Last week, the Center for Medicare and Medicaid Services released new guidance to nursing home surveyors on dementia care and unnecessary drug use. The guidance update includes several enhancements to F309 (Quality of Care) standards to ensure that person-centered care (and not a psychotropic drug) is the frontline treatment for dementia. F329 (Unnecessary Drugs) has also been updated to discourage misuse of antipsychotics for nursing home residents, particularly those with dementia. The guidance now includes the following statements:
“Antipsychotic medications are only appropriate in a small minority of circumstances . . . . All antipsychotic medications carry a Food and Drug Administration (FDA) Black Box Warning. Since June 16, 2008, FDA warned healthcare professionals that both conventional and atypical antipsychotics are associated with an increased risk of death in elderly patients treated for dementia-related psychosis.
Antipsychotic medications may be considered for elderly residents with dementia but only after medical, physical, functional, psychological, emotional, psychiatric, social and environmental causes have been identified and addressed. Antipsychotic medications must be prescribed at the lowest possible dosage for the shortest period of time and are subject to gradual does reduction and re-review.”
The changes to F309 and F329 are welcome but the guidance will only be effective if surveyors are dedicated to diligently applying it during all nursing home surveys. The federal regulations have required person-centered care that does not rely on psychotropic drugs for treating dementia for over twenty years but, until recently, the overuse of psychotropics in nursing homes has gone on unabated. The rules have been clear for a generation but the disinterested enforcement of those rules by CMS and California’s Department of Public Health has fostered an epidemic of chemical restraints. Here’s hoping that the new guidance is accompanied by a new attitude for robust enforcement.