Medicare and Medicaid Pushing for a Reduction in the Use of Antipsychotic Medications in California Nursing Homes

A recent article published in the Journal of American Medical Directors Association titled “Antipsychotics and Dementia: A Time for Restraint?” reports on the usage of antipsychotic medications in nursing homes. It is true, indeed, that antipsychotic medications have in many ways improved quality of care for those with illnesses such as schizophrenia and bipolar disorder. However, the reality of the situation is that most of the time, antipsychotics are not being used to treat either of these disorders. Instead, antipsychotics are most frequently used for the off-label purpose of subduing patients with dementia. That being said, the Center for Medicare and Medicaid Services (CMS) has realized the reality of the situation, and has implemented an initiative to reduce the use of antipsychotic medications in nursing homes.

It is important to note that the Food and Drug Administration (FDA) does not approve of the off-label use of antipsychotics. In fact, pharmaceutical companies are required to place a label on their medications warning patients that use of antipsychotic medications for treatment of dementia nearly doubles the risk of mortality, and may also lead to side effects including strokes and delirium. Despite the warning on the dangers of these drugs, off-label use of antipsychotics still accounts for 80% of prescriptions in nursing homes.

This astonishingly large statistic indicates a wider issue that is prevalent in nursing homes nationwide: inadequate staffing . Past surveys have actually indicated a link between understaffing in nursing homes and an increased amount of federal and state deficiency citations for improper use of physical restraints. This is due to the fact that when there is insufficient nursing personnel to care for residents, nurses often resort to the use of restraints. Because dementia patients can be agitated and combative, nurses, especially when they are short staffed, may find it more convenient to chemically restrain such patients with antipsychotic drugs, which are known to have sedative effects.
Besides this being a direct violation of the Patients’ Rights, the use of chemical restraints does not effectively improve the quality of life for dementia patients in any way. Specialists actually recommend that non-pharmacological alternatives, such as recreational activities, instead be used to treat dementia. However, given that these activities require significantly more time than simply just administering drugs to patients, it is unlikely that residents of understaffed facilities are receiving the care and treatment they deserve.

Elder abuse is a practice that is far too prevalent in California and Los Angeles skilled nursing facilities. The initiative by CMS discussed in this report is not the first to address the prevalence of nursing home neglect in skilled nursing facilities. Past initiatives include incentives to nursing homes for reducing incidents of preventable injuries, such as falls and pressure ulcers.


Nursing home litigation is a very specialized area of the law that requires extensive knowledge of the numerous injuries that are prevalent in skilled nursing facilities. The elder abuse specialists at the Law Offices of Ben Yeroushalmi are confident that we can provide you and your loved one with the legal services that you need to achieve justice. If you believe you’re your loved one is a victim of nursing home neglect, please do not hesitate to contact us today for a free consultation.