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An Overview of Medication Policy and Procedure for Assisted Living

By Melissa LeeFebruary 3, 2022
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With the vast majority of adults 65+ in the U.S. taking prescription medications regularly, understanding how senior living communities administer and manage medications can influence the decision you and your loved one make in selecting a community. While each state dictates precise guidelines, it remains important to understand the basics of medication administration, medication management, and what traits indicate a quality assisted living medication management program.

Medication administration vs. medication management

Medication administration refers to the methods by which medications can be given to or taken by a resident, and to those overseeing the process. Often referred to as routes of medication, methods of administration may include taking medication orally, injecting the medication into the body, applying the medication to the skin, or inhaling the medication. Keep in mind that the term, medication, typically refers to prescriptions. It may include medical marijuana in states where medical marijuana is legal.

Medication administration may be performed by a variety of people, depending on the route and other factors. Each state dictates who may administer medications to residents in what types of senior living communities, and what qualifications they must have to do so. Generally, physicians, nurses, certified medical technicians, and residents themselves may administer medications in most states.

The five rights, or five Rs, of medication administration guide those performing this task. Most administrators adhere to the following checkpoints for administering medications:

  • Right resident: The person administering should always confirm the resident’s identity.
  • Right drug: With many drugs having similar names, suffixes, and prefixes, the administering person should verify the drug name as prescribed by the physician.
  • Right route: Some medications may be given in multiple ways. The administering person should confirm that the correct route is being used.
  • Right time: Medication timing can be key to the effectiveness and prevention of overmedicating or undermedicating the resident. The administering person should verify the time intervals prescribed by the physician.
  • Right dose: Medications may not always be packaged the same. The administering person should verify the dosage and confirm any conversion of units or substance concentrations as a way to prevent medication errors.

Medication management can be understood as the process of overseeing the medications themselves and tracking them as they are administered to residents in senior living communities. Programs for medication management in elderly care environments may also be built around the concept of the “five Rs,” along with applicable state regulations and best industry practices. While medication administration focuses on the route and the person giving or taking the medication, mediation management remains a larger umbrella above the former. It focuses on overall medication safety, including medication administration, medication compliance, drug interaction prevention, drug allergy detection, and education of caregivers and residents.

Questions to ask prospective senior living communities

To learn more about a senior living community’s medication administration and medication management policies and procedures, you can ask them how they would handle your loved one’s unique medical situation.

Dig deeper into a community’s medication policies and procedures by asking the following questions:

  • Does your community have a medication management program and medication administration policies? What kind of training does your staff receive to ensure they follow your community’s medication procedures?
  • Is your community’s program regularly updated to meet the latest best practices and state guidelines?
  • How does your community document medications administered to residents? (Electronic system? Physical logbook?)
  • How does this program monitor residents for new drug allergies? What happens if my loved one experiences a drug allergy during medication administration?
  • Does this program actively look for drug interactions between over-the-counter medications, such as St. John’s wort or vitamin pills, and the resident’s prescription medications?
  • How are medications stored in your community? Will my loved one who self-administers medication be able to store it in their living space?

Which types of communities offer medication administration and medication management programs?

Individual states control many aspects of how senior living communities operate within their boundaries. In most places, this includes medication administration policies and medication management practices. What qualifies as medication administration and medication management varies depending on the locality. This can also vary between the types of communities themselves.

Senior Apartments and Independent Living

While guidelines and regulations vary by state, senior apartments and independent living communities almost always allow the resident to self-administer and rarely play an active role in medication administration. In many locations, the resident will take their prescription medication without any assistance from community staff or caregivers — a practice referred to as self-administration.

For seniors who need gentle reminders, technological advances can aid them in managing their medications in their independent living community or their senior apartment. Automated medication dispensers — branded under many different company names — provide management of a person’s medications by alerting them and dispensing the right prescription drugs at the appropriate time. Some of these dispensers offer subscription services, technical support, and monitoring services to detect medication noncompliance. Speak with your loved one’s medical care team to determine if an automated medication dispenser makes sense for tracking their prescriptions.

