Nursing Facility Assessments and Care Plans for Residents Receiving Atypical Antipsychotic Drugs

WHY WE DID THIS STUDY

Nursing facilities must meet Federal quality and safety standards to participate in the Medicare and/or Medicaid programs. The standards require extra protections for nursing facility residents receiving antipsychotic drugs. Nursing facility staff are required to assess each resident's functional capacity upon admission to the facility and periodically thereafter. Staff must specify in a written care plan, based on these assessments, the services that each resident needs. CMS contracts with State agencies to ensure that nursing facilities comply with the standards for resident assessments and care plans.

HOW WE DID THIS STUDY

This study used a random sample of records from a previous OIG study of elderly nursing facility residents with Medicare claims for atypical antipsychotic drugs between January and June 2007 (OEI-07-08-00150). We reviewed the records for evidence of compliance with Federal requirements for resident assessments and documentation of decision making. We also reviewed the records for evidence of compliance with Federal requirements for care plan development and implementation.

WHAT WE FOUND

Nearly all records reviewed (99 percent) failed to meet one or more Federal requirements for resident assessments and/or care plans. The resident assessment and care plan process involves four steps. One-third of records reviewed did not contain evidence of compliance with Federal requirements regarding resident assessments, the first step. Further, for 4 percent of records, nursing facility staff did not document consideration of the Resident Assessment Protocol for psychotropic drug use as required, the second step. Ninety-nine percent of records did not contain evidence of compliance with Federal requirements for care plan development, the third step. Finally, 18 percent of records reviewed did not contain evidence to indicate that planned interventions for antipsychotic drug use-the fourth step-actually occurred.

WHAT WE RECOMMEND

We recommend that CMS: (1) improve the detection of noncompliance with Federal requirements for resident assessments and care plans for residents receiving antipsychotic drugs, (2) take appropriate action to address noncompliance with these requirements, and (3) provide methods for nursing facilities to enhance the development and usefulness of resident assessments and care plans. CMS concurred with all of our recommendations.