An Overview of Medication Policy and Procedure for Assisted Living

While medication administration focuses on the route and the handling of and proper dispensing of medication, medication 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.

Medication management can be understood as the process of overseeing the medications themselves and tracking them as they’re administered to residents in senior living communities. Programs for medication management in elderly care environments may also be built around the concept of the “seven Rs” (described below), along with applicable state regulations and best industry practices.

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.^[02] Keep in mind that the term medication typically refers to prescriptions and may include medical marijuana in states where medical marijuana is legal.

When administering medication, all administrators must adhere to the following checkpoints, called the seven rights, or seven Rs, of medication administration:

• 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.^[03]
• Right documentation. The person giving the medication needs to record giving the medication on the right chart. If it is placed on the wrong chart, this would be a medication error.
• Right response. Prior to administration, the person giving the medication should confirm that the medication will have the right effect or that they’re using the right medication for the right reason. For example, if a nurse is preparing to administer blood pressure medication for high blood pressure in a resident, they should confirm that the resident currently has high blood pressure. If the resident’s blood pressure was already low, giving blood pressure medication intended for high blood pressure would be wrong.

Medication administration may be performed by a variety of people, depending on the route and other factors. In some cases, this may be referred to in the community as “passing meds.”

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, the following people may be seen administering medicines in assisted living:

• Physicians
• Nurses
• Certified medical technicians
• Allied health professionals, such as respiratory therapists

In most states, residents may also administer medications to themselves under specific circumstances.

Is assisted living the right fit?

To learn more about a senior living community’s medication administration and medication management policies and procedures, you can ask them how they’d 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? Is there an electronic system or a 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?

Individual states control many aspects of how senior living communities operate within their jurisdictions. 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.

Assisted living, memory care, and nursing homes

Seniors 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 living environments 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.

As a courtesy to residents, some communities may provide medication reminders without administering medication. 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 your local area’s guidelines for the type of community you’re considering, and you may need to investigate how those guidelines apply to your loved one’s specific prescriptions.

Senior apartments and independent living

While guidelines and regulations vary by state, senior apartments and independent living communities rarely play an active role in medication administration and almost always allow the resident to self-administer. 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 senior apartment or independent living community. 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 questions? Get expert help

You may be wondering how state laws, rules, and regulations affect medication administration in senior living communities. It may be best to ask the senior living community you’re considering about what their license allows them to provide for medication administration. Keep in mind that different types of senior living communities — assisted living, memory care, and nursing homes — may be licensed to provide different kinds of medication administration.

Please note that state-specific requirements change frequently, so it’s always best to check with your state regarding the most up-to-date guidelines. In addition to reviewing your state’s requirements, you might wish to ask to see a copy of the community’s license, which are usually displayed in a public place in the community. Here you can see which department licenses and regulates communities, and this can give you a good starting place for further research.

Read more:What Are the State Requirements for Assisted Living Communities? An Overview

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.^[04]

Polypharmacy — taking more than five prescription drugs on a routine basis — and having prescriptions from multiple doctors or pharmacies can also complicate a senior’s attempt to self-administer their medications with timeliness and accuracy.

Medical error research typically looks at long-term care facilities as a combined group. In the United States, there are an estimated 800,000 preventable medication-related injuries each year in these communities, according to a study in Quality and Safety in Health Care.^[05]

The same study indicated that the following situations account for the most common types of medication errors in long-term care facilities:

• Dose omission
• Overdose
• Underdose
• Wrong resident
• Wrong product
• Wrong strength

While this may sound scary, the study indicated that only 8% of these errors were identified as having “a serious patient impact.”

In general, these types of medication errors can happen for a variety of reasons, according to the Academy of Managed Pharmacy Care (AMPC). Those reasons include the following:^[06]

• Lack of information about all of the medications that are prescribed together for a person
• Illegible handwriting on prescriptions
• A medication regimen being too complex
• Sound-alike drug names being confused when spoken aloud
• Failure to recognize allergic sensitivities or other past-dose relationships

However, some errors can be prevented by using systems to prescribe and order medications, as noted by the AMPC.^[06]

A well-executed and effective medication management program in a senior living community helps maintain the health, safety, and general well-being of residents. This is largely because ensuring that medications are taken as prescribed can reduce medication-related errors.

Medication management programs typically accomplish the following:^[07]

• Limiting accidental overdoses
• Maintaining prescriptions at therapeutic levels
• Preventing dangerous drug interactions
• Flagging drug allergies
• Saving lives

Active seniors may function well with an automated medication dispenser in their independent living community, senior apartment, or in their home. It can be a good idea to compare in-home care and assisted living. 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.