A coalition of consumers, advocacy organizations, providers, and professional associations is called to reduce the use of antipsychotic medications in long-stay nursing home residents, according to the Centers for Medicare and Medicaid Service (CMS).
Some members of the National Partnership to Improve Dementia Care include CMS, the American Health Care Association, LeadingAge, Advancing Excellence in America’s Nursing Homes, and AMDA — The Society for Post-Acute and Long-Term Care Medicine. The coalition established the goal of reducing use of these medications by 25% by the end of 2015 and by 30% by the end of 2016.
There is some controversy with the numbers being proposed. Representatives from California Advocates for Nursing Home Reform, the Center for Medicare Advocacy, National Consumer Voice for Quality Long-Term Care and the Long Term Care Community Coalition wrote to CMS in July that they could not endorse the goals set.
“…we feel the proposed goals do much too little to protect nursing home residents from overuse of antipsychotic medications and will not meaningfully improve current drugging practices, which place too many nursing home residents at risk of harmful treatment,” the authors wrote to Karen Trist, CMS director of Nursing Home Survey and Certification.
The use of antipsychotics in long-stay nursing home residents has already been reduced by 15.1% between the end of 2011 and the end of 2013 to a rate of 20.2% nationwide. Over the last 21 months use has reduced even further to a rate of 19.8%. However, the coalition is looking to reduce the rate even further.
All 50 states and ever CMS region showed at least some improvement, according to a report from CMS. Hawaii led the charge with a 31.4% reduction in the use of antipsychotic medications, followed by North Carolina (29.9%) and Vermont (28.2%).
In 2011, Medicare Part D spending on antipsychotic drugs totaled $7.6 billion, accounting for 8.4% of spending.
“We know that many of the diagnoses in nursing home residents do not merit antipsychotics but they were being used anyway,” said Patrick Conway, MD, 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.”
Ultimately, the Partnership is aiming to enhance use of non-pharmacologics and person-centered care. As the use of antipsychotics is reduced, CMS will monitor the situation to ensure nursing homes are not replacing antipsychotics with other drugs.