OHCA Spring Summer 2017

19 / 28

Spring/Summer 2017 The Oregon Caregiver 21
LEGAL & REGULATORY
The use of antipsychotic medications
by seniors is receiving attention
from lawmakers both in Oregon
and on the national stage. While there
is concern that older Americans in
general may be receiving an increased
amount of prescriptions for antipsychotic
and psychotropic drugs (see Journal of
American Medicine, “Trends in Central
Nervous System-Active Polypharmacy
Among Older Adults Seen in Outpatient
Care in the United States,” February 13,
2017), that concern does not apply to
long term care.
The National Partnership to Improve
Dementia Care in Nursing Homes
December 2016 Data Report shows
that the percentage of nursing facility
residents who are receiving a prescription
for antipsychotics actually decreased by
32% between 2011 and 2016. The National
Partnership is a private-public coalition
that includes the Centers for Medicare
and Medicaid (CMS), consumers,
advocacy organizations, providers, and
professional associations partnering to
promote delivery of health care that is
person-centered, comprehensive, and
interdisciplinary with a specific focus
on protecting residents from being
prescribed antipsychotic medications
unless there is a valid, clinical indication
and a systematic process to evaluate each
individual’s need.
Existing regulations reinforce this goal
of focusing use of antipsychotics only
where they are most appropriate. CMS,
in its recently adopted Nursing Facility
Requirements of Participation, dictates
that a nursing facility must ensure that
residents who have not used psychotropic
drugs previously are not given them
unless the medication is necessary to
treat a specific diagnosed condition.
Residents who use psychotropics are
to receive gradual dose reductions and
behavioral interventions unless clinically
contraindicated. The rules also limit PRN
usage of psychotropic drugs, providing
that PRN orders for psychotropic drugs
are limited to 14 days unless the physician
or prescribing practitioner specifically
indicates an extension is warranted. These
new requirements go into effect November
28, 2017. (42 CFR 483.45 )
Antipsychotic Prescriptions Drop
for Nursing Facility Residents
By Gwen Dayton, J.D., Oregon Health Care Association
Oregon law also addresses this issue
for community based care. Assisted
living and residential care facility
administrative rules provide that
psychoactive medications only may
be used if required to treat a resident’s
medical symptoms or to maximize a
resident’s functioning and even then
may only be used in consultation
with a physician or other health care
professional. (OAR 411-054-0055).
All caregivers are required to know
the specific reasons for the use of the
medication, the common side effects,
and when to contact a health professional
regarding side effects.
At the time of print, Oregon has not
passed any new legislation relating to
these types of drugs. OHCA members
can keep updated on any changes to this
through our newsletters. 
If you have any questions regarding this issues addressed in this
article, please contact Gwen Dayton, OHCA general counsel
and executive VP, at or 503-726-5229.
Nursing facility residents
receiving prescriptions for
antipsychotics decreased by
between 2011
and 2016. 32%