Dementia Care, LTC Survey and Antipsychotic Medication Use

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

“The National Partnership to Improve Dementia Care in Nursing Homes is committed to improving the quality of care for individuals with dementia living in nursing homes. The National Partnership has a mission to deliver health care that is person-centered, comprehensive and interdisciplinary with a specific focus on protecting residents from being prescribed antipsychotic medications unless there is a valid, clinical indication and a systematic process to evaluate each individual’s need. The Centers for Medicare & Medicaid Services (CMS) promotes a multidimensional approach that includes; research, partnerships and state-based coalitions, revised surveyor guidance, training for providers and surveyors and public reporting.

CMS is tracking the progress of the National Partnership by reviewing publicly reported measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those residents diagnosed with schizophrenia, Huntington’s Disease or Tourette’s Syndrome. In 2011Q4, 23.9 percent of long-stay nursing home residents were receiving an antipsychotic medication; since then there has been a decrease of 36.6 percent to a national prevalence of 15.1 percent in 2017Q4. Success has varied by state and CMS region, with some states and regions having seen a reduction of greater than 40 percent.”

Earlier this year, CMS announced a new national goal, involving a 15 percent reduction of antipsychotic medication use by the end of 2019 for long-stay residents in those homes with currently limited reduction rates. “While the initial focus was on reducing the use of antipsychotic medications, the Partnership’s larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices.” CMS continues to conduct additional Focused Dementia Care Surveys across the country, targeting nursing homes that have high rates of antipsychotic medication use.

Two documents have been released that speak to dementia care and antipsychotic medication use. One was released 2 years ago, the other just recently.

In case you missed it: on June 3, 2016, CMS issued an Update Report on the National Partnership to Improve Dementia Care in Nursing in the form of a Survey and Certification notice – S&C: 16-28-NH. This 20-page S&C, including the Update Report, also describes the results of the Focused Dementia Care Surveys conducted in Fiscal Year (FY) 2015. Here’s the Table of Contents for this Update Report:

TOC_UpdateReport

Page 6 of the report has numerous hyperlinks to pertinent websites, tools and resources related to dementia and antipsychotic medication use. You’ll note that this report references F329 which “belongs” to the previous survey process. With the current LTC survey process, F329 translates to F758. Here’s how we stand as of today, in terms of citations for this tag:

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Additionally, the 3-page Antipsychotic Medication Use Data Report (April 2018) provides a visual of the Quarterly Prevalence of Antipsychotic Use for Long-Stay Residents by State.

Both documents are worth the read.