Measuring Quality Through Antipsychotic Use (or Non-Use)

Since December 2008, the federal government’s Centers for Medicare and Medicaid Services (CMS) has used a five-star quality ratings system as a measure of the quality of care provided in nursing homes to include in its consumer-oriented Nursing Home Compare website.  The five-star system is based on three performance categories: health inspections performed by the states, staffing levels, and quality measures.  Each category yields a score which is then aggregated into a final rating from one to five stars.  For quality measures, CMS assigns points (ranging from 20 to 100), based on a nursing home’s self-reported data on 11 different facets of resident health.

In February, CMS announced that two new quality measures dealing with the administration of antipsychotic drugs will be added to the five-star formula. The main measure of antipsychotic use is for “long-stay residents” – the percentage of residents who have lived in the nursing home for more than 100 days who receive an antipsychotic drug at least one time a week.  The measure excludes residents with schizophrenia, Tourette’s Syndrome, or Huntington’s Disease.

In order to receive the full 100 points for the long-stay antipsychotic use quality measure, a nursing home’s rate must be below 8.1%.  To receive 80 points, the rate must be below 14.3%.  Sixty points goes to homes with a rate below 19.6% while those below 26.8% receive 40 points. Nursing homes with rates at 26.8 % or more receive 20 points – the fewest possible.

Hopefully, the inclusion of antipsychotic drugs usage rates in the five-star formula will give more incentive to nursing homes to decrease their use and to devote more resources to comfort-focused dementia care rather than simply sedating residents who are perceived as behaviorally challenging.  Nursing homes everywhere seem to be highly concerned with their five-star rankings, so it’s likely this change will lead to less antipsychotic use and hopefully, better dementia care.

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About achicotel

Anthony Chicotel is a staff attorney for CANHR. His areas of expertise include the rights of long-term care residents, nursing home litigation, health care decision-making, and conservatorships.
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