Project PAUSE Urges Reform of Nationwide Metric Used to Determine Prescribing Antipsychotics in Long-Term Care Settings
WASHINGTON, D.C. / ACCESS Newswire / November 19, 2025 / Project PAUSE (Psychoactive Appropriate Use for Safety and Effectiveness) today announced the release of a new white paper, Assessing the Impact of the Long-Stay Antipsychotic Medication Quality Measure on Treatment of Neuropsychiatric Symptoms of Alzheimer's and Related Diseases, produced by Manatt Health with support from the Alliance for Aging Research.
The report reveals that the Centers for Medicare & Medicaid Services' (CMS) Long-Stay Antipsychotic Medication quality measure, while originally intended to prevent inappropriate use of antipsychotic drugs in nursing homes, has led to unintended consequences that restrict access to safe and effective treatments for more than 3 million residents with Alzheimer's and related conditions.
"We all share a mission to protect nursing home residents and all older adults from any potential medication risks," said Chad Worz, Chief Executive, ASCP, a partnering convener for Project PAUSE. "However, the current CMS long-stay antipsychotic quality measure inadvertently misaligns risk-benefit and interferes in clinical care decision making between patients and their medical team. Clinicians should be able to prescribe FDA-approved treatments for residents living with neuropsychiatric symptoms and other serious mental health conditions, when they need them, to enhance their safety, quality of life, and dignity."
Key findings:
The measure fails to distinguish between clinically appropriate and inappropriate use of antipsychotic medications.
The measure may have increased inappropriate prescriptions of other psychotropics (e.g., anticonvulsants, antidepressants, anxiolytics) and opioids as substitutes for antipsychotics.
The measure does not reflect current clinical guidelines.
The measure incorporates inaccurate diagnosis coding and insufficient exclusion criteria.
The measure's use in the Nursing Home Care Compare Five-Star Quality Rating System lacks critical context for patients, families, and caregivers.
While CMS recently updated the measure to use additional data sources and delayed its reintroduction into the Nursing Home Care Compare Five-Star Quality Rating System until January 2026, the report concludes that critical issues remain unresolved. Project PAUSE and its partners urge CMS to revise, remove, or retire the current measure from the Five-Star Quality Rating System.
"People with Alzheimer's and related diseases deserve access to evidence-based that aligns with current practice guidelines, individualized care that aligns with current practice guidelines," said Dr. Amita Patel, a practicing geriatric psychiatrist, and a member of Project PAUSE. "Quality measurement should support-not hinder-medical professionals' ability to provide safe and effective treatment options."
Project PAUSE (Psychoactive Appropriate Use for Safety and Effectiveness) is a multi-stakeholder initiative dedicated to ensuring that older adults receive person-centered, evidence-based treatment for neuropsychiatric symptoms of dementia. Members include clinicians, researchers, long-term care providers, and patient advocacy organizations such as the Alliance for Aging Research and the American Society of Consultant Pharmacists (ASCP).
Read the full white paper and an executive summary. Learn more about Project PAUSE at AgingResearch.org/ProjectPAUSE.
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To interview someone from Project PAUSE on this report, email John O'Connor, Senior Associate at Keybridge Communications, at john@keybridge.biz, Katie Riley, Alliance for Aging Research Vice President of Communications, at kriley@agingresearch.org, or ASCP Senior Director of Communications Melissa Blacketer, at mblacketer@ascp.com.
SOURCE: Alliance for Aging Research
View the original press release on ACCESS Newswire