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CMS' Partnership to Improve Dementia Care in Nursing Homes


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​A large number of the individuals in skilled nursing centers 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 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
AHCA Toolkit: Clinical Considerations of Antipsychotic Management​ - AHCA Members Only Content (login required)
Additional Resources

Lakewood Continuing Care Center

Waterville, ME

by Cathy McKay, RN, CRN, DON
Director of Nursing Services

The Centers for Medicare and Medicaid Services (CMS) identified reducing the off-label use of antipsychotics in nursing facilities as a top priority in 2012. With the help of our dedicated nursing staff, physicians, our consultant pharmacist, and support from administration, Lakewood has achieved excellent results in this national goal. The national average was scored at 24%, the state average 27.2%, our top performing peers at 20.30%, and Lakewood scored a remarkable 7.2%.
We've implemented several steps to make progress on this goal... Continue >>

Share your facility's story on safely reducing antipsychotic use

As of the end of the 2nd Quarter of 2015:
AHCA Member Progress:
  • AHCA member centers have reduced the off-label use of antipsychotics by 26.5% (17.3% in Q2 2015 versus 23.6% in Q4 2011).
    • About 36,293 individuals in AHCA member centers in 2015 Q2 are no longer receiving these medications
  • As of Q2 2015, 61.6% of AHCA members (5,513 member centers) had achieved the original Quality Initiative goal of a 15% reduction in antipsychotic use, while 51% of AHCA members (4,565 member centers) had already achieved the 2015 goal of a 25% reduction and 45.5% (4,074 member centers) had achieved the 2016 goal of a 30% reduction.
2015 Q1 News:

2013 Q4 News:

Skilled Nursing Care Centers Reach Milestone in Reducing Antipsychotic Use in Residents with Dementia: AHCA and CMS joint announcement sets goals to further decrease use


LTC Trend Tracker

The LTC Trend Tracker(sm) tool, a free AHCA member benefit, allows organizations to track and compare their performance on the new CMS quality measures, including both long-stay prevalence and short-stay incidence in the off-label use of antipsychotics. Find out your rates at now!
​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.