Nursing homes should be penalized for overuse of antipsychotic medications for dementia residents, federal investigator says

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The Centers for Medicare & Medicaid Services should penalize physicians and nursing homes that continue to inappropriately prescribe and administer antipsychotic medications to dementia residents, regulators urged Wednesday.

In testimony to a Senate Special Committee on Aging hearing, Health and Human Services Inspector General Daniel Levinson proposed penalties — such as barring Medicare payments — to nursing homes that inappropriately use antipsychotics. In May, Levinson's office issued a damning report that linked an increased risk of death in dementia patients to off-label prescribing of antipsychotics.

The hearing, titled “Overprescribed: The Human and Taxpayers' Costs of Antipsychotics in Nursing Homes,” also included expert testimony from nursing home advocates and physicians who discussed alternatives to medication for at-risk residents.

LeadingAge's Senior Vice President of Advocacy, Cheryl Phillips, M.D., pointed out that treating underlying pain in dementia residents can reduce the confusion and agitation that contribute to aggressive behaviors.

Tom Hlavacek, executive director Alzheimer's Association of Southeast Wisconsin, described training programs that have helped nursing home workers identify dementia behaviors.

“Staff training and education is critical and should happen at all levels in facilities,” Hlavacek said. “It's often the janitor, someone else who picks up on behaviors earlier, before waiting for problem to get worse.”

Additionally, he pointed out that high turnover rates among direct care staff can contribute to over-reliance on medications to control residents' behavior.

“We don't value these positions too highly in our society. Why aren't we providing a better standard of living for people working in these facilities?” he asked.
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