The Cost of Antipsychotic Drugs in Senior Care

Phase 2 of the Requirements of Participation is around the corner, and antipsychotic drug use is on the mind of leading senior care providers. According to a recent AARP article, more than one in six nursing home residents living with dementia are being administered antipsychotic drugs that they don’t need.

Pharmacologic interventions are often used to address the “behaviors” associated with Alzheimer’s disease and other dementias. They are expensive, ineffective, and most importantly dangerous. The Food and Drug Administration has continuously alerted healthcare providers that the use of antipsychotic medications to treat older adults living with dementia increases the risk of mortality.

What Is This Reliance on Antipsychotics Costing Us?
Recent discussions in senior care have been focusing on the use and overuse of antipsychotic drugs for people living with dementia, and it’s important to understand the actual cost of these drugs. Assisted living communities are often burdened with the staggering cost of antipsychotic drugs as part of their cost of care, meaning they cannot invest the amount that they would like in engagement activities and education.

Skilled nursing facilities are not usually paying directly for the cost of antipsychotics, rather Medicare, Medicaid, and private insurance are the payers. But they do face rehospitalization, compliance, and risks in addition to jeopardizing the health and well-being of their residents by using drug-based interventions rather than person-centered, individualized therapeutic engagement.

The Office of the Inspector General outlined in a report from 2011 that of the 2.1 million nursing home residents, 304,983 had at least one Medicare claim for an atypical antipsychotic drug. Of the 8.5 million claims for atypical antipsychotic drugs for all Medicare beneficiaries, 20% were claims from nursing home residents amounting to $309 million.

Providers can avoid the costs by committing to decrease the percentage of residents living with dementia using antipsychotic drugs. If a skilled nursing facility currently has 20% of residents living with dementia using antipsychotic drugs, a reduction of just 4% would mean, assuming the SNF has 110 beds, a total of four residents would no longer be taking the drugs which cost about $2,000 per year per resident, totaling $8,000 per facility per year.

Simply put, there are ethical, emotional, and financial costs that go hand in hand with the decision to use antipsychotics. The decision by any healthcare provider to incur such costs is troubling, especially when non-pharmacological strategies are safe, cost-effective and address the individualized needs and interests of each resident regardless of their current stage of Alzheimer’s disease and other dementias.

Aside from being the right thing to do, it is important to use meaningful, non-pharmacologic strategies because reimbursements for care now depend on the effective use of these interventions thanks to the new Medicare and Medicaid Requirements of Participation, which became effective on November 28 2016, from the Centers for Medicare and Medicaid Services.

It is time to pay attention to the growing number of studies that are exploring the effectiveness of art, music, dancing, exercise, and nutrition on the health and well-being of older adults living with dementia. However, a community cannot simply use a non-drug intervention and anticipate immediate results and a person-directed status.

Follow the link to learn more about the impact of Requirements of Participation.

Or, to learn more about mental health in senior care, read An Ounce of Prevention Goes a Long Way.