That’s How We’ve Always Done It.

Because “that’s how we’ve always done it” isn’t a justification. It’s a warning sign.

That phrase grates for a reason. Not because change is easy—it rarely is—but because unexamined routines in healthcare can quietly turn into risks.

I get teased by my husband and son for rearranging systems just to see if they work better, but in care settings, regular evaluation isn’t tinkering. It’s responsibility.

For years, psychotropic, antipsychotic, and anticonvulsant medications have been used off‑label to manage behaviors that were difficult to interpret or difficult to staff.

The intent was stability.

The outcome was often suppression.

The OIG’s Nursing Facility Industry Segment‑Specific Compliance Program Guidance (ISPG) pushes us toward more accountable practice: accurate diagnoses, documented symptoms or behaviors, and ongoing review of whether the medication remains appropriate.

It’s a shift toward accuracy, transparency, and clinical alignment.

But when medication use tightens, the behaviors don’t disappear. They resurface—sometimes more intensely—because the underlying needs were never addressed.

That’s the real inflection point.

·       How is your team responding when behaviors escalate?

·       Are care plans truly individualized, or are they still built from templates?

·       Do staff have the skills and confidence to support residents without defaulting to medication?

What’s one behavior pattern your team is struggling with right now that needs a clearer, more sustainable approach?