Unintended Impact of Focused Dementia Care Surveys

April 1, 2021
April 1, 2021

Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.

Focused Dementia Care Surveys Are Reducing the Use of Antipsychotic Medication, with Unintended Consequences

In 2012, CMS launched the National Partnership to Improve Dementia Care, which includes stakeholders from regulatory entities, providers, advocacy groups and professional organizations. The very important goal of the partnership is to promote adoption of practices that enhance the quality of life for long-term care residents while promoting goal directed, person centered care for each individual. One important strategy is to promote the use of non-pharmacological care and reduced antipsychotic medication use in long-stay nursing home residents. To support this effort, CMS announced in March 2019 their “initiative of enhanced enforcement for nursing homes that continued to show high rates of antipsychotic usage with little to no reduction in these rates since 2011. The goal was for these ‘late adopters’ to reduce antipsychotic utilization rates by 15% by the end of 2019” (Eyigor, 2020). This survey program is continuing in 2020.

Continuing as part of the National Partnership, providers will continue to see “focused surveys” in 2020, with a priority placed on schizophrenia-focused surveys with dementia-focused surveys also occurring—“these surveys are generally completed by a CMS contractor, though the state agency may also participate or conduct the survey. Similar to standard or complaint surveys, a focused survey will be unannounced, and a provider will receive a Statement of Deficiencies for which they may be required to submit a Plan of Correction. Surveys will examine the use of antipsychotic medications, appropriateness of schizophrenia diagnoses, and availability of appropriate care and services for residents diagnosed with dementia” (Eyigor, 2020).

These surveys are a burden for long-term care facilities, but the long-term achievements of the program are impressive. In 2019, CMS released their results, sharing that “In 2011Q4, 23.9 percent of long-stay nursing home residents were receiving an antipsychotic medication; since then there has been a decrease of 40.1 percent to a national prevalence of 14.3 percent in 2019Q2” (CMS, 2019). There is some indication of unintended consequences, “specifically higher rates of reported schizophrenia [than would be expected in this population]. That’s one of the excluded illnesses [for which anti-psychotic medication usage is approved], along with Tourette’s syndrome and Huntington’s disease” (Newman, 2016). Nevertheless, the survey effort is helping the Partnership achieving its goal of an overall reduction in unnecessary medication use.


CMS, “National Partnership to Improve Dementia Care in Nursing Homes,” CMS.gov, February 18, 2020, Retrieved at https://www.cms.gov/Medi­care/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.
Eyigor, J., “Nursing Home Round-Up January 2020,” Leading Age, January 21, 2020, Retrieved at https://leadingage.org/regulation/nurs­ing-home-round-january-2020.
Newman, E., “CMS surprise: New nursing home survey process to debut in late 2017,” McKnight’s Long-Term Care News, September 30, 2016, Retrieved at https://www.mcknights.com/news/cms-surprise-new-nursing-home-survey-process-to-debut-in-late-2017/.


This blog post continues a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:

  • Short Staffing in Long-Term Care Is Having an Impact on Resident and Financial Outcomes
  • The Patient-Driven Payment Model (PDPM) Has Changed Reimbursement for Physical Therapy in Skilled Nursing Facilities
  • Low Rates for Medicaid Reimbursement, Coupled with Additional Recent State Funding Cuts, May Be Precipitating Skilled Nursing and Long-Term Care Facility Closures
  • Long-Term Care Continues to Feel the Financial Impact of Civil Money Penalties and Civil Money Penalty Reimbursement Programs
  • Efforts to Decrease Widespread Antipsychotic Drugs in Long-Term Care Facilities Require Individualized Care Plans
  • Infection Control Surveys Reveal a Widespread Problem Across Long-Term Care

There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.