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State of California—Health and Human Services Agency
California Department of Public Health

AFL 12-56
November 27, 2012

Skilled Nursing Facilities
Nursing Facilities

California Forging Major Campaign to Improve Dementia Care and Reduce Unnecessary Antipsychotic Drug Use in Nursing Homes

This All Facilities Letter (AFL) is being issued to inform all nursing homes of a national initiative and statewide campaign regarding dementia care and antipsychotic medication use.

On March 29, 2012, the Centers for Medicare & Medicaid Services (CMS) launched a national partnership to improve dementia care and reduce unnecessary antipsychotic medication use in nursing homes. As part of the partnership, CMS is developing a national action plan that will use a multidimensional approach to improve care for individuals with dementia that includes public reporting, raising public awareness, regulatory oversight, technical assistance, provider education and research.

In California, a unique partnership of nursing home providers, advocates, physicians, government agencies and others are working together with CMS and the California Department of Public Health (CDPH) to embrace the national initiative and present solutions. At an initial meeting on August 17, 2012, the "California Partnership" set a goal to lead the nation in stopping the unnecessary use of antipsychotic drugs. The initial goals are to reduce the overall use of antipsychotic drugs in nursing homes by at least 15 percent at the end of 2012 and by at least 30 percent by June 30, 2013.

The Partnership participants included representatives from:

  • Centers for Medicare & Medicaid Services Central Office and Region IX;
  • California Department of Public Health Center for Health Care Quality;
  • Alzheimer's Association;
  • Gerontological Advanced Practice Nurses Association;
  • Health Services Advisory Group, Inc.;
  • California Association of Health Facilities;
  • Aging Services of California;
  • California Advocates for Nursing Home Reform;
  • Advocacy, Inc.;
  • California Senate Subcommittee on Aging and Long Term Care;
  • Foundation for Aiding the Elderly;
  • California Attorney General's Office;
  • Disability Rights California;
  • California Association of Long Term Care Medicine;
  • Ventura Long Term Care Services;
  • California Pharmacists Association;
  • Bet Tzedek Legal Services;
  • Ventura County Public Defender's Office:
  • California Office of the State Long-Term Care Ombudsman, and
  • Statewide local offices of Long-Term Care Ombudsman.

CMS, CDPH, industry and advocacy partners have embraced the national initiative and are taking steps to achieve the goal of improved care and antipsychotic medication reduction in California's nursing homes. Actions to help achieve these goals will include: focused enforcement of regulations related to quality of care, antipsychotic medication use and informed consent. Additionally, training on improving dementia care and strengthening consumer awareness is planned by various stakeholder groups.
One final meeting is scheduled in Sacramento in December, to finalize a summary report with recommendations to be submitted to executive leadership within CDPH.
Additional information on the California Partnership to Improve Dementia Care and Antipsychotic Medication Reduction in Nursing Homes Collaborative can be found at the CDPH website: ( The Advancing Excellence in America's Nursing Homes website also has information on the national initiative (



Original signed by Debby Rogers

Debby Rogers, RN, MS, FAEN
Deputy Director
Center for Health Care Quality

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