Assisted Living, Memory Care, and Nursing Homes

Those residing in assisted living communities, memory care communities, and nursing homes remain the most likely to have access to medication administration and medication management programs through their senior living communities. Even if these types of care offer medication administration, a resident —typically after being determined by a qualified medical professional as meeting state or local guidelines for eligibility — may still be able to self-administer medications.

Some communities may provide medication reminders without administering medication as a courtesy to residents. This helps keep residents on track with their wellness goals while still allowing them to administer medications to themselves. You may find that some states also allow family members to administer medications to their loved ones, regardless of their loved ones’ eligibility to self-administer medications.

When choosing a community for your loved one, you should seek to understand the guidelines of your local area for the type of community you are considering, and you may need to investigate how those guidelines apply to your loved one’s specific prescriptions.

How do state guidelines for medication administration vary?

You may be wondering how state laws, rules, and regulations affect medication administration in senior living communities. View how California, Texas, and New York compare in the table below.

Please note that state-specific requirements change frequently. It is always best to check with your state regarding the most up-to-date guidelines.

Medication Administration CriteriaCaliforniaNew YorkTexas
Can a resident self-administer medication?Yes*Yes*Yes*
Can a family member administer medication to a loved one in a senior living community?Yes*UnclearUnclear
Can assisted living, memory care, and/or skilled nursing facilities have staff administer medication?Yes**Yes**Yes**
Can a resident be forced by a senior living community to take medication?Generally, no – exceptions may applyUnclear

Unclear

Can staff assist a resident with administering medical marijuana?Sometimes – restrictions/ limitations may existUnclearUnclear

*State-specific restrictions, guidelines, regulations, and/or laws may apply.

**Staff must meet specific qualifications, guidelines, and regulations, and/or comply with laws when administering medication, which may vary by state.

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What are the benefits of medication administration and medication management for seniors?

Seniors may experience an increased risk of medication-related errors when self-administering medications due to a variety of age-related factors, including memory issues, vision changes, limited dexterity in hands, and more. When facing financial pressures, older adults may not follow physicians’ directions and instead may skip or halve medication doses in an attempt to save money. Polypharmacy — taking more than five prescription drugs on a routine basis — and having prescriptions from multiple doctors can also complicate a senior’s attempt to self-administer their medications with timeliness and accuracy.

A well-executed and effective medication management program in a senior living community may reduce such medication-related errors. Medication management programs typically limit accidental overdoses, maintain prescriptions at therapeutic levels, and, ultimately, save lives by preventing dangerous drug interactions and flagging drug allergies as they occur.

Active seniors may function well with an automated medication dispenser in their independent living community or senior apartment. However, if your loved one experiences issues with self-administering their medications, you may want to consider an assisted living community, memory care community, or nursing home that offers medication administration as part of its medication management program. A Senior Living Advisor at A Place for Mom can help guide you through the process of finding a senior living community for your loved one’s unique medication needs.

Sources

California Department of Social Services. (2016). Medications Guide Residential Care Facilities for the Elderly.https://caassistedliving.org/pdf/resources/dss_meds_guide.pdf

Georgetown University McCourt School of Public Policy Health Policy Institute. Prescription Drugs.https://hpi.georgetown.edu/rxdrugs/

Hanson, A. & Haddad, L. M. (2021). Nursing Rights of Medication Administration. https://www.ncbi.nlm.nih.gov/books/NBK560654/

Hughes, R. G. & Blegen, M. A. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 37: Medication Administration Safety. https://www.ncbi.nlm.nih.gov/books/NBK2656/

Kim, J. & De Jesus, O. (2021). Medication Routes of Administration. https://www.ncbi.nlm.nih.gov/books/NBK568677/

Office of the Assistant Secretary for Planning and Evaluation. (2015). Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition – New York Profile. https://aspe.hhs.gov/reports/compendium-residential-care-assisted-living-regulations-policy-2015-edition-new-york-profile

Peterson, A. (2021, March 21). Medication compliance and management for seniors. Message posted to https://www.walkermethodist.org/blog/senior-medication-compliance

Ross, S. M. (2019, March 19). 8 Tips for the Medication Management Process. Message posted to https://blog.cureatr.com/8-tips-for-the-medication-management-process?hs_amp=true

Texas Secretary of State. Texas Administrative Code. Title 26. https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=3&ti=26&pt=1

Author
Melissa Lee

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