Two reports from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released on March 19, 2026, examine nursing homes’ use of antipsychotic medications; each outlined key findings and recommendations for the Centers for Medicare and Medicaid Services (CMS).

OIG examined survey results from 40 schizophrenia- and dementia-focused surveys from 2018 to 2021 to inform the reports: one detailing the use of antipsychotic medications with residents with dementia and one describing practices of assigning schizophrenia diagnoses to evade antipsychotics quality measures.

Antipsychotic Usage in Nursing Homes

In a report titled Nursing Homes’ Inappropriate Use of Antipsychotic Drugs Poses a Risk to Residents, OIG concluded that nursing homes in the sample inappropriately used antipsychotic medications to manage dementia-related behaviors for the convenience of staff.  The report included examples such as the use of antipsychotics to treat a woman with dementia who cared for therapeutic dolls, a woman with dementia who called out during the night due to unmet needs, and a woman who became combative during bathing, though staff reported the combative behavior was abated when a cup was used to pour water on the woman rather than spraying her with the shower head.

OIG reported that the nursing homes in the sample further failed to evaluate for side effects, adverse effects, or continued need of antipsychotic medications and failed to attempt gradual dose reductions, even when ordered by a physician. OIG cited that both Medical Directors and pharmacists failed to uphold responsibilities to prevent inappropriate use of antipsychotics and identify medical concerns such as failing to identify and intervene when antipsychotic drugs were given without following professional standards of care including clear indications for use and gradual dose reductions. OIG additionally noted that nursing homes failed to develop or implement policies and procedures to safeguard residents, such as monitoring for behavioral symptoms, effectiveness of medications, or dose reductions.

Assignment of Schizophrenia Diagnoses to Evade Quality Measures

In a second report,  Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia to Mask the Misuse of Antipsychotic Drugs, OIG concluded that nursing homes inappropriately assigned diagnoses of schizophrenia to residents on antipsychotic drugs in order to improve quality measure ratings on Nursing Home Care Compare. Nursing Home Care Compare evaluates nursing homes on the rates of antipsychotic drug usage among long-stay residents and the rates of short-stay residents who were newly prescribed antipsychotic drugs after admitting to the nursing home. OIG reported examples of nursing home leadership or company officials instructing clinicians to assign schizophrenia diagnoses or re-submitting resident assessments with new diagnoses added. In many circumstances, the reports indicated that staff were aware that the diagnoses were erroneous but either did not feel empowered to speak up or attempts to correct the practice were openly resisted by company officials and nursing home leaders.

What This Means for Nursing Homes

Nursing homes should expect continued high scrutiny of antipsychotic usage. Based on recommendations from OIG to CMS, it would be prudent to review and update policies and procedures and ensure staff are educated on professional standards of care for managing behavioral symptoms, including non-pharmacological interventions as a primary intervention, and appropriate prescribing, documenting, and monitoring related to antipsychotics and other psychotropic interventions. Appendix PP of the State Operations Manual clearly outlines documentation required to support appropriate antipsychotic usage and what assessments and conditions are required for appropriate assignments of schizophrenia diagnoses. Appendix PP also includes information on chemical restraints and the roles of both the Medical Director and pharmacist in identifying and addressing potential chemical restraints and other issues related to antipsychotic usage.

Nursing homes may also wish to evaluate the current level of involvement of the Medical Director. We know that CMS has shown particular interest in recent years in the role of the Medical Director and it will ultimately be the responsibility of the nursing home to ensure that Medical Directors are informed of and supported to effectively fulfill their responsibilities to coordinate medical care and assist in implementing policies that reflect current professional standards of care.

This  LeadingAge tip sheet provides a refresher on antipsychotics-related compliance.