Evaluation of neuroleptic drug use by nursing home elderly under proposed Medicare and Medicaid regulations

Abstract

Federal regulations for use of neuroleptic drugs in Medicare- and Medicaid-certified nursing homes throughout the United States were implemented October 1, 1990. These regulations constitute the first time that prescription drugs are required, by law, to be justified by indications documented in the medical chart. This study used extant data to estimate ineligible neuroleptic use at the individual and nursing home levels had these regulations been in effect in 1976 through 1985. Subjects, randomly sampled admissions (N = 5752) and residents (N = 3191), were followed up for up to 24 months in 60 nursing homes. One half of neuroleptic use in each cohort could be considered ineligible under the regulations; all but one of the nursing homes had one or more individuals who were treated with the ineligible use of neuroleptics. Improvements in documentation and/or prescription of neuroleptic drugs for nursing home elderly will be needed to ensure compliance with these new regulations.

KIE: Guidelines developed by the federal Health Care Financing Administration (HCFA) for the administration of drugs in Medicare- and Medicaid-certified nursing homes were recently implemented, marking the first time that the use of prescription drugs must be justified on the patient's medical chart. This study applied the HCFA guidelines on the administration of neuroleptic drugs to an existing set of data about medication use in nursing homes to estimate the potential impact of the federal regulations. Subjects, both randomly sampled admissions and residents, were followed through nursing and medical records for up to 24 months in 60 nursing homes in eight Western states. Comparison of the study data with the HCFA criteria revealed that one half of the neuroleptic use in each cohort was ineligible by federal standards. The authors discuss the implications that the implementation of the HCFA guidelines has for the care of the elderly.