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 Fast Facts

  • Almost 40% of assisted living residents have some type of dementia
  • Antipsychotics drugs cost Medicare over $309 million in 2007

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Dementia Beyond Drugs:
Changing the Culture of Care


A large number of the individuals in assisted living are living with some type of dementia. For these individuals and 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. 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.

Antipsychotic drugs are expensive, costing hundreds of millions of Medicare dollars. They also increase the risk of death, falls with fractures, hospitalizations and other complications resulting in poor health and high costs.

The intent of the AHCA/NCAL Quality Initiative goal to safely reduce the off-label use of antipsychotics 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.
Consumer Fact Sheet
Additional Resources

Curry House

Cadillac, Michigan

NCAL member Curry House in Cadillac, Michigan is changing the way it cares for its residents living with dementia, thanks in part, to offering staff and community members Second Wind Dreams' virtual dementia tour.

Granite Ledges

Concord, New Hampshire

Learn how one community used a team approach to decrease off-label use of antipsychotics. Read More

Share your community's story on safely reducing off-label use of antipsychotics

Unlike skilled nursing centers, assisted living communities are not required to publicly report antipsychotic data.  To track this data for assisted living communities, NCAL has collaborated with the New Jersey Hospital Association’s Patient Safety Organization (PSO).  The primary function of a PSO is to allow healthcare providers to report quality and patient safety data without fear of legal discovery.
Therefore, through the National PSO for Assisted Living, NCAL members can electronically submit their performance on clinical performance outcomes (including antipsychotic use) and processes while still protecting themselves from any liability issues as a result of their data.  Learn more or join the PSO today!  If your community is not an NCAL member and would like to join the PSO, you can contact your AHCA/NCAL State Affiliate to learn about joining AHCA/NCAL to be eligible to sign up for the PSO. 

​DISCLAIMER: The AHCA/NCAL quality programs’ contents, including their goals and standards, represent some preferred practices, but do not represent minimum standards or expected norms for skilled nursing and/or assisted living providers. As always, the provider is responsible for making clinical decisions and providing care that is best for each individual person.​