Assisted Living Community Measures (v2027A)
Posted: 8/7/2026

Release Notes:
Release Notes
Version 2027A

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Release Notes for the ALC2027A Manual

Measure Information Forms

SectionRationaleDescription
ALC-01 Rationale updated to reflect updated references Rationale

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Nearly two out of five individuals in assisted living are living with some type of dementia. For these individuals and as illness progresses, behavior often becomes a key form of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior.

To:

Nearly two out of five individuals in assisted living are living with some type of dementia. (American Health Care Association/National Center for Assisted Living [AHCA/NCAL], 2024). For these individuals and as illness progresses, behavior often becomes a key form of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior.

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The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia. They increase the risk of death, falls and fractures, hospitalizations, and other complications resulting in poor health and high costs. Additionally, antipsychotic drugs are expensive, costing Medicare hundreds of millions. American Health Care Association/National Center for Assisted Living (AHCA/NCAL). https://www.ahcancal.org/Assisted-Living/About-NCAL/Pages/default.aspx

To:

The American Geriatrics Society Beers Criteria® Update Expert Panel (2023) continues to stress the need to avoid antipsychotics and other medications for behavioral problems of dementia and delirium as their use is frequently associated with harm. The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia (Rashid et al., 2022). They increase the risk of death, falls and fractures, hospitalizations, and other complications resulting in poor health and high costs. (American Geriatrics Society Beers Criteria® Update Expert Panel, 2023).

Selected References

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  • American Geriatrics Society 2023 updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. American Geriatrics Society Beers Criteria® Update Expert Panel. J Am Geriatr Soc. 2023;71(7):2052-2081.

To:

  • American Geriatrics Society Beers Criteria® Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71 (7), 2052–2081. https://doi.org/10.1111/jgs.18372

Add:

  • Rashid, N., Wetmore, J. B., Irfan, M., & Abler, V. (2022). Adverse outcomes associated with off-label agents used to treat dementia patients with psychosis: A case-control Medicare database study. American Journal of Alzheimer’s Disease & Other Dementias, 37. https://doi.org/10.1177/15333175221081374

ALC-02 Rationale updated to reflect updated references Rationale

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(CDC, 2016)

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(Centers for Disease Control and Prevention [CDC], 2025)

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(CDC, 2024)

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(CDC, 2026)

Selected references

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  • Centers for Disease Control and Prevention. (2016). Behavioral Risk Factor Surveillance System (BRFSS) data. Retrieved from https://www.cdc.gov/steadi/

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  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2024). Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Retrieved March 11, 2024, from https://wisqars.cdc.gov/

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  • García-Martínez, A., García-Rosa, S., Gil-Rodrigo, A., et al. (2024). Prevalence and outcomes of fear of falling in older adults with falls at the emergency department: A multicentric observational study. European Geriatric Medicine, 15(6), 1281–1289. https://doi.org/10.1007/s41999-024-00992-1

To:

  • García-Martínez, A., García-Rosa, S., Gil-Rodrigo, A., Torres Machado, V., Pérez-Fonseca, C., Nickel, C. H., Artajona, L., Jacob, J., Llorens, P., Herrero, P., Canadell, N., Rangel, C., Martín-Sánchez, F. J., Lázaro del Nogal, M., & Miró, Ò. (2024). Prevalence and outcomes of fear of falling in older adults with falls at the emergency department: A multicentric observational study. European Geriatric Medicine, 15 (6), 1281–1289. https://doi.org/10.1007/s41999-024-00992-1

ALC-03 Rationale updated to reflect updated references Rationale

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(Institute for Healthcare Improvement, n.d.).

Selected references

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ALC-04 Rationale updated to reflect updated references Rationale

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(NQF 2006; IOM, 2014; Yadav et al., 2017)

To:

(Kim et al., 2025)

Selected references

Remove:

  • Institute of Medicine (IOM). (2014). Dying in America: improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.

  • National Quality Forum. (2006). A National Framework and Preferred Practices for Palliative and Hospice Care Quality. Washington, DC: National Quality Forum.

