with that assessment.