WASHINGTON, D.C. — A major federal investigation has found that nursing homes across the country are inappropriately administering antipsychotic medications to residents with dementia, using the drugs to manage behavior for the convenience of staff despite warnings that the medications may increase the risk of death, according to a report released this month by the U.S. Department of Health and Human Services Office of Inspector General.
The OIG report, published March 19, 2026 (Report No. OEI-02-23-00200), represents the first installment of a two-part series examining the misuse of antipsychotic drugs in American nursing homes. The investigation reviewed 40 focused nursing home inspections completed by the Centers for Medicare & Medicaid Services and uncovered what the federal watchdog characterized as "alarming instances" of inappropriate antipsychotic drug use, according to the report.
The findings reveal a systemic breakdown at multiple levels of oversight within nursing home operations. According to the OIG, facilities administered antipsychotic medications to dementia patients specifically to control their behavior — a practice that runs directly counter to Food and Drug Administration guidance. The FDA has issued explicit warnings that antipsychotic drugs are not approved to treat dementia and may increase mortality risk among elderly patients with dementia-related conditions. Despite these well-established warnings, the OIG found that nursing homes failed to implement the required safeguards meant to protect residents who received these powerful medications.
The investigation also identified critical failures among the professionals tasked with protecting residents from pharmaceutical harm. According to the report, medical directors at the reviewed facilities failed to prevent the inappropriate prescribing and administration of antipsychotic drugs. Equally troubling, nursing home pharmacists — who serve as a vital safety check in long-term care settings — failed to identify medical concerns associated with antipsychotic use and did not recommend dose reductions as required under federal regulations, the OIG found. Additionally, the report determined that inadequate facility policies and procedures further undermined the regulatory safeguards designed to protect vulnerable residents.
Federal regulations require that nursing homes employ or contract with pharmacists who conduct monthly drug regimen reviews for each resident. These reviews are intended to catch potential medication problems, including the unnecessary use of antipsychotic drugs. The failure of this safety mechanism at multiple facilities points to a structural problem within the industry rather than isolated incidents at individual homes.
CMS Inspection History
The inappropriate use of antipsychotic medications in nursing homes has been a persistent and well-documented problem within the long-term care industry. CMS tracks antipsychotic drug usage rates at every Medicare- and Medicaid-certified nursing home through its Nursing Home Compare system, and the metric has been a key quality indicator for over a decade.
According to CMS data, the national effort to reduce antipsychotic drug use in nursing homes — known as the National Partnership to Improve Dementia Care — has made progress since its launch in 2012, bringing down the national average of residents receiving antipsychotic medications. However, the OIG's latest findings suggest that significant problems persist beneath the surface-level improvements. The 40 focused inspections reviewed by the OIG revealed that even facilities subject to direct regulatory scrutiny were found to be misusing these medications, raising questions about the true scope of the problem industry-wide.
The OIG report noted that the inappropriate use of antipsychotic drugs has been a "longstanding concern" for Congress and other stakeholders, according to the report. The sedative properties of these medications have fueled persistent concerns that some facilities use them as chemical restraints — effectively sedating residents to reduce the staffing burden associated with managing behavioral symptoms of dementia through non-pharmacological approaches.
Ownership & Operations
The OIG report did not single out specific facility chains or ownership groups, instead characterizing the problem as one with "implications for the wider nursing home population" beyond the 40 inspections reviewed. This framing suggests the federal watchdog views the misuse of antipsychotic drugs as an industry-wide systemic issue rather than a problem limited to particular operators.
In response to the findings, the OIG issued four recommendations to CMS, according to the report. The watchdog urged CMS to develop additional resources for nursing homes and increase transparency around antipsychotic drug use, take action to ensure medical directors fulfill their oversight responsibilities, hold pharmacists accountable for their required role in monitoring antipsychotic prescribing, and help facilities strengthen their internal policies and procedures.
However, CMS's response to the recommendations was notably lukewarm, according to the OIG. The agency did not explicitly agree or disagree with the first and fourth recommendations and actively rejected the second and third recommendations — those focused on holding medical directors and pharmacists accountable for their oversight failures. The OIG stated in the report that it had added clarifications to the rejected recommendations and encouraged CMS to reconsider its position.
The lack of full agreement from CMS on key accountability measures may concern advocates for nursing home residents, as it suggests the regulatory agency may not take immediate steps to address the oversight failures identified in the investigation.
Resources for Families
Families who are concerned about the use of antipsychotic medications on their loved ones in nursing homes have several avenues for seeking help and reporting potential problems.
The National Long-Term Care Ombudsman Resource Center can be reached at 1-800-677-1116. Ombudsman programs exist in every state and advocate on behalf of nursing home residents, investigating complaints and working to resolve issues related to care quality, including concerns about inappropriate medication use.
Families should request a complete list of all medications being administered to their loved one, including the specific diagnosis justifying each prescription. Federal law gives residents and their representatives the right to access this information. If an antipsychotic medication is being administered, families should ask whether a documented medical condition — other than dementia-related behavioral symptoms — supports its use, whether non-pharmacological interventions were attempted first, and whether gradual dose reductions have been considered.
Concerns about inappropriate medication use can also be reported directly to the state survey agency responsible for nursing home inspections or through the CMS complaint process. Additional information and resources are available through the National Long-Term Care Ombudsman Resource Center at [ltcombudsman.org](https://ltcombudsman.org).
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