Bloomberg Law
Jan. 18, 2023, 4:58 PMUpdated: Jan. 18, 2023, 6:05 PM

Antipsychotic Drug Use in Nursing Homes Draws HHS Scrutiny (1)

Tony Pugh
Tony Pugh

The Biden administration is stepping up oversight of nursing home patients with a schizophrenia diagnosis to help reduce the inappropriate use of antipsychotic medications in the facilities.

Beginning this month, the Centers for Medicare & Medicaid Services will conduct targeted, off-site audits to see if nursing homes are properly assessing and coding residents diagnosed as schizophrenic. Erroneous diagnoses increase the risk of poor care and of inappropriate use of antipsychotic medications, the agency said.

Antipsychotics are dangerous among the frail nursing home population because of their potential side effects, including death. The effort is the latest action under the Biden-Harris administration’s push to improve the safety and quality of nursing home care.

“No nursing home resident should be improperly diagnosed with schizophrenia or given an inappropriate antipsychotic. The steps we are taking today will help prevent these errors and give families peace of mind,” Health and Human Services Secretary Xavier Becerra said in a statement.

In addition, the CMS will increase the transparency of nursing home information by publicly displaying alleged deficiencies identified in state inspections that individual facilities are disputing. Currently, when a nursing home challenges a deficiency, it is not posted to the CMS’ Care Compare website until the dispute process—which can take 60 days or longer—is complete.

Disputed deficiencies can include severe instances of non-compliance such as immediate jeopardy (IJ) citations, in which residents could be at risk for serious injury, harm, impairment or death.

Informed Choices

“Displaying this information while it is under dispute can help consumers make more informed choices when it comes to evaluating a facility,” the CMS said in a statement.

The new information will start appearing on Care Compare on Jan. 25. The disputed deficiencies will not be included in a facility’s five-star quality rating calculation until the dispute is complete.

LeadingAge, the association of nonprofit aging services providers, supports the move to heighten enforcement of antipsychotic drugs in nursing homes.

“We understand the challenges of implementing alternatives to drugs, particularly if programs that reduce the use of antipsychotics require more or specialized staff. There is a workforce shortage in skilled nursing. However, this is a serious quality of care and quality of life issue for residents. Inappropriate use of potent drugs can compromise a person’s overall health. If stepped up enforcement is needed, we support that approach,” Katie Smith Sloan, LeadingAge president and CEO, said in a statement.

The audits will target facilities with high rates of schizophrenia diagnoses and “examine the facility’s evidence for appropriately documenting, assessing, and coding a diagnosis of schizophrenia,” the CMS guidance said. Facilities that have “inaccuracies” will have their overall quality measure rating downgraded, along with other quality measures.

This will help “incentivize compliance and make sure the public is aware of these illegal practices in nursing homes,” said a statement from the National Consumer Voice for Quality Long-Term Care.

‘More Must Be Done’

“Despite today’s announcement more must be done to protect residents,” the group’s statement said. “Importantly, CMS announced no other enforcement action against facilities who are found to be using this illegal practice.”

“Additional penalties, including civil monetary penalties, should be assessed,” the group said. “Additionally, CMS should take steps to penalize medical professionals that inappropriately diagnose residents with schizophrenia to illegally prescribe antipsychotics.”

A government watchdog agency last year called on the Biden administration to better protect Medicare beneficiaries from inappropriate use of psychotropic drugs by nursing homes after a study found unusually high use in some facilities.

From 2011 through 2019, about 80% of Medicare long-stay nursing home residents received some type of psychotropic drugs, which affect brain activities associated with mental processes and behavior, the HHS Office of Inspector General reported Nov. 14.

These drugs include antipsychotics, anticonvulsants, mood stabilizers, and central nervous system agents. Their use in nursing homes is concerning because their possible side effects include increased risk of death, suicidality, and falls among the elderly.

(Updates with additional details and reaction beginning in 11th paragraph.)

To contact the reporter on this story: Tony Pugh in Washington at

To contact the editor responsible for this story: Brent Bierman at