A broad category of medications, called psychoactives or psychotropics are administered by physicians in skilled nursing centers. The term psychoactive is an all-encompassing description which includes mood stabilizers (anti-manic agents), anti-depressants, anti-anxiety, hypnotics and antipsychotics.
CAHF encourages its members to take part in a national effort to safely reduce the unnecessary use of antipsychotic medication in skilled nursing homes by 15 percent by December, 2013. We believe the number of residents that are being prescribed antipsychotic medication can be reduced and we continue to explore ways to prevent and manage difficult behavior without medications.
The intent of the national initiative is to encourage alternative strategies for responding to challenging behavioral expressions in persons living with dementia before considering medications and to ensure that antipsychotic medications, when used, are as appropriate and safe as possible.
A large number of the individuals in skilled nursing centers are living with some type of dementia. For these individuals, as illness progresses, behavior often becomes a key form of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior.
According to the latest government data, posted on Nursing Home Compare, California physicians prescribed less antipsychotic medication to nursing home residents than in 40 other states. However, we need to continue to monitor, and where possible, reduce the use of unnecessary medications.
The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia.
Long-term care doctors in skilled nursing settings strive to offer the best care possible using the least amount of medication. When medications are appropriate, physicians must carefully weigh the dangers against the individual benefits starting with the lowest dose possible. Physicians are also required to reassess the use of psychoactive drugs on a quarterly basis.
In addition, the resident or a representative must provide informed consent regarding the use of these medications, except in emergencies.
The use of psychoactive medication is legal and strictly regulated by the state and federal government.
California skilled nursing providers are leaders in reducing the unnecessary use of antipsychotic medication when compared to the rest of the nation.
During 2012, California caregivers were able to reduce the use of this medication from 21.1 percent to 19.3 percent - a drop of 8.5 percent.
By Q2, 2013, caregivers further reduced the use of antipsychotics to 18.0 percent - an overall drop of 14.7 percent compared to the beginning of the campaign.
This information is tracked quarterly by the federal government and made available at the Nursing Home Compare website, as a service of the Centers for Medicare & Medicaid Services (CMS).