While in recent years, there has been a push to reduce the use of psychotropic drugs in nursing homes, a 2022 report conducted by the Department of Health and Human Services Office of the Inspector General (HHS OIG) found that 80% of Medicare’s long-stay nursing home residents were prescribed psychotropic medications between 2011 and 2019.
Additional findings from the report noted increased antipsychotics and anticonvulsant use and a shocking 194% increase in misdiagnosed schizophrenia cases, leading to the inappropriate use of antipsychotic drugs. These findings validate concerns previously raised by lawmakers while highlighting the need for more tracking of antipsychotic use and more appropriate diagnoses in medication administration.
Meanwhile, nursing home operators have revealed that residents are often admitted with outdated medication prescriptions from physicians outside the nursing home. However, when family members are broached with newer, potentially more effective drugs, facilities face resistance from family members opposed to medication changes.
The Need for More Communication and Collaboration
To address the issue of medication mismanagement, industry experts are calling for greater support and transparency from nursing home operators. In that light, the CMS has started conducting off-site audits related to how nursing homes assess and code residents diagnosed with schizophrenia. And a new measure introduced by the CMS mandates that survey citations related to antipsychotic use and related penalties for nursing homes are displayed publically on its Care Compare web page.
Some operators believe there is also an urgent need for more effective communication and collaboration among healthcare providers and caregivers—facilities, nursing homes, physicians, and family members—to combat the rise and overuse of psychotropic medications.
Industry experts like Tom Syverson, director of government and external affairs at the Evangelical Lutheran Good Samaritan Society, have stressed the importance of a partnership between healthcare providers and facilities. And Mike Bassett, vice president of the American Health Care Association, highlights the urgent need for improved communication between nursing homes, hospitals, and the community to obtain a comprehensive patient history.
Bassett also advocates for enhanced educational outreach with the CMS to reduce the use of psychotropic drugs. In addition, he emphasizes educating family members and fostering better collaboration between healthcare providers and primary care physicians to improve medication optimization and management, improving the quality of care in nursing homes.
Addressing the Problem
The surge in psychotropic drug prescriptions in nursing homes is a cause for serious concern. To address this issue effectively, physicians, family members, and nursing homes must collaborate to overcome communication barriers, update medication prescriptions, and provide comprehensive education to reduce psychotropic drug overuse.
In the face of a concerning amount of psychotropic drug overuse, there have been some clinical models, such as the dementia care model, champion a holistic approach that reduces the use of psychotropic drugs.
One such example is the New Jewish Home Manhattan. Their clinical team has taken a proactive approach to discontinuing psychotropic medications after assessing potential interactions with other drugs. This has led the team only to prescribe antipsychotics for dementia patients on rare occasions and only when all other alternatives have been exhausted.
These models suggest that if nursing homes adopt a holistic approach while providing adequate support and resources, this will create a healthier environment where residents can thrive while improving their overall well-being and quality of care.
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