Image of male nurse pushing senior woman in a wheelchair in nursing facility

It turns out McKnight’s Editor Jim Berklan is psychic, or at least a well-read prognosticator of long-term care.

On the day he predicted that federal interest in antipsychotics wasn’t going to go away, an expanded federal initiative was unveiled that, in part, says that the American Health Care Association’s quality goal to reduce antipsychotic off-label use by 15% in 2012 is a good idea.

To be fair, the Centers for Medicare & Medicaid Services stepped into the waters of this months ago when it announced the “National Initiative to Improve Behavioral Health & Reduce the Use of Antipsychotic Medications in Nursing Home Residents” in March. Then, it said at the American Association of Nurse Assessment Coordinators meeting in April that antipsychotic use should be part of the 5 Star Quality Measurement system.

It’s no great surprise that Wednesday’s phone call featured not only Shari Ling, M.D., CMS Deputy Chief Medical Officer, AHCA’s David Gifford, M.D., and LeadingAge’s Cheryl Phillips, M.D., but also a woman giving testimony about her father’s experience being given antipsychotics in a nursing home, and fire and brimstone comments from Claire E. Curry, the legal director of Civil Advocacy Program for the Legal Aid Justice Center. Curry talked about not only the issue of antipsychotics, but the group’s desire for pharmacists being independent in nursing homes, and I could imagine various industry sorts banging their heads against their desk. 

That said, it felt rare to get a Kumbaya moment between CMS, AHCA, LeadingAge and consumer groups, and there’s hope that maybe everyone is on the same page. If you didn’t know better, you could be baffled by the antipsychotic pushback from nursing home administrators that can be found in McKnight’s comments sections online. But what underpins the lack of desire for change is fear. The biggest theme we hear about is a lack of staff — if there’s not enough money to hire staff to deal with the residents, of course, medication is the easy answer. The other is that family members are often pushy about keeping their loved one from acting out and want them to be medicated.

That’s why, as cynical as I am about many government initiatives, I was pleased that CMS is providing staff training, and suggestions from alternative activities, not just slapping down the 15% goal. Those who scoff at the idea of non-traditional cures for behavioral problems should spend time watching the various videos of pets in nursing homes, or witness the joy that comes from residents doing horticulture therapy.

LeadingAge’s Phillips made the accurate point that not all off-label use of antipsychotics is wrong; consumer groups, meanwhile, will continue to push for higher percentages of residents weaned off the antipsychotics. But for the moment, it’s refreshing to see a common goal uniting those on all sides of the long-term care industry.