Nursing Homes Patients’ Chronic Pain Often Left ‘Unnoticed and Untreated’

A new study by researchers at Brown University Medical School found that 14.7% of nursing home residents experience "persistent pain" after being assessed by the nursing home staff. Appearing as a letter in the April 25 issue of the Journal of the American Medical Association, the study examined the rate of "persistent severe pain" among all 2.2 million residents of U.S. nursing homes within 60 days of April 1, 1999, finding that of those residents who reported "moderate or excruciating pain" at first assessment, 41.2% reported "severe" pain at a second assessment 60 to 180 days later (Teno et al., Journal of the American Medical Association, 4/25). Researchers attributed the "pain problem" to several factors, including insufficient Medicaid reimbursements for nursing homes, a shortage of geriatricians and a fear of drug abuse if "too much" medication is prescribed to treat pain (West, Arizona Republic, 4/24). Moreover, researchers suggest that the reported number of nursing home residents who experience persistent pain is likely to be "underestimate[d]" because the data were reported by home staff members rather than residents themselves. In addition, the researchers note that states with lower rates of persistent pain may not "adequately" assess the problem, while states with high rates of reported pain "recogniz[e]" but fail to adequately treat the problem (Journal of the American Medical Association, 4/25). Dr. Joan Teno, a geriatrician and co-author of the study, said, "Some [nursing home residents] are labeled as disruptive, difficult or demented, and the issue is they are in pain and going untreated. [W]e are dealing with a fragmented health care system, and one not built around meeting the health care needs of an older and frailer population." Teno also suggested that state and federal inspectors rate the quality of pain management during nursing home inspections and that families should ask about a nursing home's "pain treatment policy" when choosing a facility.

Arizona Examines Problem
While Arizona ranked seventh-highest among states in persistency of "severe pain" among its nursing home residents, the Arizona Republic reports that the state "may be ahead" of other states in solving the problem. According to Anjali Tierney, communications director for the Arizona Health Care Association, the state has more skilled nursing facilities than it did when the study was conducted two years ago, adding that many state nursing homes have started "extensive pain management" programs. In addition, the state Legislature this year approved a "long term care council" tasked with addressing elder care issues (West, Arizona Republic, 4/24). The study, including a state by state comparison of pain rates, is available here.