WASHINGTON, D.C. — Federal officials are reviewing long-standing policies that discourage nursing homes from using antipsychotic medications to manage behavioral issues in residents with dementia, according to a March 6 report by The Washington Post.
The Centers for Medicare and Medicaid Services confirmed it is reexamining the policy "with the goal of supporting clinically indicated use while continuing to discourage inappropriate prescribing," as reported by The Washington Post. The review follows what the Post characterized as "a sustained lobbying campaign by groups backed by the manufacturers of antipsychotics."
According to The Washington Post, federal regulators have worked for more than ten years to reduce the use of these medications for controlling behavior in nursing home residents diagnosed with dementia. Under current federal oversight systems, facilities with higher rates of antipsychotic use among residents can receive lower ratings on the federal Nursing Home Care Compare website, which consumers use to evaluate and select long-term care facilities.
Current Prescribing Patterns and Medical Context
Data from CMS shows that approximately 17% of long-stay nursing home residents receive antipsychotic medications, according to figures from June 2025 cited in the report. Long-stay residents are defined as those living in facilities for more than 100 days, representing roughly 36% of the approximately 1.3 million nursing home residents nationwide, according to the American Health Care Association.
Most antipsychotic medications — including generic versions of drugs marketed as Seroquel, Risperdal, and Zyprexa — have received FDA approval for treating conditions including schizophrenia, bipolar disorder, and major depressive disorder, as reported by The Washington Post. Physicians sometimes prescribe these medications off-label to address behavioral symptoms associated with dementia, despite FDA black-box warnings about increased risks for elderly patients with dementia-related psychosis.
Federal black-box warnings represent the most serious type of alert the FDA can require on prescription drug labeling, indicating significant risk of adverse effects or death. The warnings specifically caution against use of antipsychotic medications in elderly patients with dementia-related psychosis due to increased mortality risk.
Regulatory History and Quality Measures
The current federal approach to antipsychotic use in nursing homes emerged from years of research showing that these medications were frequently prescribed to manage behaviors such as agitation, wandering, or verbal outbursts in dementia patients, often without documented medical necessity. Federal regulations established under previous administrations created financial and reputational incentives for facilities to reduce reliance on these medications by incorporating antipsychotic use rates into the five-star quality rating system displayed on Nursing Home Care Compare.
This rating system allows families and potential residents to compare facilities based on multiple quality measures, including staffing levels, health inspection results, and quality indicators such as antipsychotic use rates. Facilities with higher-than-expected antipsychotic prescribing rates can see their quality ratings decrease, potentially affecting their ability to attract new residents and maintain census levels.
Patient advocacy organizations have expressed concern that relaxing these restrictions could lead to increased inappropriate prescribing. According to The Washington Post, advocates warn that the policy review represents part of a pattern of federal decision-making that prioritizes industry demands over patient safety considerations.
Industry Perspective and Clinical Considerations
The nursing home industry has argued that current policies may prevent appropriate medical treatment for residents who could benefit from antipsychotic medications when prescribed for clinically appropriate reasons. Industry representatives have contended that the focus on reducing antipsychotic use rates may inadvertently discourage physicians from prescribing these medications even when they would provide legitimate therapeutic benefit for conditions beyond dementia-related behavioral management.
Federal regulations do not prohibit antipsychotic use in nursing homes but require that such prescriptions be based on documented clinical indications and include regular monitoring for effectiveness and adverse effects. Current requirements mandate that facilities attempt non-pharmacological interventions before resorting to antipsychotic medications for behavioral management, and that any use of these drugs for dementia-related behaviors be carefully documented and regularly reviewed.
The policy review comes at a time when nursing homes continue to face scrutiny over medication practices, staffing challenges, and quality of care issues. Any changes to federal oversight of antipsychotic prescribing would represent a significant shift in the regulatory approach that has guided nursing home practices for more than a decade.
Resources for Families
Families with concerns about medication practices in nursing homes can contact the National Long-Term Care Ombudsman Resource Center at 1-800-677-1116. The ombudsman program provides free, confidential advocacy services to residents of nursing homes and assists families in addressing concerns about care quality, resident rights, and facility practices.
Additional information about nursing home quality ratings, including antipsychotic use rates for specific facilities, is available through Medicare's Nursing Home Care Compare website at medicare.gov/care-compare. Families can also report concerns about inappropriate medication use or other quality of care issues to their state survey agency, which conducts inspections and investigates complaints about nursing home facilities.
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