Skip Ribbon Commands
Skip to main content

 From Our Bookstore

Dementia Beyond Drugs:
Changing the Culture of Care




 The Issue


Nearly two out of five 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. They increase the risk of death, falls and fractures, hospitalizations, and other complications resulting in poor health and high costs. Additionally, antipsychotic drugs are expensive, costing Medicare hundreds of millions.

The intent of this Quality Initiative goal 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.


 Ideas to Get Started

  • ​Start tracking your off-label use of antipsychotics with LTC Trend Tracker
  • Make sure staff understand dementia and the disease process
  • Implement consistent assignment, so that staff works with residents closely to understand preferences and communication methods
  • Look for non-pharmacologic interventions to enhance an individual’s quality of life
  • Help educate family members, health care partners, and other community members about the risks associated with off-label us of antipsychotics

Get other ideas from Granite Ledges in New Hampshire, which used a team approach to decrease off-label use of antipsychotics.


 Track Your Progress



Consumer Fact Sheet
Additional Resources


  • Curry House

    ​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.


  • The Bus Stop to Nowhere

    ​This memory care community in Hingham, Massachusetts built a 'bus stop to nowhere' in their courtyard as part of its life enrichment program.


​​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.​