Antipsychotic utilization in skilled nursing facilities (SNFs) is a major focus of regulatory compliance and a key theme in resident care. This created opportunities for innovations in clinical care of behavioral and psychological symptoms of dementia (BPSD). In a shared initiative with one of our SNF operators, the authors implemented a joint clinician/facility program focused on rigorous clinical diagnosis and “best practices” in clinical care, specifically aimed at assessing and reducing antipsychotic use where appropriate.