Long-Stay Antipsychotic Measures: What They Mean and Why They Matter in Nursing Homes

The use of antipsychotic medications in long-term care has been under increased scrutiny for more than a decade. Today, it remains one of the most closely watched indicators of quality, safety, and clinical decision-making in nursing homes.

The Centers for Medicare & Medicaid Services (CMS) tracks this through the Long-Stay Antipsychotic Quality Measure, a key metric publicly reported and embedded within the Five-Star Quality Rating System.

This measure does more than report medication use. It reflects how well a facility assesses behaviors, implements non-pharmacological interventions, documents appropriately, and aligns interdisciplinary care.

What the Long-Stay Antipsychotic Measure Tracks

At its core, the measure looks at:

• The percentage of long-stay residents receiving antipsychotic medications during a target period

“Long-stay” typically refers to residents who have been in the facility for more than 100 days and are receiving ongoing care.

This measure excludes residents with specific clinical diagnoses such as:

• Schizophrenia
• Huntington’s disease
• Tourette’s syndrome

These exclusions are intended to ensure the measure focuses on potentially inappropriate use rather than clinically necessary treatment.

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What Has Changed in 2026

CMS has significantly evolved how this measure is calculated, and those changes have real implications for nursing home performance.

A Shift to Hybrid Data

Historically, the measure relied primarily on Minimum Data Set (MDS) coding. That is no longer enough.

CMS now uses a hybrid methodology, combining:

• MDS assessment data
• Medicare and Medicaid claims data
• Medicare Advantage encounter data

This change allows CMS to capture antipsychotic use beyond the traditional 7-day lookback window, improving accuracy and reducing underreporting.

What This Means for Facilities

• Reported rates may increase, even if prescribing practices have not changed
• Documentation inconsistencies are more visible
• Diagnosis coding must align across clinical and claims data
• Five-Star ratings may shift due to recalibrated scoring thresholds

In short, CMS is no longer just measuring what is documented. It is validating what actually occurs.

Why This Measure Carries Significant Risk

Antipsychotic use in long-term care is not just a regulatory concern. It is a clinical and ethical one.

These medications are associated with:

• Increased risk of falls and injury
• Sedation and reduced engagement
• Higher mortality risk in certain populations, particularly those with dementia

Because of these risks, CMS and survey agencies are increasingly focused on:

• Whether antipsychotics are clinically justified
• Whether non-pharmacological interventions were attempted first
• Whether behaviors were fully assessed and understood
• Whether the interdisciplinary team is actively involved

This is where many deficiencies emerge. Not from a single decision, but from a breakdown in clinical documentation and system processes..

Where Facilities Struggle

The long-stay antipsychotic measure is rarely a standalone issue. It is often a symptom of deeper gaps, including:

• Inconsistent behavioral health assessment processes
• Limited use or documentation of non-pharmacological interventions
• Communication gaps between nursing, providers, and pharmacy
• MDS coding that does not reflect actual clinical practice
• Diagnosis documentation that does not align with claims data

With the updated CMS methodology, these gaps are no longer hidden. They are measurable.

How Qsource Works with Facilities to Improve Performance

Improving antipsychotic rates is not about eliminating medications altogether. It is about ensuring appropriate, well-documented, and clinically justified use supported by strong systems.

Qsource works alongside facilities to address this measure at its root.

Clinical and Behavioral Review

• Identification of residents triggering the measure
• Deep review of behavioral symptoms, diagnoses, and medication indications
• Alignment of clinical documentation with regulatory expectations

Interdisciplinary Process Strengthening

• Integration of nursing, social services, providers, and pharmacy into decision-making
• Structured behavior management approaches
• Clear communication pathways for medication review and adjustment

Documentation and Coding Alignment

• MDS accuracy and consistency with clinical records
• Diagnosis validation to ensure appropriate exclusions
• Support for aligning EMR, MDS, and claims data

Non-Pharmacological Intervention Development

• Implementation of individualized behavior interventions
• Staff education on alternative approaches
• Integration of interventions into care plans and daily practice

Ongoing Monitoring and QAPI Integration

• • Trending of antipsychotic use over time
  • Root cause analysis for new or continued use
  • Integration into QAPI programs for sustained improvement

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Moving from Compliance to System Reliability

Facilities that succeed are not simply reacting to survey pressure. They are building systems that:

• Identify behavioral changes early
• Engage the right disciplines at the right time
• Use medications appropriately and thoughtfully
• Maintain documentation that reflects the full clinical picture

With CMS continuing to expand the use of claims-based validation and data transparency, the expectation is clear.

Performance must be consistent.
Documentation must be accurate.
Systems must be reliable.

The long-stay antipsychotic measure is no longer just a quality metric. It is a reflection of how well a facility understands and manages complex resident needs.

Organizations that take a proactive, system-based approach will not only improve their scores. They will strengthen care delivery, reduce risk, and create better outcomes for residents.

That is where sustainable improvement begins.