Vulnerable elderly residents face serious risks and premature death from antipsychotics, as nursing homes and their prescribers evade meaningful accountability.
By Jan Eastgate
President CCHR International
April 17, 2026
Vulnerable elderly residents in U.S. nursing homes continue to face serious risks of premature death from antipsychotics. Facilities and their prescribers are evading meaningful accountability. Despite decades of federal investigations, congressional promises, and repeated calls for reform, the dangerous drugging of our elderly persists—with penalties remaining far too weak to deter the abuse.
The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently issued two related reports examining psychotropic drugging in nursing homes. In a review of 40 Centers for Medicare and Medicaid Services (CMS) inspections, the OIG found that facilities routinely administered antipsychotics—drugs not FDA-approved for dementia and linked to increased mortality—to control resident behavior, while frequently failing to implement required safeguards.[1]
“The inappropriate use of antipsychotic drugs in nursing homes has been a longstanding concern for Congress and others,” the OIG stated.[2] The reports also exposed a deliberate tactic: some nursing homes misdiagnose residents with “schizophrenia” to bypass accountability and artificially improve public quality ratings. The OIG recommended that CMS strengthen oversight, closely monitor schizophrenia diagnosis rates, target high-risk facilities, and ensure residents and families receive clear information about antipsychotic use.[3]
We’ve heard it all before. This abuse has been reported for decades—especially promises of increased oversight—yet doctors continue to deliberately misdiagnose residents and ply the elderly with debilitating antipsychotics. What makes this particularly outrageous is that despite repeated investigations and warnings, the penalties are so weak they fail to deter anyone.”
Current penalties—capped at $1,000–$5,000 for false certifications—are woefully inadequate and fail to deter ongoing abuse.[4] HHS OIG may impose greater sanctions, yet enforcement has historically been lax.
In 2011, OIG Inspector General Daniel Levinson declared: “Government, taxpayers, nursing home residents, as well as their families and caregivers, should be outraged—and seek solutions.”[5] Fifteen years later, that outrage has yet to produce lasting change. In 2023, although HHS identified serious problems with inappropriate antipsychotic use and inaccurate schizophrenia diagnoses, the agency stopped short of meaningful action. It did not impose substantial financial penalties on offending nursing homes and prescribers.[6]
Antipsychotics carry well-documented dangers for the elderly. In 2005, the Food and Drug Administration (FDA) issued a black-box warning for their use in dementia patients due to elevated death risks.[7] In 2007, FDA senior drug safety official Dr. David Graham warned that at least 15,000 nursing home residents die annually from these drugs.[8] A 2024 American Association of Retired Persons report found that in people with dementia aged 50 and older, antipsychotics more than doubled the risk of pneumonia—the leading cause of death in this population—while also increasing risks of stroke, acute kidney injury, blood clots, bone fractures, heart attack, and heart failure.[9] A Journal of Clinical Psychiatry study further noted that side effects are particularly problematic in elderly patients due to age-related changes.[10]
A Long History of Failed Oversight
The problem dates back decades:
- 1987: Congress passed the Omnibus Reconciliation Act, including the Nursing Home Reform Act, intended to curb chemical restraints—yet the practice shifted to medication-based “chemical restraints.”[11]
- 2007: Sen. Chuck Grassley called for an OIG review of antipsychotic use and marketing in nursing homes.[12]
- 2008: CMS added the Five Star Rating System to the Medicare.gov website, Nursing Home Compare (now known as Care Compare), and was given a rating system comprising three domains: Health Inspections, Staffing, and Quality Measures.[13]
- 2011: The OIG reported that 88% of antipsychotics were prescribed off-label to elderly dementia patients despite FDA warnings.[14] The Lancet revealed that more than half of Medicare-paid antipsychotics for those over 65 were for unapproved uses, costing $116 million in six months.[15]
- 2012–2015: CMS’s National Partnership to Improve Dementia Care reduced prescribing somewhat, but “schizophrenia” diagnoses rose 194% from 2015 to 2019, undermining progress.[16]
- 2017-2018: Despite new enforcement rules and civil money penalties, 10% of citations associated with “Actual Harm” or “Immediate Jeopardy” resulted in no fine, and nearly one fourth resulted in a fine of less than $20,000.[17]
- 2019–2020: Roughly 20% of skilled nursing facility residents—about 298,650 people weekly—received antipsychotics. A House Ways and Means report described the crisis as “one of patient harm, inadequate oversight, and insufficient staffing.” Antipsychotics use in senior citizens cost $50 billion (non-fatal) and $754 million (fatal) for the 65 and older population.[18]
- 2021: OIG determined the reporting for the number of long-stay residents receiving antipsychotics may not accurately reflect the number prescribed them. [19]
- 2023–2024: Further crackdowns and reports showed over 250,000 residents (more than one in five) were still receiving these drugs.[20]
- 2025: CMS reported: “The inappropriate use of antipsychotic medications is very dangerous for nursing home residents in terms of acting as a chemical restraint or causing death. For over a decade, CMS has strived to reduce the unnecessary use of these drugs. CMS publishes the percentage of long-stay residents receiving antipsychotics and includes this information in the Five Star Quality Rating System.”[21]
- 2025, October: CMS reported it would be replacing its measures to more appropriately reflect the number of residents prescribed antipsychotics. [22]
This continued drugging despite repeated investigations and promised reforms is outrageous. Accountability has been negligent. Substantial civil, financial, and criminal penalties must be imposed, starting with the prescribers who diagnose and prescribe antipsychotics, followed by the nursing homes complicit in the abuse. The elderly who have been harmed deserve compensation.
