On Friday, the Center for Medicare and Medicaid Services (CMS) announced its new goals for reducing antipsychotic drugs in nursing homes. Touting the 15% reduction in antipsychotic use in nursing homes since 2011, CMS wants antipsychotic use to decline by 30% from 2011 levels by the end of 2016.
For the tiny fraction of nursing home residents who will benefit from the new CMS goals, the announcement is good news. For the 70% of residents who will continue to be drugged with antipsychotics and other chemical restraints, the announcement is yet another abandonment. The marginal CMS goals send the message that most antipsychotic drug misuse is tolerable.
We know that around 90% of nursing home residents who receive antipsychotics have dementia. We know the FDA and study after study have warned the world that antipsychotics are almost always bad news for people with dementia and are often fatal. The ineffectiveness and dangers of the drugs are more than enough to justify swift remedial action but what really turns the issue from health care crisis to human tragedy is the fact that there is a better way – treating challenging “behavior” as communication of unmet needs – that leads to drastically better quality of life. Instead of stupor-inducing warehouses, the best nursing homes are those with true care partners thriving together in life-enhancing environments.
In response to CMS’s weak goals, several leading resident advocacy groups, including CANHR, have called for much stronger action. The advocates warned that “by the end of 2016, we will still have more than 250,000 nursing home residents receiving antipsychotics, inappropriately and at tremendous personal cost to them and their families, not to mention tremendous financial cost to taxpayers.”
We must do our best to ensure that CMS’s goals do not define or limit the campaign to end antipsychotic misuse. Rather than focusing on incremental 5% annual reductions, we must focus on the powerful evolution of dementia care that is happening in long-term care environments around the country. If we continue to work hard to improve care and stop our costly reliance on dehumanizing drugs, the CMS goals will not matter.