Biden administration targets overuse of antipsychotic drugs in nursing homes
Abigail Adcox
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The Biden administration is planning to investigate the inappropriate use of certain antipsychotic drugs and wrongful diagnoses of schizophrenia in nursing homes as part of an initiative to crack down on the misuse of medications that may cause dangerous side effects.
Starting this month, the Centers for Medicare and Medicaid Services will conduct targeted audits to determine whether nursing homes are accurately diagnosing patients with schizophrenia and prescribing antipsychotic medications, which are meant to help reduce psychotic symptoms such as hallucinations or delusions.
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“We have made significant progress in decreasing the inappropriate use of antipsychotic medications in nursing homes, but more needs to be done,” said Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure. “People in nursing homes deserve safe, high-quality care, and we are redoubling our oversight efforts to make sure that facilities are not prescribing unnecessary medications.”
The use of psychotic medications is an indicator of nursing home quality and is used in the nursing home’s Five-Star Quality Rating System, which is publicly available for families to assess a facility’s quality of care. However, residents with schizophrenia are excluded from that indicator, giving nursing homes more reason to code a resident as having the disease when they do not.
Now, if an audit identifies that a nursing home has been inaccurately coding patients as having schizophrenia, then it will negatively affect the facility’s rating.
CMS will also ramp up efforts to increase transparency regarding citations that nursing homes are disputing, which could include Immediate Jeopardy citations that are issued when the health and safety of residents could be at risk for serious injury, impairment, or death.
Now, CMS will make citations that are being disputed by facilities immediately available to the public on its Care Compare website so that “consumers make more informed choices when it comes to evaluating a facility,” the Biden administration said. Previously, CMS did not post a citation to the website before the dispute was resolved, which takes roughly 60 days.
Last November, a government watchdog found that from 2011 through 2019, roughly 80% of Medicare’s long-stay nursing home residents were prescribed a psychotropic drug, detailing that the number of unsupported schizophrenia diagnoses increased during that time period as well.
A 2018 study also outlined a trend of nursing homes inappropriately prescribing antipsychotic drugs to patients with dementia or Alzheimer’s disease as a means to control common symptoms of the disease.
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“Antipsychotic drugs alter consciousness and can adversely affect an individual’s ability to interact with others. They can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there,” according to a summary of a report by Human Rights Watch.
The latest announcement is a part of the Biden administration’s efforts to improve nursing home transparency, safety, and accountability. The administration said in October it would take more aggressive action toward the poorest-performing nursing homes in the country, escalating penalties for violations.