WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services has confirmed it is reviewing federal policies on antipsychotic drug use in nursing homes, according to reports from multiple healthcare industry publications. The reexamination could reverse more than a decade of federal efforts to discourage the use of these powerful sedative medications on residents with dementia.
CMS Administrator Mehmet Oz stated the agency is reexamining its antipsychotic policy with the goal of supporting clinically indicated use while continuing to discourage inappropriate prescribing, as reported by McKnight's Long-Term Care News. The policy review follows nonbinding congressional directives included in a recent spending bill that instructed CMS to distinguish between appropriate and inappropriate antipsychotic prescribing in nursing facilities.
According to data from the American Health Care Association, approximately 17 percent of long-stay nursing home residents currently receive antipsychotic medications. Long-stay residents, defined as those remaining in facilities for more than 100 days, represent 36 percent of roughly 1.3 million total nursing home residents nationwide. Generic versions of medications including Seroquel, Risperdal, and Zyprexa are commonly prescribed off-label to manage dementia-related behaviors, despite FDA black-box warnings about increased mortality risks in elderly patients with dementia.
The policy review was prompted by sustained lobbying efforts from manufacturer-backed advocacy groups, according to Becker's Behavioral Health. Patient safety advocates have expressed concern about potential rollbacks of protections established following widespread documentation of inappropriate sedation practices in nursing facilities.
Federal regulations created in 2012 established a Long-Stay Antipsychotic Medication quality measure that has been credited with reducing antipsychotic use by approximately one-third since 2011, as reported by DNYUZ. The measure tracks facilities' rates of antipsychotic prescriptions for residents without qualifying diagnoses such as schizophrenia or Huntington's disease.
Concerns About Data Accuracy and Inappropriate Use
A 2021 investigation by the Department of Health and Human Services Office of Inspector General identified significant gaps in facility reporting of antipsychotic use. According to the Center for Medicare Advocacy, the OIG found that of 249,135 long-stay residents with Medicare Part D antipsychotic drug claims in 2018, approximately 12,091 residents were not reported in facility assessments as receiving these medications.
The investigation also found irregularities in diagnosis reporting. Of 98,227 residents reported as having schizophrenia—a diagnosis that exempts facilities from the quality measure—more than 29,000 lacked supporting Medicare claim evidence for that diagnosis, according to the OIG findings. A 2011 Senate hearing documented that 83 percent of antipsychotic claims were for non-FDA-approved uses.
Patient advocates have documented cases where antipsychotics were administered for staff convenience rather than clinical necessity. Reported cases include a Minnesota facility that gave a resident antipsychotics after he grieved his wife's death, a Philadelphia facility that medicated a resident for yelling during evening shifts, and a Michigan facility where overmedication left a resident unable to use bathroom facilities independently, as reported by DNYUZ.
Medical Risks and Alternative Approaches
Antipsychotic medications carry documented risks for elderly patients with dementia, including increased likelihood of falls, strokes, and death. Federal drug safety regulations require black-box warnings on antipsychotic medications noting these elevated risks when prescribed to dementia patients.
Currently, only one medication—Otsuka's Rexulti—has received FDA approval specifically for treating agitation in Alzheimer's disease patients, distinct from the broader category of dementia-related psychosis. Most antipsychotic use in nursing facilities involves off-label prescribing for behaviors such as wandering, verbal outbursts, or resistance to care.
According to Skilled Nursing News, more than 3 million nursing facility residents nationwide have been diagnosed with dementia, representing 48 percent of all residents. Research indicates that 97 percent of Alzheimer's patients experience neuropsychiatric symptoms during the course of their illness.
Some industry groups have argued that the current quality measure may have unintended consequences. The Alliance for Aging Research and Project PAUSE released a white paper in November 2025 urging CMS to revise or retire its antipsychotic quality measure, suggesting it may have increased inappropriate prescriptions of substitute medications including anticonvulsants, antidepressants, anxiolytics, and opioids, according to Skilled Nursing News.
However, data from state-level monitoring suggests compliance challenges persist. Attorney Tony Chicotel of California Advocates for Nursing Home Reform found that California facilities reported 23 percent antipsychotic rates in the first quarter of 2021, approaching the 24 percent levels documented before federal partnership initiatives began.
Policy Implications
The Trump administration previously rescinded Biden-era minimum staffing requirements for nursing homes, according to published reports. Patient safety advocates have expressed concern that loosening antipsychotic restrictions could similarly reduce protections for vulnerable residents.
Sam Brooks of the National Consumer Voice for Quality Long-Term Care, Sue Peschin of the Alliance for Aging Research, and Dr. Michael Steinman of the University of California San Francisco have publicly commented on the policy review, emphasizing the need to balance appropriate clinical use with protection against chemical restraint practices.
The current review comes as CMS continues to refine quality measures used to evaluate nursing facility performance and inform consumer choice through the Care Compare website rating system.
Resources for Families
Families concerned about medication practices in nursing facilities can contact their state's Long-Term Care Ombudsman program. The National Long-Term Care Ombudsman Resource Center operates a toll-free hotline at 1-800-677-1116 and maintains resources at ltcombudsman.org.
Residents and family members can also file complaints directly with state health departments and CMS. Federal regulations require nursing facilities to obtain informed consent before administering psychotropic medications and to attempt non-pharmacological interventions first when addressing behavioral symptoms.
Families are encouraged to request detailed explanations of medication decisions, ask about non-drug alternatives, and review medication administration records during facility visits.
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