Beers and Nursing Homes: Two Lists that are Too Important to Miss

The topics today are drugs and sorry nursing homes.

We will start with drugs first.

For those 65 and older, there is a relatively secret list of medications that they should avoid or consider with caution.  It is called the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly known as the Beers List.  Created in 1991 and updated every 3 years, the Beers List is actually 5 lists compiled using a uniform criteria for rating.

The 2019 AGS Beers Criteria includes 30 individual medication or medication classes to avoid, 40 medications or medications classes to use with caution or avoid when the patient lives with certain diseases or conditions, and several changes to medications previously identified as potentially inappropriate.

The Beers List is not an easy read because it is primarily intended for use by health care professionals.  However, since anecdotally many of those professionals do not routinely consult the Beers List, it falls on you, the patient or caregiver, to check prescribed medications against the list.

Check out the list here.

If you do find that a prescribed medications is listed as “avoid” or “use with caution,”  then contact your doctor immediately to discuss.  The AGS does not recommend that you stop taking the drug immediately since that could be dangerous.

Now let’s address sorry nursing homes.

U.S. Senators Bob Casey (D-Pa) and Pat Toomey (R-PA) released a report examining federal oversight of poor-performing nursing homes.    It focused on the Special Focus Facility program, which targets nursing homes that substantially fail to meet the required care standards and resident protections.

The Senators uncovered a huge problem.

It appears that over 500 facilities have been placed on the list for the program because of their abysmal rating, but because of “limited resources” only 88 facilities are actually in the program.  In the jargon used by the Centers for Medicare and Medicaid Services, the facilities in the program are called participants and the remaining facilities on the list are called candidates.

The names of the program participants are made public on the CMS website and are denoted with a small yellow triangle next to their name.

However, the names of the candidates have been kept private.  Even more worrisome, the candidates are not receiving any additional oversight from CMS.

The Senators were outraged and complained mightily.  CMS listened and provided the Senators with the candidates’ names, provider numbers and state names.

There are currently 435 candidate nursing homes that have documented problems.  Some have one or more of the following: unnecessary hospitalizations due to avoidable pressure sores, escaped residents with dementia, mismanagement of medication, uncleaned oxygen tubes, insect infestations, sexual assaults, unchanged dressings, and raw sewage backups in the kitchen.

The Senators appended the list to their report.

Scroll to the 25th page to find the 40 Texas facilities that made the list.

Virginia Hammerle is a licensed Texas attorney.  Her practice includes estate planning, litigation, guardianship and probate law.  See hammerle.com for her blog and newsletter sign-up.  This column does not constitute legal advice.