Coalition analysis shows 1 in 5 nursing home residents still getting antipsychotics

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Editor's Note: This article has been updated from its original form.

Approximately 20% of nursing home residents — more than 250,000 nationwide — are still receiving antipsychotic drugs as part of their long-term care treatment, according to an analysis of federal data released this week by a consumer advocacy group.

The Long-Term Care Community Coalition claims only 2% of the population will ever have a diagnosis for a condition which the government uses when it risk-adjusts for potentially appropriate use.

Despite concerted industry and government efforts to phase out the use of certain drugs — and improvement noted by them and CMS — several patient advocacy organizations have continued to criticize their prevalence in long-term care.

“Too many residents and families are not even made aware of the dangerous potential side-effects of these drugs, or the fact that they are not clinically indicated for so-called dementia ‘behaviors,'” said Richard Mollot, executive director of LTCCC. The New York State based coalition of consumer, community, civic and professional organizations says its goals including raising quality and accountability of care.

The use of antipsychotics has been watched closely since at least 1987, when a sweeping new nursing home reform law prohibited inappropriate drugging and the use of chemical restraints.

In 2005, the Food and Drug Administration issued a “Black-Box Warning” on serious risks of atypical antipsychotic drugs for elderly patients with dementia.

The analysis, based on first-quarter information for 2018, provides usage rates for “every” U.S. nursing home and provides state breakdowns. It piggy-backs on other efforts to keep the heat on providers.

In February, Human Rights Watch issued “‘They Want Docile': How Nursing Homes in the United States Overmedicate People with Dementia,” a scathing report that estimated 179,000 U.S. nursing home residents are given antipsychotics without an appropriate diagnosis each week.

At the time, providers and a national association representing them said the report ignored the improvements made in nursing homes since the Centers for Medicare & Medicaid Services set a 15% reduction target in 2012.

"Skilled nursing providers across the country have worked tirelessly to safely reduce the unnecessary use of antipsychotic medications over the last six years,” David Gifford, M.D., senior vice president of quality and regulatory affairs for The American Health Care Association, said at the time. “This report does little to highlight the effort launched by our profession in 2012 that has resulted in a dramatic decline in the use of these medications, with more than half of our members achieving at least a 30 percent reduction.”

In March, AHCA announced its latest round of quality initiatives would push providers nationwide to reduce their off-label use of antipsychotics by another 10%.

CMS has also linked financial outcomes to quality improvements and prescription management.