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Some Experts Caution against Antipsychotics Overreaction

The Biden administration’s nursing home reform plan, which was released in an official announcement on February 28, touched on the controversial issue of antipsychotic drug use in nursing homes. The announcement applauded efforts by the Centers for Medicare & Medicaid Services (CMS) to reduce antipsychotic drug use in nursing homes through a program called the “National Partnership to Improve Dementia Care in Nursing Homes” (hereafter, CMS Dementia Partnership).

Biden’s nursing reform announcement said the CMS Dementia Partnership resulted in a “dramatic decrease in the use of antipsychotic drugs in nursing homes in recent years.” The announcement then also warns against complacency, saying “However, inappropriate diagnoses and prescribing still occur at too many nursing homes. CMS will launch a new effort to identify problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications.”

The CMS Dementia Partnership promotes systematic processes for evaluating every dementia patient individually in order to identify the best possible healthcare approach for that individual. In doing so, CMS partners with federal and state agencies, nursing homes and other healthcare providers, advocacy groups, and caregivers.

The CMS website says that its Dementia Partnership is designed to facilitate a comprehensive approach to dementia care by finding “new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident.”

According to Leading Age New York, a group that represents non-profit care providers and senior housing facilities, the goal of the CMS Dementia Partnership is to continue reducing the use of “unnecessary antipsychotic medications [and] other potentially harmful medications” in nursing homes and other care settings.

However, some health care professionals have cautioned that blindly waging war against antipsychotics is misguided because some people actually need them. In an opinion piece published by McKnight’s Long-Term Care News, long-term care psychologist Dr. Eleanor Feldman Barbera said that “attempts to reduce antipsychotics might disregard the needs of [long-term care] residents,” and that regulations dealing with antipsychotics should be designed “with a recognition that there are many residents who need these medications in order to maintain their emotional stability”

According to data compiled by, the number of long-term care residents with severe mentally illnesses has more than doubled in nearly every state between 2000 and 2020. Dr. Feldman Barbera said that this number probably increased even further in 2021 due to COVID-19 and that maintaining the use of antipsychotic medications is “essential.”

In a separate opinion piece written by Dr. Feldman Barbera published in the same outlet in 2019, she said that CMS regulations designed to gradually reduce psychotropic medication dosage are “generally inappropriate” for long-term care residents with severe mental illnesses. She added, “It can take many years of medication adjustment to stabilize someone with [severe mental illnesses]. Reducing psychotropic usage without clear psychiatric reasoning and close monitoring – which most LTC facilities are unable to provide – could lead to rehospitalization.”

Dr. Eleanor Feldman Barbera is not alone in her belief that the federal government has been wrong to pursue antipsychotic reduction at all costs. In a statement released in response to President Biden’s nursing reform plan, the President and CEO of the Alliance for Aging Research, Sue Peschin, criticized Biden’s new plan for antipsychotics as simply a continuation of the flawed approach taken by previous administrations, saying “Unfortunately, the focus [has been] on reducing overall use of antipsychotics in nursing homes—not on ensuring the appropriate utilization of them for resident who needed them.”

Ultimately, the shortage of mental health professionals available to long-term care residents only compounds the challenges faced by residents with severe mental illness, but Biden’s nursing home reform plan only focused on boosting the number of skilled nurses without addressing the shortage of mental health professionals, an issue that must be addressed in order to ensure residents with severe mental illnesses obtain the care they need.

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