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CMS, Partners to Reduce Antipsychotic Drugs for Dementia in Nursing Homes

Government joins providers, caregivers, patients to ensure better use of antipsychotic drugs in nursing homes; follows bi-partisan senate action to curb use of the drugs<

May 31, 2012 - With a goal of reducing use of antipsychotic drugs in nursing home residents by 15 percent by the end of this year, the Centers for Medicare and Medicaid Services yesterday introduced the Partnership to Improve Dementia Care. No doubt a motivating factor is a bill crafted by Sen. Herb Kohl, chair of the Special Committee on Aging, that will require Health and Human Services to gain consent from nursing home patients or their guardians prior to the administration of these drugs.

In making the announcement, CMS Acting Administrator Marilyn Tavenner, said the initiative to ensure appropriate care and use of antipsychotic medications for nursing home patients is a partnership among federal and state partners, nursing homes and other providers, advocacy groups and caregivers

Unnecessary antipsychotic drug use is a significant challenge in ensuring appropriate dementia care, according to CMS. Agency data show that in 2010 more than 17 percent of nursing home patients had daily doses exceeding recommended levels.


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

“We are partnering with nursing homes, advocates, and others to improve the quality of care these individuals receive in nursing homes.”

Sen. Kohl, D-Wis., was joined in his amendment to S. 3187 by senators from both political party, including Sen. Chuck Grassley, R-Iowa, and Richard Blumenthal, D-Conn. The bill is the Food and Drug Administration Safety and Innovation Act.

It will require the Health and Human Services Secretary to issue standardized protocols for obtaining informed consent, or authorization from patients or their designated health care agents or legal representatives, acknowledging possible risks and side effects associated with the antipsychotic, as well as alternative treatment options, before administering the drug for off-label use.

CMS says it and industry and advocacy partners are taking several steps to achieve this goal of improved care, including:

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. CMS is also providing training focused on behavioral health to state and federal surveyors;

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.

“A CMS nursing home resident report found that almost 40 percent of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point in 2010, even though there was no diagnosis of psychosis,” said CMS Chief Medical Officer and Director of Clinical Standards and Quality Patrick Conway, M.D.

“Managing dementia without relying on medication can help improve the quality of life for these residents. The Partnership to Improve Dementia Care will equip residents, caregivers, and providers with the best tools to make the right decision.”

In addition, to address this challenge in the long-term, CMS is conducting research to better understand the decision to use or not to use antipsychotic drugs in residents with dementia.

A study is underway in 20 to 25 nursing homes, evaluating this decision-making process. Findings will be used to target and implement approaches to improve the overall management of residents with dementia, including reducing the use of antipsychotic drugs in this population.


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