Nursing homes in disadvantaged neighborhoods are more likely to rely on antipsychotics, especially when understaffed, compared to those in more affluent areas, according to a new study in Jama Network Open.
The complex challenges faced by such nursing homes suggests that policymakers should attempt to support them with targeted aid, rather than penalize them for poor performance, the researchers suggested.
Examining data for nearly 11,000 nursing homes — including more than 1,800 from severely socioeconomically deprived areas — the authors found that nursing homes in the deprived areas were using antipsychotics inappropriately for 19.2% of residents. Nursing homes in less-deprived areas were doing so for 17.1% of residents.
That seemingly small gap of about 2% can have a significant impact on residents, according to Jasmine Travers, PhD, assistant professor of nursing at NYU and lead author of the study published Wednesday.
“This means that in a 100-bed nursing home that is understaffed, two additional residents would inappropriately receive an antipsychotic medication if the nursing home was in a disadvantaged neighborhood versus a more well-off area,” she said in a report on the study Wednesday.
Push for less antipsychotic use
Antipsychotic medications have become an area of increasing concern in recent years, with providers being accused of using them to control behaviors of residents who don’t actually need the medications. The Centers for Medicare & Medicaid Services has ramped up audits of schizophrenia diagnoses in nursing homes with the goal of reducing such inappropriate antipsychotic use.
Antipsychotics can be a way of keeping residents sedate in situations where there are not enough care workers to attend to their needs, Travers explained.
The researchers noted that the 2% gap in antipsychotic use shrunk significantly in nursing homes that had enough staff to provide 3.0 hours of care per resident per day. This could be interpreted as an argument in favor of higher staffing requirements for nursing homes, but also suggests that disadvantaged nursing homes could benefit from targeted aid rather than penalties.
“Instead of penalizing nursing homes located in deprived neighborhoods and with poorer quality outcomes, such as increased antipsychotic medication use, state and federal entities could focus on targeting funds at the ZIP code level to better support staffing initiatives in these areas,” the authors wrote.
Provider impact
Tailored aid programs have already been used in other care settings, such as home health, and could have a positive impact if applied to long-term care, according to co-author Jason Falvey, PhD, assistant professor at the University of Maryland School of Medicine.
“Since 2001, Medicare has provided (albeit inconsistently) payment add-ons for home health care agencies serving rural beneficiaries, as defined by those in certain areas based on counties and/or by population density,” Falvey told McKnight’s Long-Term Care News Wednesday. “These add-on payments are a form of ‘micro-targeting’ policy resources at the geographic level, supporting access to care and helping maintain a rural workforce. A similar type of “micro-targeting” of policy resources might be effective for long-term care settings, giving payment add-ons, for example, to facilities in the most deprived census block group areas or ZIP codes to directly support the long-term care workforce.”
Favley noted that these targeted payments could be especially helpful to facilities with a higher percentage of Medicaid beneficiaries among their residents, which is common in deprived neighborhoods.
Travers told McKnight’s that the recently finalized staffing mandate could help close the gap over time, but providers can take steps now to address the antipsychotic use problem.
Examples included better tracking of antipsychotic use in the facility, promoting behavior and health and person-centered care training to staff and equipping CNAs to report changes in resident behavior as early as possible so that their needs can be addressed before those changes escalate.
