B.C. care homes provide anti-depressants without diagnoses — (Times Colonist)

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Times Colonist

Lori Culbert Rob Shaw and Tara Carman / Vancouver Sun

April 7, 2016 07:47 AM

B.C. care homes provide anti-depressants without diagnoses

New data from B.C.’s Seniors Advocate shows residents in the majority of care homes in the province are still being prescribed anti-depressants and anti-psychotics without having a diagnosis for those ailments.

It has been a priority in B.C. to reduce these numbers, but a Vancouver Sun analysis has found 22 facilities in which more than 40 per cent of residents are taking anti-depressants without a diagnosis of depression. The Evergreen Seniors Home in Campbell River was doing this for 58 per cent of residents in 2014/15, according to the report by advocate Isobel Mackenzie.

And there are a whopping 54 homes in which more than 40 per cent of residents are taking anti-psychotics without a diagnosis. The Kiwanis Care Centre in North Vancouver, for example, was doing this for 65 per cent of residents.

Nearly all of the 292 care homes in B.C. were over-prescribing one or both of these meds without a diagnosis, ranging from a low of 0.5 per cent of clients to a high of 100 per cent.

Despite the shocking numbers, the situation is improving. Between April 2010 and June 2011, the health ministry said half of seniors in residential care facilities were being prescribed anti-psychotics. Four years later, Mackenzie said, about a third of the 25,000 people in residential care are prescribed the drugs.

Change started in 2012, with Ministry of Health guidelines for doctors and other health care workers designed to reduce these prescriptions. The guidelines suggest an individual approach to each patient to explore alternatives such as calming touch, music, physical activity or distraction.

The government also created a project called CLeAR — Call for Less Antipsychotics in Residential Care — to help long-term care facilities find other ways to treat dementia patients.

The B.C. Care Providers Association, which represents approximately 60 per cent of the government’s contracted-out beds, has as well issued an anti-psychotic best practices guide for its members, said director of policy Michael Kary.

“We definitely think it is an issue and we have taken steps to see it reduced,” he said.

Kary noted, however, it is doctors, not the care facilities, who prescribe medication to the patients.

Fraser Health Authority spokeswoman Tasleem Juma said care homes collaborate with physicians regarding patient medications. A new protocol has “created a cultural shift away from a more medical model towards a person- and family-centred model” that has reduced the use of anti-psychotics.

And last year, Fraser Health began a pilot program in two different care homes — The Residence in Mission and the George Derby Centre in Burnaby — that aims to reduce polypharmacy (the use of four or more medications by seniors), Juma said.

The NDP attacked the government Wednesday for the over-use of medication in care homes. Critic Judy Darcy said some seniors are drugged because they become disruptive due to dementia and there aren’t enough staff to care for them.

“It’s called chemical restraint and it’s an inhumane way to treat our seniors,” said Darcy.

Health Minister Terry Lake said it’s a concern for his ministry.

“We’ve made some progress, and the Senior Advocate I think recognizes we’ve made some progress, but we’re not where we need to be especially compared to some other provinces,” said Lake.

“We need to continue to reduce the unnecessary use of medications. I’m a firm believer in trying to get away with the least amount of medications because they can have obvious positive impacts but particularly when you are getting into polypharmacy there are potentially negative impacts as well.”

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