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Nursing home operators report that GLP-1 medications are becoming more common among new residents and are being used for conditions beyond diabetes and weight loss. Providers say the drugs may offer health benefits, but older residents need close monitoring and payment rules can leave facilities or residents with significant costs.
GLP-1 medications are increasingly arriving with nursing home residents, according to clinicians at two care operators, bringing new demands for nutrition and safety monitoring as facilities confront high drug costs and limited coverage. The drugs are being used not only for diabetes and weight loss but also for other chronic and cardiovascular-related health concerns, while Medicare’s longer-term coverage approach remains unsettled.
Lisa Chubb, chief nursing officer for New Jersey-based Venza Care, said about 30% to 40% of newly admitted residents at the operator are taking a GLP-1. She said the share is higher at facilities with more short-stay residents. Chubb described a shift from prescriptions focused on diabetes and weight loss toward what she characterized as preventive use connected to cardiovascular conditions, metabolic health and organ health.
At Venza, interdisciplinary teams hold weekly “nutrition at risk” meetings and use electronic health record assessments to document medication review, education and weight monitoring, Chubb said. Registered dietitians are involved in care for residents taking the drugs. She said teams must weigh residents’ choices and potential benefits against concerns including muscle weakness and frailty.
Cost depends on coverage and the resident’s status. Jessie McGill of the American Association for Post-Acute Care Nursing said Medicare’s bridge program covers certain GLP-1s prescribed for weight loss for eligible Part D participants, with a $50 monthly fee in addition to Part D coverage. McGill named Wegovy, Zepbound and Foundeo as eligible drugs. Residents who cannot afford the fee may still face a barrier, and a facility may be responsible for medication costs for residents covered under Medicare Part A, she said.
More Medication, More Monitoring
The growth in use could affect both resident care plans and facility budgets. Nursing home residents may already have frailty, multiple chronic conditions, nutrition concerns or limits on daily functioning, making weight loss an outcome that requires individual assessment rather than an automatic benefit. Lauren Stenson, a curriculum development specialist with AAPACN, said clinicians also need to account for possible side effects including nausea, vomiting, constipation and dehydration.
Facilities must also determine how to educate staff, track changes in residents’ nutrition and function, and manage medication costs. Jody O’Mara, chief nursing officer for Journey Skilled Nursing, said the drugs could affect facility assessments, admission decisions and quality assurance programs. Her view that benefits can outweigh costs is an operator’s assessment, not a settled finding for every resident or facility.
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Medicare Coverage Still Shifting
Medicare Part D covers GLP-1s prescribed for diabetes, McGill said. The bridge program offers coverage for certain drugs prescribed for weight loss when the resident has not already been prescribed a GLP-1 for diabetes, subject to program criteria and the monthly fee. McGill said the program was extended through 2027.
A more permanent program, known as BALANCE, was delayed without a future implementation date, according to the source report. McGill said nursing homes may have to account for high-cost medications for residents receiving Medicare Part A. She identified expanding consolidated billing to include high-cost drugs such as GLP-1s as a possible policy change, which would require congressional action.
“We see a lot of our new admissions coming in with GLP-1s.”
— Lisa Chubb, chief nursing officer for Venza Care
Coverage and Resident Outcomes
The report does not establish how many nursing home residents nationwide use GLP-1 drugs, how many qualify for the bridge program, or what share stop treatment because of cost or side effects. It also does not provide outcome data showing how the drugs affect health or quality of life specifically in nursing home populations. The long-term coverage plan remains unsettled, and eligibility details can vary by medication and resident circumstances.
Clinicians’ statements about potential benefits reflect their professional assessments; they do not establish that treatment is appropriate for every older adult. How facilities will balance resident preferences, clinical risks and costs is likely to vary by resident, payer and operator.
Bridge Program Runs Through 2027
The immediate coverage milestone is the bridge program’s extension through 2027. No future start date has been announced for BALANCE. Any change to consolidated billing that would shift how facilities pay for high-cost medications would require congressional action, McGill said.
In the meantime, providers will need to review medication coverage and resident-specific risks at admission, document education and monitoring, and account for potential uncovered expenses. Further details on the permanent program and evidence about GLP-1 use in nursing home populations remain pending.
Key Questions
Are GLP-1 medications becoming more common in nursing homes?
Clinicians at Venza Care and Journey Skilled Nursing report seeing more residents on these medications. Venza’s Lisa Chubb said about 30% to 40% of new admissions at her operator take a GLP-1; that figure is not a national estimate.
What does Medicare’s bridge program cover?
According to AAPACN’s Jessie McGill, the program covers certain GLP-1s prescribed for weight loss for eligible Medicare Part D participants who have not already been prescribed a GLP-1 for diabetes. The drugs she identified are Wegovy, Zepbound and Foundeo, with a $50 monthly fee in addition to Part D coverage.
Who may pay for the medication during a nursing home stay?
Payment depends on coverage and circumstances. McGill said facilities may be responsible for GLP-1 costs for residents on Medicare Part A, particularly when a medication is not covered through the bridge program. Part D participants may face the program’s monthly fee and other costs.
What health concerns do clinicians monitor?
Clinicians cited concerns about frailty, muscle weakness and nutrition, as well as possible nausea, vomiting, constipation and dehydration. Care teams described monitoring weight and involving dietitians; decisions should be made for each resident’s circumstances.
When will permanent Medicare coverage begin?
The source report says the proposed BALANCE program was delayed and has no future implementation date. The bridge program has been extended through 2027.
Source: skillednursingnews.com
