Daily Editors' Notes

Push to decrease antipsychotics use has only just begun

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James M. Berklan, McKnight's Editor
James M. Berklan, McKnight's Editor
If you feel like you've been reading a lot about antipsychotics lately, you're not alone. People inside and outside of long-term care alike have been feeling the pressure to lessen antipsychotics' use.

The federal government is both riding providers' own initiative, and digging its spurs into them to make sure something gets done.

Cheryl Phillips, M.D., Leading Age's Vice President for quality matters wrote an excellent piece within the last week about “getting a jump on nursing home quality” by addressing inappropriate use of antipsychotics. If you're a provider, you need to check it out for important checklists.

Then, independent of that, Uncle Sam almost immediately announced a new national initiative aimed to lessening “unnecessary antipsychotic use.”

You'll want to tune in to the good Uncle's (OK, it's really the Centers for Medicare & Medicaid Services') one-hour video event at 1 p.m. (Eastern) on March 29. Attendees will receive an overview of the program, resources for technical assistance, and information about plans for upcoming educational offerings.

And who do you have to thank for all of this heightened attention — and tension?

While providers have been investigating the issue, they've also received more than a helping hand from Sen. Charles Grassley (R-IA), who held a hearing on the topic last year and hasn't let go since. That has kept the fire stoked for CMS to put some bite in its growl about these matters, LeadingAge's Phillips acknowledged.

“I don't think anyone would say that 20% [the average of LTC residents on antipsychotics] across the country is a good number or the right thing. We can do better,” Phillips told me Tuesday. “A push came from advocates, but at the same time, many providers have been working hard at the local level to do a better job of dementia care. Providers really believe they can do a better job.”

There have been plenty of “little hiccups of activity” around the antipsychotics issue in recent years, Phillips noted. But now many forces have “coalesced” to bring about change.

That includes the American Health Care Association saying one of its quality goals deals with antipsychotics, and the Advancing Excellence campaign taking the issue as one of its quality goals.

“Nobody's saying we're going to outlaw antipsychotics or eliminate them, but we do see the opportunity how we can do a better job of caring for people with dementia,” Phillips said. “All of these forces can be aligned for a common good.”

And before you get the wrong idea, don't think less antipsychotic use necessarily means more exorbitant staffing costs for more workers who need to keep an eye on more unpredictable residents.

Phillips rightly points out that less antipsychotic use means staff have to spend less time with certain documentation, and residents are less likely to need as much help completing activities of daily living.

Sound observations, but definitely not the last word on the issue of antipsychotics in long-term care. As you'll see, and feel, for yourself in the coming days.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.


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