WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services is undertaking a formal review of its longstanding policies discouraging antipsychotic medication use in nursing homes, a shift that could reshape how more than one million long-term care residents receive psychiatric treatment. The review, confirmed by the agency under CMS Administrator Mehmet Oz, follows pressure from both Congress and pharmaceutical industry-linked advocacy groups, according to reporting by The Washington Post.
The agency stated in an email obtained by The Washington Post that it is conducting the review "with the goal of supporting clinically indicated use while continuing to discourage inappropriate prescribing," as reported by the newspaper on Friday. The development marks a significant potential departure from more than a decade of federal efforts to reduce antipsychotic use in skilled nursing facilities.
According to The Washington Post, Congress included non-binding language in recent budget negotiations instructing CMS to better differentiate between appropriate and inappropriate antipsychotic prescribing in its skilled nursing policies. The directive adds legislative weight to a growing chorus of critics who argue the current quality measure — now nearly 15 years old — penalizes facilities even when medications are being prescribed for legitimate clinical reasons.
Since 2012, nursing homes across the country have substantially reduced their use of antipsychotic drugs, as reported by McKnight's Long-Term Care News. However, CMS has continued to push for further reductions through an escalating combination of audits, financial penalties, and star rating deductions. Critics contend these enforcement mechanisms have created a chilling effect that discourages clinicians from prescribing medications that some residents genuinely need.
Chad Worz, chief executive of the American Society of Consultant Pharmacists, told McKnight's Long-Term Care News that an advocacy initiative closely affiliated with his organization had advocated for the Congressional language. "Project PAUSE continues to press CMS to reform the [antipsychotics] long-stay measure as the current measure, now almost 15 years old, is not a validated measure for quality and does not distinguish between an [antipsychotic] used appropriately versus potentially inappropriately," Worz said, as quoted by McKnight's. He added that the publicly reported data "does not fairly represent whether those medications are being used appropriately in individual nursing homes."
The policy review carries significant implications for the roughly 17 percent of long-stay nursing home residents who currently receive antipsychotic medications such as quetiapine (Seroquel), risperidone (Risperdal), and olanzapine (Zyprexa), according to The Washington Post's reporting. Long-stay residents account for approximately 36 percent of the 1.3 million people living in nursing homes nationwide.
Outside of nursing home settings, antipsychotic medications are frequently used to manage neuropsychiatric symptoms that affect an estimated 97 percent of patients with Alzheimer's disease, according to a white paper published by Manatt Health and the Alliance for Aging Research. That report argued that the current quality measure is actively discouraging the use of clinically necessary medications. Sue Peschin, CEO of the Alliance for Aging Research, has been among the most prominent voices advocating for reform of the quality measure, as reported by The Washington Post. The Alliance has received funding from Otsuka, the manufacturer of brexpiprazole (Rexulti), which received FDA approval specifically for agitation associated with Alzheimer's dementia.
The pharmaceutical industry's involvement has raised concerns among patient safety advocates who fear that loosening restrictions could lead to a return of widespread chemical restraint practices in nursing homes. Federal regulations require that nursing home residents be free from unnecessary drugs, and antipsychotic medications carry FDA black box warnings about increased mortality risk in elderly patients with dementia. However, proponents of reform note that these warnings have not been updated to reflect newer medications specifically designed for dementia-related conditions.
As recently as November, CMS had publicly defended its efforts to curb what it characterized as the "overuse" of antipsychotic drugs in nursing homes, according to McKnight's Long-Term Care News. At that time, a CMS spokesperson emphasized that the agency "does not dictate which diagnoses are acceptable for the prescription of antipsychotic medications" and that practitioners retain "the flexibility to provide individualized treatments" based on clinical judgment.
CMS Inspection History
The policy review has broad implications for nursing facilities nationwide, including those in states with significant long-term care populations. Federal inspection data maintained by CMS tracks antipsychotic prescribing rates as part of its quality measure system, and facilities are scored based on the percentage of long-stay residents receiving these medications. Homes with higher prescribing rates face potential reductions in their overall CMS star ratings, which serve as a primary tool for families evaluating nursing home quality.
The current quality measure does not account for whether an antipsychotic is prescribed for a clinically validated reason or whether the resident's care team has determined the medication is the most appropriate intervention. This lack of nuance in the measure has been a central criticism from both provider organizations and pharmacy professionals. Any changes to the measure could affect how thousands of nursing homes across the country are rated and evaluated by the public, potentially shifting star ratings for facilities that have been penalized for clinically appropriate prescribing.
Ownership & Operations
The policy discussion cuts across all ownership types in the nursing home industry, from nonprofit community facilities to large for-profit chains. Industry trade groups have long argued that the antipsychotic quality measure creates perverse incentives that can compromise resident care. The American Health Care Association and other provider organizations have advocated for a more nuanced approach that accounts for clinical appropriateness. Meanwhile, consumer advocacy groups have cautioned that the nursing home industry has a documented history of overusing psychotropic medications as a cost-saving measure to manage resident behavior with fewer staff, rather than investing in non-pharmacological interventions and adequate staffing levels.
Resources for Families
Families with loved ones in nursing homes who have questions or concerns about antipsychotic medication use should know their rights. Federal law requires that residents or their representatives be informed about all medications, including their purpose, potential side effects, and alternatives. Families can request a care conference at any time to discuss medication management.
For assistance or to file a complaint regarding medication practices in Washington state nursing homes, contact the Washington Long-Term Care Ombudsman at 1-800-562-6028. Residents and families nationwide can reach the Eldercare Locator at 1-800-677-1116 for guidance on connecting with local ombudsman programs. Additional resources are available at [ltcombudsman.org](https://ltcombudsman.org).
Families should ask nursing home staff whether their loved one is receiving antipsychotic medications, the clinical rationale for the prescription, what non-pharmacological alternatives have been attempted, and whether regular reassessment of the medication's necessity is being conducted. These are questions that care teams are obligated to answer under federal nursing home regulations.
This is a developing story and will be updated as additional information becomes available.
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