Medicare: Reduce Use of Antipsychotic Drugs in Nursing Homes

The Times Union in Albany, New York tells the story of a patient suffering from dementia who was being treated in a nursing facility. Around the same time every afternoon, she would struggle with nursing staff in order to get to the exit of the facility. Many nursing homes would choose to deal with this patient by prescribing her an antipsychotic drug such as Risperdol, which has a sedative effect, to curb her disruptive behavior. However, this particular facility was more proactive, talking with the patient’s family to learn why she may exhibit such conduct.

The family was able to shed some light on the patient’s motivation, relaying that for many years she picked her grandchildren up at the bus stop at 3 p.m. This daily ritual had ingrained itself in the patient’s memory, and even though she could not remember where exactly she was heading, she remembered she had something to do at 3 o’clock. Knowing this information, the nursing staff took creative measures to calm the patient’s behavior. They told her it was Saturday or they kept the patient occupied with activities and out of view of a clock. They never had to resort to the “chemical restraint” of powerful drugs.

Partnership to Improve Dementia Care Initiative

The Centers for Medicare and Medicaid Services (CMS) recently announced the multi-year “Partnership to Improve Dementia Care” initiative, which seeks to reduce the use of antipsychotic drugs in elderly nursing home patients and encourage of the use of other methods to calm aggressive behavior in dementia patients. For 2012, the initiative set a goal of reducing inappropriate use of these drugs by 15 percent.

CMS estimates that approximately 40 percent of dementia-afflicted nursing home residents do not suffer from a psychotic condition that would warrant the use of the drugs; however, they are prescribed the drugs anyway as a quick fix for behavior that agitates nursing staff. Data collected by CMS’ nursing home division demonstrates that in 2010, over 17 percent of residents in nursing homes were given daily doses of the drugs that exceed recommended levels.

Side effects from antipsychotics can be very serious and can include incurable muscle tremors, major weight gain, and metabolic changes that can lead to increased cholesterol and elevated glucose levels, raising the risk of diabetes. Since 2005, the Food and Drug Administration (FDA) has issued two warnings concerning the use of antipsychotics in elderly dementia patients, finding that death rates for those patients, as a result of the drugs, are much higher.

The CMS initiative plans to combat the overuse of these drugs through enhanced training of nursing staff, increased transparency of nursing homes’ use of antipsychotics and the encouragement of drug alternatives:

  • Training. A training program for nursing home staff called “Hand in Hand” will promote high quality “person-centered” care. Surveyors at the federal and state level will also receive behavioral health training.
  • Alternatives. Staff will be encouraged to use alternative methods for dealing with dementia patients that do not involve drugs. Some alternatives may consist of more time outdoors, exercise programs and individually-planned activities that cater to each patient’s interests. Acute and chronic pain management will also be emphasized.
  • Transparency. In July, CMS will begin posting data concerning the use of antipsychotics in each nursing home on the Nursing Home Compare website.

The 15 percent reduction is just a starting point for the initiative, says Alice Bonner, the director of CMS’ nursing home division. She stated, “In 2013, we will set another goal. At that point, we will be looking at even more significant reductions.”