CMS Increases Goal to Reduce Use of Antipsychotics in Long-term Care

  • It’s long been a goal of the Centers for Medicare and Medicaid to reduce the use of antipsychotics in nursing homes. Historically, these antipsychotics have often been used as chemical restraints to control “behaviors” in agitated or aggressive nursing home residents. The result was that many elders were unnecessarily drugged into passive, zombie-like behavior. This made them easier for staff to care for but the drugs not only reduced the quality of life of the elder, they often had life-threatening side effects. This type of so called care also reduced the elder to a state where his or her dignity was abused.

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    Good nursing homes ended this practice long ago. Some did so on their own as they become enlightened by the nursing home culture change movement. Others did so because they were pushed into it by action from the National Partnership to Improve Dementia Care, which is a public-private coalition focused on reducing the use of antipsychotics. Prior work by the coalition has exceeded previous goals by providing tools and support to achieve continued decreases of antipsychotics in nursing homes.


    CMS recently announced a new, even more ambitious national goal aimed at reducing the use of antipsychotic medications in long-term 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.


    “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 include the American Medical Directors Association (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. All are working hard to make the new goals a reality.


    “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.”


    Person centered care

    I've followed culture change in nursing homes for many years. Thankfully, through hard work by agencies such as the Pioneer Network, good nursing homes have gradually changed their focus to providing individual, hands-on, personalized care rather than the old models set up for staff efficiency. Not surprisingly, once person-centered care is in place, the residents of the nursing home are generally much easier to care for.


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    With person-centered care, each individual is treated as such. Good care facilities want to know how the person made a living, how large a family they have, spouses and children's names, as well as food preferences and any other personal details that can help with care. With this information, as well as anything else they learn along the way, the staff can treat the person as an individual rather than just one more resident.


    The Partnership’s long-term goal is to strengthen their focus on using non-pharmacologic approaches to caregiving so that only the most necessary drugs are used for the residents of nursing homes – drugs that enhance health for the residents.


    CMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for nursing home residents including those with dementia. The Partnership’s focus is to protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident.


    According a recent CMS press release, the Partnership has challenged the nursing home industry across the country to reduce use of antipsychotic medications. Their success in this area is expected to continue. 


    Nursing Home Compare

    Nursing Home Compare is a website hosted by CMS that helps people determine how nursing homes across the nation compare with one another in many areas. In the near future, CMS plans to add the antipsychotic measure to the calculations used for an overall rating. To use the site, go to Nursing Home Compare and type in the Zip code of the nursing home. You’ll gain a wealth of information just from these numbers.


    One caution. Nursing Home Compare is a valuable tool, however some inspections that help calculate these numbers are provided by states with lower requirements than other states. Therefore, a health inspection in one state could rate a 3 when in another state the same conditions could warrant a 5. Use this valuable tool but don’t forget that onsite visits, preferably at different times of the day and without a “tour guide,” can give you information about a nursing home that can’t be quantified by numbers.


    That being said, I applaud the CMS and its partners for their work. It often takes public-private cooperation to accomplish important goals.


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Published On: September 23, 2014