CMS wants to reduce use of antipsychotics for dementia

The Centers for Medicare and Medicaid Services (CMS) is partnering with providers, caregivers, and patients to ensure appropriate use of antipsychotic medications for nursing home patients, the government announced last week.

CMS Acting Administrator Marilyn Tavenner said the Partnership to Improve Dementia Care has set a national goal of reducing use of antipsychotic drugs in nursing home residents by 15% by the end of this year.

“We want our loved ones with dementia to receive the best care and the highest quality of life possible,” Tavenner said in a statement.

Antipsychotic drugs are not approved by FDA for dementia, and several have received black box warnings about the dangers of giving such drugs to elderly patients. Still, CMS data show that in 2010 more than 17% of nursing home patients had daily doses exceeding recommended levels.

And a study published last year by the Office of the Inspector General also found that 1 of every 7 elderly nursing home residents is receiving at least 1 atypical antipsychotic; in 83% of these cases, the drug is associated with a dementia diagnosis.

According to a news release, CMS is taking several steps with industry and advocacy partners to achieve its goal of reducing use of antipsychotic medications for patients with dementia:

• Enhanced training. CMS has developed Hand in Hand, a training series for nursing homes that emphasizes person-centered care, prevention of abuse, and high-quality care for residents.
• Increased transparency. CMS is making data on each nursing home’s antipsychotic drug use available on Nursing Home Compare starting in July of this year, and will update this data.
• Alternatives to antipsychotic medication. CMS is emphasizing non-pharmacological alternatives for nursing home residents, including potential approaches such as consistent staff assignments, increased exercise or time outdoors, monitoring and managing acute and chronic pain, and planning individualized activities.

“Managing dementia without relying on medication can help improve the quality of life for these residents,” said Patrick Conway, MD, CMS chief medical officer and director of clinical standards and quality. “The Partnership to Improve Dementia Care will equip residents, caregivers, and providers with the best tools to make the right decision.”

CMS is also conducting research to better understand the decision to use or not to use antipsychotic drugs in residents with dementia, the government’s news release said. A study is under way in 20 to 25 nursing homes, evaluating this decision-making process.