CMS Aims to Reduce Antipsychotics for Dementia in Nursing Homes

The Centers for Medicare and Medicaid Services (CMS) announced on May 30 a new partnership with federal and state agencies, nursing homes and other providers, advocacy groups, and caregivers to improve dementia care in nursing homes by ensuring that antipsychotic medications are used appropriately.

The Partnership to Improve Dementia Care has set a national goal to reduce antipsychotic medication use in nursing homes by 15 percent by the end of this year. Key to the partnership’s strategy is to improve training for nursing aides.

“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,” said CMS Chief Medical Officer and Director of Clinical Standards and Quality Patrick Conway, M.D., in a press release announcing the new initiative.

Of nursing home residents with dementia, more than 17 percent were taking daily medication doses that exceeded recommended levels, according to CMS.

The following steps are being taken by the partnership to improve care:

• Enhanced training: CMS has developed Hand in Hand, a new training series targeted to nursing aides that emphasizes person-centered care, prevention of abuse, and high-quality care for residents. DVD copies of the training program will be sent to every nursing home this summer, a CMS spokesperson told PHI. CMS is also providing training focused on behavioral health to state and federal surveyors.
• Increased transparency: Beginning in July, CMS will make data available on Nursing Home Compare on each nursing home’s antipsychotic drug use.
• Alternatives to antipsychotic medication: CMS is emphasizing non-pharmacological alternatives for nursing home residents, including potential approaches such as consistent staff assignments (pdf), increased exercise or time outdoors, monitoring and managing acute and chronic pain, and planning individualized activities.

CMS is also conducting research at 20-25 nursing homes to evaluate the decision-making process for using — or not using — antipsychotic drugs for residents with dementia. The study findings will be used to target and implement approaches to improve the overall management of residents with dementia, including reducing the use of antipsychotic drugs.

— by Deane Beebe