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May 30, 2012
WASHINGTON, D.C. CORRECTION APPENDED
A national partnership is working to reduce use of antipsychotic medications for nursing home patients, officials from the Centers for Medicare & Medicaid Services announced today.
The Partnership to Improve Dementia Care aims to reduce off-label antipsychotic use by 15 percent by the end of 2012. Treating dementia with antipsychotics is considered an off-label use of the drugs, which are approved to treat schizophrenia and bipolar disorder.
“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 Dr. Patrick Conway, chief medical officer and director of clinical standards and quality at CMS. “Managing dementia without relying on medication can help improve the quality of life for these residents.”
The partnership consists of federal and state agencies and advocacy groups, nursing homes, caregivers and other medical providers. The Kansas Department on Aging and the Kansas Health Care Association, a trade group that represents nursing homes, are among the partners here.
Cindy Luxem, chief executive of the Kansas Health Care Association, said the group has been working together since February, when about 500 participants met in Texas.
"This is a very big undertaking," Luxem said. "When you change people's behavior by taking them off certain medications, you have to make sure they have activities that can fulfill those times when they'll be more active. And you have to have appropriate nutrition and make sure your direct health care staff knows what's going on."
Among the approaches being used to reduce reliance on the drugs:
• Making public information on individual nursing homes and their use of antipsychotic drugs easily available to the public via the internet. That is scheduled to start in July. The information will be posted at Nursing Home Compare and will allow people to compare the use of antipsychotics from one facility to the next.
• Promoting alternatives to the drugs, including consistent staffing, more individualized activities and increased exercise or time outdoors for nursing home residents, improved monitoring and management of acute and chronic pain.
• Prevention of abuse and improved care for residents through a new training program for nursing homes called Hand in Hand.
Luxem said 24.2 percent of Kansas nursing home patients are given antipsychotics, compared to the national average of 23.2 percent.
Joe Ewert, commissioner of survey and certification at the Kansas Department on Aging, said that CMS is relying primarily on new regulations to lower the use of antipsychotics at nursing homes.
He said during annual inspections of the facilities, Kansas officials have looked at a sample of three residents on antipsychotics to determine whether their use was appropriate. Now CMS is requiring all states to look at 10 such residents during each inspection, he said.
"What CMS is doing is having all states cast the net more broadly," Ewert said.
There are 344 nursing homes in the state. Luxem said the CMS initiative is also being voluntarily extended to the state's 132 assisted living centers and 96 home-plus programs, which are state regulated.
Mitzi McFatrich, executive director of Kansas Advocates for Better Care, said her group has been among those urging CMS to rein in use of the drugs. She said low staffing levels in Kansas nursing homes lead to more inappropriate use of antipsychotics.
"If you have 60 people you're responsible for, how much time are you spending with them in an eight-hour period?" McFatrich said. Staff "are not necessarily going to be connecting the medications they're giving people with anything that might happen to them."
CORRECTION: An earlier version of this story misstated the name of Joe Ewert, commissioner of survey and certification at the Kansas Department on Aging.
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