Reducing the Use of Antipsychotic Medications in Nursing Homes
National Partnership to Improve Dementia Care: exceeds goal to reduce use of antipsychotic medications in nursing homes: CMS announces new goal
- Coalition provides tools and support to achieve continued decreases
The National Partnership to Improve Dementia Care, a public-private coalition, today established a new national goal of reducing the use of antipsychotic medications in long-stay nursing home residents by 25 percent by the end of 2015, and 30 percent by the end of 2016. The coalition includes the Centers for Medicare & Medicaid Services (CMS), consumers, advocacy organizations, providers and professional associations.
Between the end of 2011 and the end of 2013, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 15.1 percent, decreasing from 23.8 percent to 20.2 percent nationwide. The National Partnership is now working with nursing homes to reduce that rate even further.
“We know that many of the diagnoses in nursing home residents do not merit antipsychotics but they were being used anyway,” said Patrick Conway, M.D., deputy administrator for innovation and quality and the CMS chief medical officer. “In partnership with key stakeholders, we have set ambitious goals to reduce use of antipsychotics because there are – for many people with dementia – behavioral and other approaches to provide this care more effectively and safely.”
Coalition members, including AMDA – The Society for Post-Acute and Long-Term Care Medicine, American Health Care Association (AHCA), LeadingAge and Advancing Excellence in America’s Nursing Homes, are committed to achieving these new goals. The groups set these goals because they are challenging, yet achievable with the continued hard work of many stakeholders. These goals build on the progress made to date and express the coalition’s commitment to continue this important effort. The National Partnership seeks to optimize the quality of life for residents in America’s nursing homes by improving care for all residents, especially those with dementia.
“We have created many tools for nursing homes to use to help achieve these goals,” said Dr. Conway. “Ultimately, nursing homes should re-think their approach to dementia care, re-connect with the person and their families, and use a comprehensive team-based approach to provide care.”
While the initial focus is on reducing the use of antipsychotic medications, the Partnership’s larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices. CMS will monitor the reduction of antipsychotics as well as the possible consequences. For example, CMS will review prescriptions of anxiolytics and sedative/hypnotics to make sure nursing homes do not just replace antipsychotics with other drugs. In addition, CMS will review the cases of residents whose antipsychotics are withdrawn to make sure they don’t suffer an unnecessary decline in functional or cognitive status as a nursing home tries to reduce its usage.
Some states have achieved significant reduction in their rate of antipsychotic usage. For example, Georgia reduced its rate by 26.4 percent and North Carolina saw a 27.1 percent reduction. CMS released a fact sheet today with full state-by-state data as well as other data from the program.
CMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident. The Partnership has engaged the nursing home industry across the country around reducing use of antipsychotic medications with momentum and success in this area that is expected to continue. In 2011, Medicare Part D spending on antipsychotic drugs totaled $7.6 billion, which was the second highest class of drugs, accounting for 8.4 percent of Part D spending.
In addition to posting a measure of each nursing home’s use of antipsychotic medications on the CMS Nursing Home Compare website, in the coming months CMS plans to add the antipsychotic measure to the calculations that CMS makes for each nursing home’s rating on the agency’s Five Star Quality Rating System.
Antipsychotic Medical Survey Requirements
FYI: CMS issued new antipsychotic medication survey requirements for nursing homes.
On May 24, 2013, CMS issued four documents changing the survey protocols regarding the review of antipsychotic use in nursing homes:
- CMS S&C: 13-35-NH (five pages) Memo summarizing changes to Appendices P and PP related to nursing home residents with dementia and unnecessary drug usage.
- Pub. 100-04 (four pages) Changes to Appendix P of the State Operations Manual — provides interim guidance to surveyors' assessment for compliance with requirements related to nursing home residents with dementia and unnecessary drug use.
- Pub. 100-04 (48 pages) Changes to Appendix PP of the State Operations Manual — provides interim guidance to surveyors' assessment for compliance with requirements related to nursing home residents with dementia and unnecessary drug use.
- Surveyor checklist (two pages) Tool for surveyors' review of care and services for residents with dementia.
In addition to the above four documents, CMS also issued notice of the third of three mandatory surveyor video-streaming recorded programs — this one covering the topic of how to cite scope and severity for survey findings of persons with dementia and unnecessary antipsychotic drug use.
All three of the mandatory surveyor training programs covering the topic of antipsychotic drug use in nursing homes are (or will be) available for providers to view. To view the programs (as a non-surveyor):
- Go to http://surveyortraining.cms.hhs.gov
- Click on the "I am a Provider" tab.
- Click on "Reduction in Unnecessary Medications in Nursing Homes" at the menu at the top of the screen.
- Click on the program that you wish to view.
- Dept. of Veterans Affairs - A Systematic Evidence Review of Non-pharmacological Interventions for Behavioral Symptoms of Dementia
- Effect of medication on the aging body (Example: Patient Safety Advisory from the Pennsylvania Patient Safety Authority; pages 11-15)
- JAMDA: Exploratory Evaluation of Medication Classes Most Commonly Involved in Nursing Home Errors
- Medication Safety: Anticoagulant medication errors in nursing homes
- New antipsychotic drug use guidelines released
- Advancing Excellence
- AGS - Guide to the Management of Psychotic Disorders and Neuropsychiatric Symptoms of Dementia in Older Adults
- AHCA Quality Initiative
- Algorithm for Treating BPSD Assessment and Non-Drug Management
- Alzheimer’s Association
- American Health Care Association
- American Medical Directors Association
- American Society of Consultant Pharmacists
- Improving Antipsychotic Appropriateness in Dementia Patients (IA-ADAPT)
- INTERACT II
- National Ombudsman Resource Center
- Online training source - CARES Approach and free module
- Relationship Building and Communication Information from Jolene Brackey’s book, “Creating Moments of Joy”
- YouTube video about the Sunrise Home reduction efforts
Tools and Resources