Nursing facilities have been successful in reducing the number of antipsychotics in the past few years, even exceeding the CMS goal. The monitoring of antianxiety and hypnotic medications, while once a discussion, is now a reality, as CMS announced last week that they will now be monitoring antianxiety and hypnotics. While there is not a specific goal for reduction, CMS has added the utilization of these drugs to the list as the 5th new, quality measure for the consumer-based Nursing Home Compare.
Now one has to wonder, why? Does CMS believe that these medications are substitutes for the decrease in antipsychotics? Are they?
All of these medications have a place in long-term care when properly used, monitored and discontinued, and they are not meant to be used for the remainder of a person’s life.
However, the use of these medications for some can be life changing and truly impact a resident’s quality of life. When someone is anxious and confused with no recognizable source to relieve their discomfort, using medication seems more humane.
The concern is that these medications are used on too many residents, particularly those with dementia when their confusion and behaviors become unruly or disruptive. A dementia diagnosis does not justify use in all residents. In many settings, both nursing facilities and assisted living, I have seen these medications used repeatedly for the convenience of staff who lack education and knowledge about the disease, or who simply don’t want to deal with a resident’s behavior. Unfortunately medication use versus education in many environments has been an acceptable practice. Never a good solution.
When consulting with facilities to create or enhance person-centered memory care programs we find that staff want to understand the disease, want to improve their ability to manage care, and desire systems and processes that give them the personal information and strategies necessary to provide effective care.
The choice: medications and regulatory penalties, or education and an organizational strategy for memory care. It’s up to you.