According to data from CMS, the percentage of long-term nursing home residents being given antipsychotic drugs dropped from about 24 percent in late 2011 to under 16 percent last year. CMS says the data show its National Partnership to Improve Dementia Care in Nursing Homes, created in 2012, has served its goal to reduce unnecessary antipsychotic medications in nursing homes.
The Partnership
CMS explains its National Partnership utilized a multidimensional approach which included public reporting, partnerships and state-based coalitions, research, training for providers and surveyors, and revised surveyor guidance to empower and build upon the efforts of organizations across the country. The initial focus of the partnership was on reducing antipsychotic medications. However, it eventually grew into a larger mission of enhancing the use of non-pharmacologic approaches and person-centered dementia care practices.The National Partnership to Improve Dementia Care announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent by the end of 2016. It also announced a new goal of a 15 percent reduction by the end of 2019 for long-stay residents in those homes with currently limited reduction rates.
Data Trends
CMS reports that between the end of 2011 and the end of quarter one of 2017, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 34.1 percent, decreasing from 23.9 percent to 15.7 percent nationwide. All 50 states showed improvement. Some states showed much more improvement than others. The states that have reduced their rate by the most percentage include the District of Columbia (47.8 percent), Tennessee (43.5 percent), California (43 percent), and Arkansas (41.6 percent).
Reaction
As reported, there was mixed reaction to the news from CMS. Dr. Jerry Gurwitz, chief of geriatric medicine at the University of Massachusetts Medical School, is quoted as describing the decrease as “one of the most dramatic changes I’ve seen in my career.” Gurwitz suggests that some nursing homes might be finding other medications that sedate their patients into passivity without drawing the same level of scrutiny as antipsychotics.
Advocacy groups like the Washington-based Center for Medicare Advocacy and AARP Foundation Litigation say even the lower rate of antipsychotic usage is excessive, given federal warnings that elderly people with dementia face a higher risk of death when treated with such drugs.
“Given the dire consequences, it should be zero,” said attorney Kelly Bagby of the AARP foundation, which has engaged in several court cases challenging nursing home medication practices. Bagby contends that the drugs are frequently used for their sedative effect, not because they have any benefit to the recipients.