Nursing homes continue to administer psychotropic drugs to a high proportion of residents more than a decade after regulators began scrutinizing how the drugs are used, the Department of Health’s Office of Inspector General and Human Services reported Monday.
Eight out of 10 Medicare long-term nursing home residents received psychotropic drugs between 2011-2019, the HHS OIG found when reviewing Medicare data. Residents of facilities with a low staffing rate and a high percentage of low-income people were more likely to receive psychotropic drugs.
The Centers for Medicare and Medicaid Services addressed the issue of antipsychotic drug use in nursing homes following a major OIG report published in 2011. Oversight varies between administrations. President Barack Obama, Donald Trump and Joe Biden.
The OIG also determined that nursing homes’ calculations of how many patients had schizophrenia did not match Medicare’s requirements for psychiatric medications between 2015 and 2019. Unsupported listings actually increased in 2019, the most recent year the OIG analyzed, but the increase was concentrated at 99 facilities.
An independent federal watchdog reported that CMS’s monitoring of antipsychotic use in nursing homes did not include people with schizophrenia, which could allow nursing homes to misreport diagnoses while still prescribing the drug and achieve a higher quality rating.
A five-star nursing home reported 36 residents with schizophrenia in 2019, but only three patients were involved with Medicare claims supporting the diagnosis. According to the OIG report, 29 of them had been prescribed antipsychotics.
The Office recommends that CMS further evaluate the use of psychotropic drugs in nursing homes, determine which facilities use these drugs the most, and collect diagnostic data on Medicare Part D requirements.
Biden has vowed to increase nursing home surveillance, in part due to the large number of COVID-19 cases and deaths in long-term care facilities.