Our seniors deserve compassion and safety, not sedation and premature death.
Congress, CMS, and state authorities should enact immediate, enforceable protections—including strong penalties on prescribers and facilities—and to prioritize non-drug alternatives for behavioral care in nursing homes.
[1] Nursing Homes’ Inappropriate Use of Antipsychotic Drugs Poses a Risk to Residents, OIG, 16 Mar. 2026, https://oig.hhs.gov/reports/all/2026/nursing-homes-inappropriate-use-of-antipsychotic-drugs-poses-a-risk-to-residents/
[2] Nursing Homes’ Inappropriate Use of Antipsychotic Drugs Poses a Risk to Residents, OIG, 16 Mar. 2026, https://oig.hhs.gov/reports/all/2026/nursing-homes-inappropriate-use-of-antipsychotic-drugs-poses-a-risk-to-residents/
[3] Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia to Mask the Misuse of Antipsychotic Drugs, OIG, 19 Mar. 2026, https://oig.hhs.gov/reports/all/2026/nursing-homes-inappropriately-diagnosed-residents-with-schizophrenia-to-mask-the-misuse-of-antipsychotic-drugs
[4] “Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia to Mask the Misuse of Antipsychotic Drugs,” HHS OIG, Mar. 2026, p. 19
[5] https://www.cchrint.org/2023/01/27/dangerous-mental-health-practices-must-stop-on-our-elderly-in-nursing-homes/; ; “Overmedication of Nursing Home Patients Troubling,” OIG, 1 June 2011, https://oig.hhs.gov/newsroom/news-releases-articles/overmedication-nursing-home-patients-troubling
[6] https://www.cchrint.org/2023/01/27/dangerous-mental-health-practices-must-stop-on-our-elderly-in-nursing-homes/; “Nursing Homes Under Investigation for Abuse of Antipsychotics,” Newsmax.com, 18 Jan. 2023, https://www.newsmax.com/health/health-news/nursing-homes-government-federal/2023/01/18/id/1104862/
[7] Jeanne Lenzer, “FDA warns about using antipsychotic drugs for dementia,” BMJ, 23 Apr. 2005, https://pmc.ncbi.nlm.nih.gov/articles/PMC556368/
[8] https://www.cchrint.org/2025/06/20/profiting-from-elder-harm-end-psychiatric-drugging-nursing-homes/; Testimony by Dr. David Graham, House Hearing, 110th Congress – The Adequacy of FDA to Assure the Safety of the Nation’s Drug Supply General, 13 Feb. 2007, https://www.govinfo.gov/content/pkg/CHRG-110hhrg35502/pdf/CHRG-110hhrg35502.pdf, p. 66
[9] “Antipsychotics Pose New Risks for People With Dementia,” AARP, 24 Apr. 2024, Updated 27 Jan. 2026, https://www.aarp.org/health/conditions-treatments/dementia-risks-antipsychotics/
[10] P S Masand, “Side effects of antipsychotics in the elderly “J Clin Psychiatry, 2000, https://pubmed.ncbi.nlm.nih.gov/10811243/
[11] “Under-Enforced and Over-Prescribed: The Antipsychotic Drug Epidemic Ravaging America’s Nursing Homes,” Report of the Committee on Ways and Means Majority U.S. House of Representatives, July 2020, p. 9
[12] “Grassley seeks thorough review of nursing home use of anti-psychotic drugs,” 6 Dec. 2007, https://www.grassley.senate.gov/news/news-releases/grassley-seeks-thorough-review-nursing-home-use-anti-psychotic-drugs-0
[13] “State Survey Agency Directors,” CMS Center for Clinical Standards and Quality, 18 June 2025, p. 2
[14] https://www.cchrint.org/2025/06/20/profiting-from-elder-harm-end-psychiatric-drugging-nursing-homes/; “Overmedication of Nursing Home Patients Troubling,” OIG1 June 2011, https://oig.hhs.gov/newsroom/news-releases-articles/overmedication-nursing-home-patients-troubling
[15] Sharmila Devi, “Report criticises antipsychotic use in US nursing homes,” Lancet, 9 July 2011, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61073-8/fulltext
[16] https://www.cchrint.org/2025/06/20/profiting-from-elder-harm-end-psychiatric-drugging-nursing-homes/; “Long-Term Trends of Psychotropic Drug Use in Nursing Homes,” Health and Human Services Office of the Inspector General, 11 Nov. 2022, https://oig.hhs.gov/reports/all/2022/long-term-trends-of-psychotropic-drug-use-in-nursing-homes/
[17] “Under-Enforced and Over-Prescribed: The Antipsychotic Drug Epidemic Ravaging America’s Nursing Homes.” Report of the Committee on Ways and Means Majority U.S. House of Representatives, July 2020, p. 8
[18] “Under-Enforced and Over-Prescribed: The Antipsychotic Drug Epidemic Ravaging America’s Nursing Homes.” Report of the Committee on Ways and Means Majority U.S. House of Representatives, July 2020, pp. 6, 16
[19] “State Survey Agency Directors,” CMS Center for Clinical Standards and Quality, 18 June 2025, p. 3
[20] LTCCC Alert: Antipsychotic Drugs Administered to More Than One in Five Nursing Home Residents. 3 June 2024, https://nursinghome411.org/alert-ap-drug-q4-2023/
[21] “State Survey Agency Directors,” CMS Center for Clinical Standards and Quality, 18 June 2025, p. 3
[22] “State Survey Agency Directors,” CMS Center for Clinical Standards and Quality, 18 June 2025, p. 3
SHARE YOUR STORY/COMMENT