CMS Calls on Nursing Homes to Cut Dementia Meds by 30%

In its continued efforts to reduce the use of antipsychotic medications in nursing homes, the Centers for Medicare and Medicaid Services (CMS) has launched a new national goal striving for a 30% reduction by the end of 2016.

The National Partnership to Improve Dementia Care, a coalition launched by CMS in 2012, has upped its goal from the 15% reduction in antipsychotic medication use that was slated for the end of 2012, to a 25% reduction by the end of 2015 and 30% by the end of 2016.

“We know that many of the diagnoses in nursing home residents do not merit antipsychotics but they were being used anyway,” said Patrick Conway, CMS chief medical officer, in a statement. “In partnership with key stakeholders, we have set ambitious goals to reduce [the] use of antipsychotics because there are – for many people with dementia – behavioral and other approaches to provide this care more effectively and safely.”


Antipsychotic medications are used as a short-term treatment to control psychotic symptoms, such as hallucinations, delusions or aggression. They are commonly used to treat people with Alzheimer’s disease and vascular or mixed dementia.

Between 2011 and 2013, the prevalence of antipsychotic use in nursing home residents nationwide was reduced by 15.1%, decreasing from 23.8% to 20.2% nationwide, according to CMS.

“While the initial focus is on reducing the use of antipsychotic medications, the [coalition’s] larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices,” CMS says.


One senior living provider has weaned residents off of antipsychotics entirely in some cases, favoring alternative dementia care treatments. Ecumen, which operates more than 20 senior living communities, most of which are in Minnesota, started a program called “Awakenings,” with the goal of reducing dependency and usage of these drugs.

Instead of doling out medications, Ecumen emphasizes relationship-centered care and behavioral interventions as ways to treat its memory care residents. And by doing so, the provider is saving more than $2.4 million a year in drug costs.

In the coming months, nursing homes’ overall antipsychotic usage rate will be incorporated into the calculations CMS uses for each nursing home’s rating on the agency’s Five Star Quality Rating System.

CMS will monitor the reduction of antipsychotics as well as the possible consequences. For example, the agency will review prescriptions of anxiolytics and sedative/hypnotics to make sure nursing homes do not just replace antipsychotics with other drugs.

In addition, CMS will review the cases of residents whose antipsychotics are withdrawn to make sure they don’t experience a decline in functional or cognitive status as a nursing home tries to reduce its usage.

“We have created many tools for nursing homes to use to help achieve these goals,” Conway said. “Ultimately, nursing homes should re-think their approach to dementia care, re-connect with the person and their families, and use a comprehensive team-based approach to provide care.”

Written by Emily Study