Association Between State Essential Caregiver Programs and Antipsychotic Medication Use Rate in Nursing Homes During the COVID-19 Pandemic.

OBJECTIVES: This study aims to assess the association between Essential Caregiver Programs (ECPs) implementation and antipsychotic use among nursing home residents. METHODS: We conducted a difference-in-differences analysis using quarterly data from 2018 to 2022 for Medicare- and/or Medicaid-certified nursing homes across the United States. The primary outcomes were (1) the percentage of long-stay residents receiving antipsychotic medications and (2) the percentage of short-stay residents newly prescribed antipsychotics. Models included nursing home and county covariates, state and time fixed effects, and facility-level random effects. RESULTS: Unadjusted analyses indicated that nursing homes in ECP states had higher baseline rates of antipsychotic use before program implementation compared to other states, but experienced larger reductions in rates after program implementation. Adjusted DID analyses showed no significant ECP-associated changes in antipsychotic use during the first 4 quarters following ECP implementation; however, significant reductions emerged after 4 quarters among long-stay residents (coef. = -0.260 percentage points; 95% CI: -0.355 to -0.164; p <0.01) and short-stay residents (coef. = -0.062 percentage points; 95% CI: -0.104 to -0.020; p <0.01). Stratified analyses indicated that ECP-associated reductions are mainly observed in for-profit nursing homes and nursing homes with lower quality ratings. DISCUSSION: One year after program implementation, state ECPs were associated with reduced antipsychotic use among nursing home residents, particularly in for-profit and lower-rated facilities. These findings highlight the importance of caregiver involvement to improve medication practices and resident well-being. Policies should aim to balance infection control with the therapeutic benefits of caregiver presence in nursing homes.