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Project PAUSE Statement in Response to President Biden’s Initiative to Improve Nursing Home Safety and Care

Published March 1, 2022

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WASHINGTON, March 1, 2022 – Project PAUSE (Psychoactive Appropriate Use for Safety and Effectiveness) co-convenors, Chad Worz, PharmD, BCGP, Executive Director and CEO of ASCP; and Sue Peschin, MHS, Alliance for Aging Research President and CEO, released the following statement in response to President Biden’s initiative to improve nursing home safety and care:

Chad Worz, PharmD, BCGP, Executive Director and CEO of ASCP stated:

“We appreciate President Biden and his Administration for proposing steps to address nursing home safety for both residents and staff. More than 10 years ago, the Center for Medicare and Medicaid Services’ (CMS) National Partnership to Improve Dementia Care in Nursing Homes began in collaboration with ASCP and other long-term care professional associations and advocacy organizations with a goal of reducing the inappropriate use of antipsychotic medications. While this initiative has positive results on paper, a May 2021 Inspector General report found the current CMS antipsychotic quality measure fails to distinguish between appropriate and inappropriate use, by only reporting only the percent of residents who use antipsychotics rather than shining a light on inappropriate use. This flawed metric directly impacts the Five-Star rating of facilities, including disproportionately penalizing rural facilities and providers who specialize in treating residents with neuropsychiatric symptoms (NPS) of dementia and serious mental health issues. The unintended consequences of the current policy worsen resident outcomes, reduce appropriate management of mental health conditions, increase health inequities, and cause preventable patient harm. We hope that the Administration engages all stakeholders and undertakes efforts that will examine the use of this metric and replace it with a more impactful and appropriate alternative.”

Project PAUSE has developed an alternative, more refined metric that allows improved CMS oversight of antipsychotic usage in long-term care based on FDA-approved indications and interdisciplinary clinical decision-making. Under this proposed measure, the prescribing clinician documents the clinical rationale for use and the consultant pharmacist documents any gradual dose reduction and regimen review information. This system creates checks-and-balances based on the professional recommendation of at least two, independent healthcare providers and allows for patient-centric care and greater family input. It is imperative to measure and monitor both the appropriate and inappropriate use of antipsychotics to protect beneficiary well-being and advance beneficiary care. We encourage the Administration and Congress, either through statute or less formal communication, to work with CMS to update the current antipsychotic measure, including a thorough discussion of how to advance appropriate utilization and decrease inappropriate utilization.” 

Sue Peschin, MHS, Alliance for Aging Research President and CEO, stated:

“The decade-old CMS measure constitutes a bad math problem that provides no sensitivity to detect inappropriate use, allow physicians to practice medicine or honor the wishes of residents and their family. As a result, we’ve seen a decade of good intentions that have yet to solve the problem. We need to be able to differentiate between appropriate and inappropriate use. Unfortunately, the focus was on reducing overall use of antipsychotics in nursing homes—not on ensuring appropriate utilization of them for residents who needed them. 

The method CMS uses to count antipsychotic use provides no insight on whether residents have been prescribed treatment appropriately or inappropriately, regardless of their diagnosis. Thankfully, the need for reform has been recognized by caregivers, physicians, psychiatrists, pharmacists, nurses, family members and home health workers. While reform for a nursing home-specific metric may seem unimportant, poor measures that do not reflect best practices related to clinical care lead to reduced reimbursement and fewer resources for staffing and care improvements. Additionally, the care practices developed in nursing homes inform assisted living and services for people aging at home and in their communities. 

Unfortunately for many, using medications carry a stigma, despite being safe and effective. We are proud to co-convene Project PAUSE with a number of national partners, to improve the quality of life and care for individuals living with Alzheimer’s disease and related dementias. We look forward to working with the Administration, Congress and CMS on this important initiative to improve quality and safety of care in nursing homes and that can correct an oversimplified policy that limits the clinical care of the highly stigmatized symptoms of dementia and serious mental health conditions. “ 

About the Alliance for Aging Research

The Alliance for Aging Research is the leading nonprofit organization dedicated to accelerating the pace of scientific discoveries and their application to vastly improve the universal human experience of aging and health. The Alliance believes advances in research help people live longer, happier, more productive lives and reduce healthcare costs over the long term. For more than 30 years, the Alliance has guided efforts to substantially increase funding and focus for aging at the National Institutes of Health and Food and Drug Administration; built influential coalitions to guide groundbreaking regulatory improvements for age-related diseases; and created award-winning, high-impact educational materials to improve the health and well-being of older adults and their family caregivers. For more information, visit

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