OIG Flags Inappropriate Antipsychotic Use in Nursing Homes

A new report from the Department of Health and Human Services Office of Inspector General (OIG) found that some nursing homes inappropriately administered antipsychotic drugs to residents with dementia, exposing them to serious health risks. Based on 40 focused inspections conducted by the Centers for Medicare & Medicaid Services (CMS), the report found that facilities used these drugs to manage behavior rather than for medically appropriate reasons, despite FDA warnings that antipsychotics increase the risk of death for elderly patients with dementia. 

OIG also found that nursing homes often failed to follow required safeguards when residents were prescribed antipsychotics, including attempts to reduce dosages and monitor adverse effects. The report found that medical directors and nursing home pharmacists frequently did not take steps to prevent or address inappropriate use, and weak facility policies further undermined protections for residents. 
In response, OIG recommended that CMS:

1. Further develop resources for nursing homes and increase transparency in order to reduce inappropriate use of antipsychotic drugs and improve dementia care in nursing homes.
2. Take steps to ensure that nursing home medical directors fulfill their role in reducing the inappropriate use of antipsychotic drugs.
3. Take steps to ensure that nursing home pharmacists fulfill their role in reducing the inappropriate use of antipsychotic drugs.
4. Assist nursing homes in improving their policies and procedures pertaining to antipsychotic drug use.

CMS did not explicitly concur or nonconcur with OIG's first and fourth recommendations. CMS nonconcurred with the second and third recommendations. OIG added clarification to these recommendations based on CMS’s comments to the draft and encouraged CMS to re-examine its position on concurrence in its Final Management Decision.

PALTmed has been actively engaged on this issue for some time, including many conversations with CMS. PALTmed has previously stated that, “While there is a national need for better and more approved treatments for behavioral and psychiatric symptoms in dementia, clinicians need to be mindful of and avoid labeling patients with other diagnoses to justify the use of medications or other treatments.” In addition, PALTmed has guidance to support understanding of CMS requirements related to antipsychotic medication prescribing in nursing homes.