Psychoactive (psychotropic/pharmacological) drugs are among the most frequently prescribed medications for the elderly in skilled nursing facilities and assisted living facilities designed for dementia residents. Psychoactive drugs are medications designed to alter behaviors through their tranquilizing effects, reduction of anxiety and depression, and sedative and hypnotic effects. CMS (Center for Medicare Services) has mandated that these medications are NOT to be used unnecessarily. The regulations state that an unnecessary drug is any drug when used in excessive doses (including duplicate therapy), for excessive duration, without adequate monitoring, without adequate indications for its use, in the presence of adverse consequences which indicate the dose should be reduced or discontinued, or any combinations of these reasons.” Duplicate drug therapy is defined as “any prescribed medication that duplicates a particular effect on an individual.” This includes two or more drugs used in combination to produce a similar effect on behavior. Duplicate drug therapy should always be analyzed for accumulative adverse effects. (Long Term Care Guidelines, CMS, 1992).
It is interesting to note what is expected of the Speech Language Pathologist in Medicare law as regards the appropriate evaluation of the dysphagia patient. To quote the law: “If you conduct videofluoroscopic assessment (modified barium swallow), document that the exact diagnosis of the swallowing disorder cannot be substantiated through oral exam and there is a question whether aspiration is occurring. The videofluoroscopy assessment should be conducted and interpreted by a radiologist (often with assistance and input from the physician and/or individual disciplines). The assessment and final analysis and interpretation should document a definitive diagnosis, identification of the swallowing phase(s) affected, and recommend the treatment plan. “ (Medicare Intermediary Manual, Part 3 – Claims Process, Transmittal No. 1528, section 450. Subsection D, paragraph 2).
Through my travels and as I read my emails, I am uncomfortable with the lack of knowledge that SLPs have regarding the laws that govern their responsibilities for evaluation and functional maintenance programs required for the dementia patients. Even if SLP’s have “some” knowledge of their “job” with the dementia patient, a fully implemented program is not instituted within the facility. So here’s a brief synopsis of the SLP’s responsibilities under the law.