  • Yadav, K. N., Gabler, N. B., Cooney, E., Kent, S., Kim, J., Herbst, N., Mante, A., Halpern, S. D., & Courtright, K. R. (2017). Approximately one in three US adults completes any type of advance directive for end-of-life care. Health Affairs, 36(7), 1244–1251. https://doi.org/10.1377/hlthaff.2017.0175

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  • Sedini, C., Biotto, M., Crespi Bel'skij, L. M., Moroni Grandini, R. E., & Cesari, M. (2022). Advance care planning and advance directives: An overview of the main critical issues. Aging Clinical and Experimental Research, 34(3), 325–330. https://doi.org/10.1007/s40520-021-02001-y

To:

  • Sedini, C., Biotto, M., Crespi Bel'skij, L. M., Moroni Grandini, R. E., & Cesari, M. (2022). Advance care planning and advance directives: An overview of the main critical issues. Aging Clinical and Experimental Research, 34 (3), 325–330. https://doi.org/10.1007/s40520-021-02001-y

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  • Weissman, J. S., Reich, A. J., Prigerson, H. G., Gazarian, P., Tjia, J., Kim, D., Rodgers, P., & Manful, A. (2021). Association of advance care planning visits with intensity of health care for Medicare beneficiaries with serious illness at the end of life. JAMA Health Forum, 2(7), e211829. https://doi.org/10.1001/jamahealthforum.2021.1829

To:

  • Weissman, J. S., Reich, A. J., Prigerson, H. G., Gazarian, P., Tjia, J., Kim, D., Rodgers, P., & Manful, A. (2021). Association of advance care planning visits with intensity of health care for Medicare beneficiaries with serious illness at the end of life. JAMA Health Forum, 2 (7), e211829. https://doi.org/10.1001/jamahealthforum.2021.1829

Add:

  • Kim, J., Pacino, V., Koll, T., Mickles, M. S., Potter, J. F., Ma, J., & Estabrooks, P. (2025). Enhancing advance care planning in primary care: A three-year implementation study in Nebraska. Journal of the American Geriatrics Society, 73 (8), 2553–2561. https://doi.org/10.1111/jgs.19478

ALC-05 Rationale updated to reflect updated references Rationale

Remove:

American Health Care Association/National Center for Assisted Living (AHCA/NCAL)https://www.ahcancal.org/Workforce-and-Career/Pages/Organizations.aspx

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(Li et al., 2021)

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(American Health Care Association/National Center for Assisted Living, n.d.)

Selected references

Add:

  • Li, X., Dorstyn, D., Mpofu, E., O’Neill, L., Li, Q., Zhang, C., & Ingman, S. (2021). Nursing assistants and resident satisfaction in long-term care: A systematic review. Geriatric Nursing, 42 (6), 1323–1331. https://doi.org/10.1016/j.gerinurse.2021.08.006

Data Elements

SectionRationaleDescription
Off-Label Antipsychotic Drug Prescribed Antipsychotics Table updated to reflect medications no longer available, new FDA approvals or updates based on PharmD review. Antipsychotic Table

Loxitane/Adusave/(Loxapine)

Remove:

Adasave

Thorazine (Chlorpromazine)

ADD:

acute intermittent porphyria (nausea, vomiting, and psychiatric symptoms associated with this disease)

Compro (Prochlorperazine)

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General Anxiety Disorder

To:

management of anxiety

Clozaril/Fazaclo/Versacloz (Clozapine)

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Schizophrenia

To:

Treatment resistant schizophrenia

Seroquel/Seroquel XR (Quetiapine)

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Major Depressive Disorder

To:

adjunctive treatment of major depressive disorder

Risperdal/Risperda Consta/Perseris/Uzedy (Risperidone)

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Bipolar Disorder acute mania/acute episodes with mixed features/maintenance (PO, IM)

To:

Bipolar Disorder acute mania/acute episodes with mixed features/maintenance (PO, IM, SQ)

Caplyta (Lumateperone)

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Major Depressive Disorder, as adjunct to antidepressants (PO)

Latuda (Lurasidone)

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bipolar

To:

bipolar 1 disorder

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Bysanti (milsaperidone) - Bipolar I disorder (acute treatment of manic or mixed episode) (PO) Schizophrenia (PO)

Supplemental Materials

SectionRationaleDescription
No Supplemental Material release notes for the ALC2027A release.

Release Notes
Assisted Living Community Measures (v2027A)
Applicable 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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