NH Inappropriate Antipsychotic Use

Inappropriate antipsychotic administrations take place in nursing homes when a resident receives a drug without a corresponding appropriate diagnosis (e.g., schizophrenia). About 1 in 10 nursing home residents (10 percent) received antipsychotics inappropriately in 2021. Over the last several years, literature suggests that such administrations occur disproportionately among Black residents, while more recent studies posit that decreases of inappropriate in recent years may stem from inappropriate diagnoses that would lead an antipsychotic administration to be considered appropriate. States range in performance with this indicator, from 6.7 percent to 25 percent for each state’s worst performing group, or one third lower than the national average for all groups to one and a half times higher. 

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†† Due to small sample size of one or more racial/ethnic groups, this indicator could not be calculated.  An imputed value was used for scoring, but is not displayed or ranked. 


The percentage of nursing home residents who are inappropriately receiving antipsychotic medication on target assessment. Criteria for inappropriate use excludes nursing home residents with a diagnosis of schizophrenia or bipolar disorder. The indicator measures prevalence among residents present in the facility as of the first Thursday of April 2021.
These data were averaged at the state level following the LTSS State Scorecard approach to measuring equity.

Equity adjustment: Race/ethnicity is indicated in MDS by a 6 category multiple response variable with choices:

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Native Hawaiian or Other Pacific Islander
  • White 

Residents were classified by race/ethnicity as follows:

  • Hispanic/Latino: “Hispanic or Latino” is selected
  • All Other Races/Ethnicities: exactly one race/ethnicity is selected (a resident is classified as “Asian” if and only if “Asian” is selected and no other races/ethnicity is selected)
  • Multiracial: “Hispanic or Latino” is not selected and two or more other races/ethnicities are selected

Data are presented for all residents and for each race/ethnicity group with sufficient sample size to report.  Residents without any race/ethnicity category selected are included in all residents but not in any subgroup.

For the equity adjusted metric score, residents are divided into 2 groups: White, and an aggregate grouping of {American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or Other Pacific Islander, and Multiracial}.  The lower performing group (higher percentage of residents with inappropriate antipsychotic given) is scored and ranked as a performance metric.

In Maine and Vermont, the sample size was not sufficient to score both groups.  The metric value is therefore shown as N/A and the state is not ranked.  The metric value for all nursing home residents is used for calculating dimension-level performance.

Analysis of 2021 MDS 3.0 state-level care data provided by the Changing Long-Term Care in America Project at Brown University in February-April 2023.

Brown University (2023). Changing Long Term Care in America Project at Brown University funded in part by the National Institute on Aging (1P01AG027296). Providence, RI: Brown University School of Public Health,


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