For 2015 there will be a very strong focus on antipsychotic medications and senile dementia:

  • Residents of LTCFs must never receive antipsychotic medications if the Resident has a sole diagnosis of senile dementia;
  • If a Resident has a dual diagnosis of senile dementia plus psychosis, bi-polar disorder, schizophrenia, schizoaffective disorder, dilirium, hungtington's disease, etc., those are acceptable diagnosis for those Residents with senile dementia;
  • Acceptable alternatives to antipsychotic medications include but are not limited to cholinesterase inhibitors, glutamate blockers, mood stabilizers, anxiolytic agents and antidepressants;
  • Residents should be followed by the Psychiatrist at a minimum of twice yearly;
  • The Psychiatrist should attempt gradual dose reductions for all psychoactive medications at least 1-2 times yearly unless clinically contraindicated;
  • If the Resident is stable on a psychoactive medication yet there has been no behavioral issues in 2-3 months, an attempt at a gradual dose reduction should occur;
  • Nursing must document either in the progress notes or behavioral note section any and all innapropriate behaviors, agression, outbursts, etc.;
  • The Psychiatrist should indicate the effectivness of medication therapy as well as any and all adverse effects of the medications;
  • The primary care provider (PCP) has the ultimate authority of agreeing or disagreeing with the management of the Resident.