After numerous disclosures that antipsychotics have been aggressively promoted to nursing homes, the Centers for Medicare & Medicaid Services is trumpeting a plan to reduce usage in nursing home residents by 15 percent by the end of this year. Why? CMS data show that, in 2010, more than 17 percent of nursing home patients had daily doses exceeding recommended levels.
“A CMS nursing home resident report found that almost 40 percent of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point in 2010, even though there was no diagnosis of psychosis,” CMS Chief Medical Officer and Director of Clinical Standards and Quality Patrick Conway says in a statement that announced a partnership with nursing homes, advocacy groups, caregivers and government agencies to find a way to reduce usage.
To cope with the problem, CMS plans to offer a training series for nursing homes that emphasizes “person-centered care,” prevention of abuse and high-quality care for residents. CMS is also providing training focused on behavioral health to state and federal surveyors. The agency is also making data on each nursing home’s antipsychotic drug use available on the Nursing Home Compare web site starting in July, and will emphasize “non-pharmacological alternatives” for nursing home residents, including consistent staff assignments, increased exercise or time outdoors, monitoring and managing acute and chronic pain, and planning individualized activities.
Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, tells The Boston Globe that strong rules are in place to combat overmedication in nursing homes, but regulators too often fail to enforce them. She combed through databases nationwide to track how often nursing homes were penalized specifically for overusing antipsychotics during the past six years and could find just a handful of cases. “Even when instances are cited, nothing happens," she says.
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CMS Wants to Cut Antipsychotics in Nursing Homes