CMS launches program to improve nursing homes' dementia care
The Centers for Medicare & Medicaid Services has announced a partnership with providers, care givers and patients aimed at improving the care and use of antipsychotic medications for patients in nursing homes.
According to CMS, reducing the unnecessary use of antipsychotic drugs is a significant challenge in improving dementia care and cites data from 2010 that show more than 17 percent of nursing home patients had daily medication doses that exceeded recommended levels. According to a nursing home resident report by CMS it found that nearly 40 percent of all nursing home residents with signs of dementia had received an antipsychotic medication at some point during 2010. This even though these patients had no diagnosis of psychosis.
"We want our loved ones with dementia to receive the best care and the highest quality of life possible," said Marilyn Tavenner, CMS acting administrator, in a press release. "We are partnering with nursing homes, advocates and others to improve the quality of care these individuals receive in nursing homes. As part of this effort, our partnership has set an ambitious goal of reducing use of antipsychotics in nursing homes by 15 percent by the end of this year."
To help achieve this goal CMS will implement a number of specific actions, including a training series for nursing homes called Hand in Hand that emphasizes person-centered care, prevention of abuse and high-quality care. CMS has also committed to providing behavioral health training to state and federal surveyors.
In addition, beginning in July, CMS will work to increase the transparency of how care is delivered in nursing homes by publishing the antipsychotic drug use of each nursing home on its Nursing Home Compare website.
Finally, CMS will work with nursing homes to emphasize non-pharmacological alternatives to treating patients with dementia. Other measures that can be used to care for these nursing home residents include maintaining consistent staff assignments, increased exercise or outdoor time, better monitoring and management of acute and chronic pain and developing plans for individual activities.
"Managing dementia without relying on medication can help improve the quality of life for these residents. The Partnership to Improve Dementia Care will equip residents, caregivers and providers with the best tools to make the right decision, " said Patrick Conway, MD, chief medical officer and director of clinical standards and quality at CMS, in a prepared statement.
While the immediate goal is to reduce the use of these drugs, CMS is also putting in place some long-term structures that are intended to help sustain the effort. The agency is currently embarking on a study in 20 to 25 nursing homes that will help shed light on how decisions are made in prescribing antipsychotic medications. Once the data is collected, CMS intends to use them to target and implement approaches to improve the overall management of residents with dementia, including reducing the use of antipsychotic drugs in this population.
