Inappropriate anti-psychotic drug use in U.S. nursing homes is “widespread” and requires immediate action, a report submitted to the United Nations alleges.

The Long-Term Care Community Coalition (LTCC) submitted the report last week as an update to a 2015 look at anti-psychotic use in nursing homes, finding little change since the non-profit last tackled the subject.

Richard Mollot, executive director of the LTCCC, told Skilled Nursing News that in some cases, facilities are increasing the use of other drugs in place of anti-psychotics and diagnosing residents with schizophrenia later in life.

“You don’t come down with that in your 90s,” he said. “This is something we were always afraid of, that people would start getting diagnoses for the first time in their 80s or 90s of schizophrenia so they could be given the drugs with relative impunity.”

The report comes after Human Rights Watch released its own commentary in February estimating that more than 179,000 people in U.S. nursing facilities are inappropriately given anti-psychotic drugs. The skilled nursing industry pushed back against the report at the time, but the report to the U.N. from the LTCCC said the progress touted by both the industry and by the U.S. government may be overstated.

The Centers for Medicare & Medicaid Services (CMS) began a campaign to improve dementia care in nursing homes in 2012 that had an initial goal of reducing the rate of anti-psychotic drug use by 15% in nine months, or the end of the 2012 calendar year, the LTCCC update said.

That goal was not met for an additional year, and an analysis by the LTCCC of national data in 2015 found neither CMS nor the states enforced resident protections banning the unnecessary use of anti-psychotics. The average state citation rate for inappropriate drug use was 0.31%, and of those, harm to residents was identified 2% of the time, according to the LTCCC.

“Given these poor results… one might expect that the federal government would have taken a different approach to address this burgeoning problem,” the report said. “Instead, CMS simply continued its education and outreach activities to the nursing home industry, essentially flouting its mandate to enforce federal standards and safeguard nursing home residents. Subsequently, it added new, lower goals of a five percent reduction in 2015 and 2016.”

The LTCCC’s analysis stands in contrast with more positive news out of CMS in recent months. Data released last year showed that the national prevalence of anti-psychotic use in long-term care residents was reduced by 34.1% between 2011 and early 2017. The agency also established a goal of a 15% reduction by the end of 2019.

The American Health Care Association (AHCA) additionally called for skilled nursing facilities to safely decrease off-label anti-psychotic use by 10% — or maintain a rate of 8% or less in long-stay residents and a rate of 1% or less in short-stay residents — by 2021 in its three-year goals for skilled nursing facilities released March 13.

Written by Maggie Flynn