Back in March, CMS issued a report with the results of its focused dementia care survey pilot. The pilot project involved CMS and state regulators teaming up to “more thoroughly examine the process for prescribing antipsychotic medication and assess compliance with federal requirements related to dementia care practices in nursing homes.”
The special surveys were conducted in five nursing homes in each of five states, including California. Five of the surveys were observational. From the remaining 20 surveys, a total of 68 deficiencies were issued, including four that cited actual harm to residents. Sixteen of the 20 surveyed homes were cited for either poor dementia care practices or inappropriate drugging while 11 of the 20 were cited for both.
The state surveyors who participated in the focused surveys felt a more detailed assessment of dementia care and drugging practices was important and clearly it revealed that significant problems with harmful drugging continue to plague nursing homes. Nonetheless, CMS has no plan to use focused surveys or to incorporate additional dementia care scrutiny during its regular surveys. Instead, CMS has asked for state agency volunteers to lead future focused surveys. Maybe some states will take up the opportunity. Then again, maybe some won’t.
CMS has claimed that reducing misuse of antipsychotics for nursing home residents with dementia is a high priority campaign. The focused surveys were part of this effort. It seems strange then that given the considerable time and energy spent on focused surveys and the large number of problems they identified, CMS decides to change nothing. It knows there is a huge problem out there and instead of taking robust action, asks for someone else to take charge.
With enforcement agencies so willing to tolerate harmful wrongdoing, the regulatory standards look more and more aspirational instead of minimal. No wonder nearly 300,000 nursing home residents are still getting antipsychotics under CMS’s watch.