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Nursing home operators say GLP-1 use is increasingly common among new admissions, with medications now prescribed for reasons beyond diabetes and weight loss. Providers see potential benefits but face added monitoring needs and uncertainty over who pays, especially when Medicare coverage does not apply.
GLP-1 medications are becoming more common among nursing home residents, with one operator reporting that about 30% to 40% of its new admissions are taking them. Nursing home leaders say the trend is widening beyond diabetes and weight loss, bringing potential health benefits alongside added clinical monitoring and unresolved questions about medication costs and Medicare coverage.
Lisa Chubb, chief nursing officer for New Jersey-based Venza Care, told Skilled Nursing News that the company is seeing GLP-1 use associated with cardiovascular prevention, chronic disease, metabolic health and organ health. She said the share is higher at facilities with more short-stay residents. Her figures describe Venza admissions, not nursing homes nationwide.
Chubb said the medications require more education and coordination among facility teams. Venza holds weekly “nutrition at risk” meetings, uses electronic health record assessments to document medication review and education, and involves registered dietitians in monitoring residents, including weight loss. She said providers must balance residents’ choices and possible benefits against concerns such as muscle weakness and frailty.
Jody O’Mara, chief nursing officer for Journey Skilled Nursing, said the medications could affect facility assessments, admission decisions and quality assurance programs. She described high-cost medications as a major concern, particularly where a facility bears the expense, but said she believes the benefits can outweigh the cost. That is her assessment, not a finding that applies to every resident or facility.
Coverage depends on the resident’s circumstances and the medication’s indication. Jessie McGill, a senior curriculum development specialist at the American Association for Post-Acute Care Nursing, said Medicare Part D’s temporary bridge program covers certain GLP-1s prescribed for weight loss for eligible residents, with a $50 monthly fee in addition to Part D coverage. McGill said eligible drugs include Wegovy, Zepbound and Foundeo. She noted that some residents may struggle to pay the fee even if they qualify.
Medication Costs Meet Care Needs
The increase brings a financial issue directly into decisions about care. When a resident’s medication is not covered by the bridge program, or the resident is in a payment situation that leaves the facility responsible, the drug’s cost can affect facility operating expenses. McGill said that residents entering on GLP-1s may create a substantial expense if the medication is not eligible for the program.
There is also a clinical trade-off. GLP-1 use may be intended to address serious health risks, but weight loss is not automatically beneficial for a resident who is already frail or has nutritional or functional limitations. The report cites potential adverse effects including nausea, vomiting, constipation and dehydration. Facilities therefore need to weigh the reasons for treatment against each resident’s condition and ability to tolerate it, rather than treating use as a routine medication change.
For families and residents, the practical implications include understanding who pays, what monitoring is planned and how a facility will respond if a medication affects nutrition or strength. The reported growth in use also places pressure on staff training and coordination across nursing, dietary and other clinical roles.
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Temporary Coverage, Delayed Long-Term Plan
Medicare Part D covers GLP-1s prescribed for diabetes, while the bridge program described by McGill provides limited coverage for certain medications used for weight loss among eligible residents who are not already prescribed a GLP-1 for diabetes. The program adds a monthly charge and has eligibility criteria tied to factors including BMI and other chronic conditions, according to McGill.
A more permanent program, called BALANCE, has been delayed without a future implementation date. The bridge program has instead been extended through 2027. McGill said residents receiving Medicare Part A may leave the nursing home responsible for the medication cost in some cases. She also said expanding Medicare consolidated billing to include high-cost drugs such as GLP-1s would require action by Congress; she identified chemotherapy and dialysis medications as examples of existing billing exclusions.
The care setting differs from the populations often discussed in relation to GLP-1s, Lauren Stenson, a curriculum development specialist at AAPACN, said. Nursing home residents may already have frailty, multiple chronic conditions, nutritional concerns or limits on functional ability, factors that can change how weight loss and side effects are assessed.
“We see a lot of our new admissions coming in with GLP-1s. Initially it was used solely for weight loss and diabetes, but now we’re seeing it trend in other directions as well.”
— Lisa Chubb, chief nursing officer for Venza Care
Coverage and Clinical Risks Vary
The report does not establish how widespread GLP-1 use is across nursing homes nationally; the 30% to 40% figure applies to Venza’s new admissions. It also does not provide outcome data showing whether use improves health or quality of life for nursing home residents overall, or how frequently residents experience the cited side effects.
It remains unclear when BALANCE might begin, whether Congress will change consolidated billing, and how coverage decisions will affect individual residents. Eligibility and costs depend on prescription purpose, program rules and payment arrangements. The report does not quantify the total expense for facilities or the number of residents unable to afford the monthly fee.
Facilities Prepare for More Use
For now, the bridge program is scheduled to continue through 2027, while no future start date has been set for BALANCE. Nursing home operators will need to account for medication coverage and possible facility expenses as residents arrive with prescriptions, and to adapt staff education and clinical assessments as use grows.
Further developments to watch include any announcement about BALANCE, congressional action on consolidated billing, and additional reporting on how facilities monitor nutrition, weight loss and side effects. Until those details emerge, the financial and clinical impact will depend on each resident’s prescription, health status and coverage.
Key Questions
Why are more nursing home residents taking GLP-1 medications?
Venza Care’s Lisa Chubb told Skilled Nursing News that residents are arriving on the drugs for reasons that include diabetes and weight loss as well as cardiovascular, metabolic and other chronic health concerns. The report does not establish a national rate of use.
Does Medicare cover GLP-1 medications for nursing home residents?
Coverage depends on the medication, its use and the resident’s circumstances. The report says Part D covers GLP-1s prescribed for diabetes and that a temporary bridge program provides limited coverage for certain drugs prescribed for weight loss, with a $50 monthly fee for eligible residents.
Who may pay when a resident’s medication is not covered?
A facility may be responsible for the medication cost for some residents receiving Medicare Part A, according to AAPACN’s Jessie McGill. The exact responsibility depends on the resident’s payment and coverage arrangements.
What concerns do nursing home clinicians have?
Clinicians cited frailty, muscle weakness and nutritional concerns, along with potential side effects including nausea, vomiting, constipation and dehydration. Facilities described using team education, dietitian involvement and monitoring, but risks and benefits depend on the individual resident.
When will the longer-term BALANCE program begin?
No future implementation date was reported. The temporary bridge program has been extended through 2027, while BALANCE remains delayed.
Source: skillednursingnews.com
