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Medication Management
Assisted Living's Role in Managing Resident Medication

Proper medication management is one of the major issues in assisted living facilities.

According to the Center for Excellence in Assisted Living, assisted living facilities are a social model of care but getting involved in medication management brings the facility into the medical model - that includes management of residents' medication needs.

Top 5 Recommendations on Medication Management

In today's assisted living facilities, most agree that the top 5 recommendations on medication management topics to include:

  1. Disclosure
  2. The role of unlicensed assistive personnel
  3. Resident assessment and service planning
  4. Quality improvement
  5. Medication orders, storage, and documentation

85% of the facilities have staff who assist residents with medication by providing reminders and prompting to let the them know it's time take a medication.

Do you or other staff assist residents with medication by providing medication reminders, for example, prompting that it is time to take medications?
Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Medication Management in Assisted Living

Medication Instruction
Medication Instruction

Medications are essential for the care of seniors. When used appropriately, medications are effective treatments for acute and chronic conditions. Pain relievers, for example, help a person with arthritis to button his shirt, or a woman to feed herself.

The benefits of medications invite potential hazards like toxicity, adverse drug reactions, interactions, other adverse reactions.

Yet, a great number of assisted living residents depend upon medications for treating short-term and chronic illnesses. 85% of the residents require assistance with management of their meds.

The medicines dramatically improve a resident's quality of life.

If you have a loved one in assisted care, you know that these seemingly little things can go a long way in preserving dignity and independence. On the flip side, if medicines are not taken as directed, there are serious consequences. Read our extensive interview with pharmacist Dr. Steve Leuck on medication management and adherence education.

Top Concerns Administering Medication

There are two major issues of concern when it comes to administering medicines in an assisted living facility.

  1. Staff must accurately administer medications. This means giving the right medicine at the right time to the right patient and documenting it thoroughly. In a 2013 study of the State Regulatory Review conducted by the National Center for Assisted Living showed that 63% of the staff at the ALF offer help and administration of prescription medications to residents. In the 2010 CDC Study of Residential Care Facilities, 68% of facilities reported helping the residents with medication.
  2. The prescribing doctors must meet the challenge of prescribing the best medications for each patient with regards to interactions and allergies. It's a big task to get medications correct for residents. In the CDC Survey study, 68% of facilities have a pharmacist or doctor, either on staff or through a contract with an outside service provider, who review the medications that residents receive for appropriateness.
Do you or other staff assist residents with medications by helping the resident take the medicine, for example, putting it in their mouth and handing the resident a glass of water?
Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
Does the facility have a pharmacist or doctor, either on staff or through a contract with an outside service provider, review the medications that residents receive for appropriateness?
Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Questions to Ask the Assisted Living Facility About Medication Management

1. Are residents allowed to self-administer prescriptions if they want?

In a 2010 study of the Residential Care Facilities by the CDC, it showed that 91% of the residents with medication by providing oversight and cueing to make sure the resident actually takes the medication. So, even though the resident is capable of taking the pill, the facility assists them in the medication routine.

Do you or other staff assist residents with medication by providing oversight and cueing to make sure the resident actually takes the medication?
Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
The Importance of Understanding Medications

In an ideal world, each patient can to visit with a pharmacist for 30 minutes before discharge. The pharmacist would review each discharge medication with the patient; help the patient understand why they are taking it and what to look for, while also assuring the patient understands the consequences of not taking their medications.

While some facilities are able to offer this level of service, in reality, most institutions effectively and efficiently discharge patients from their hospital without the patient ever seeing a pharmacist. Many hospitals meet their discharge medication education requirement by providing a stack of drug information leaflets while an incredibly busy nurse assures the patient understands the medication orders their physician has prescribed for them to take when they get home.

-- Dr. Steve Leuck
Pharmacist and Medication Education Expert

2. Is a nurse in charge of administering drugs, or another trained personnel allowed to oversee it?

The CDC survey found that 27% of the assisted living facilities has an RN (registered nurse) who passes or hands the residents their prescription medications.

Passing medications includes the delivery of pre-packaged doses or opening the bottle and handing the resident the correct dosage.

Who passes or hands the residents their prescription medications RN? Passing medications includes the delivery of pre-packaged doses or opening the bottle and handing the resident the correct dose.
Responses of legitimate skip (8%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

While 32% of the facilities have an RN give injections, IV medications, or apply prescription topical ointments and creams. That also includes medication administration like prescription pills; including placing the medication in residents' mouths and handing them glasses of water.

What percentage of facilities use the following staff to administer prescription medications to the residents?

Administering medications includes placing the medication in residents' mouths and handing them glasses of water, giving injections, giving IV medications, or applying prescription topical ointments and creams.

The data in this chart has been rounded and simplified.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

55% of the facilities depend on a certified medication aide, medication supervisor, or medication technician to dispense and administer medications.

And 88% have other staff to assist residents with medications by administering drops, topical ointments, etc.

Do you or other staff assist residents with medications by administering drops, topical ointments, etc?
Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

3. If a doctor is not available on a daily basis, who detects and responds to adverse drug reactions?

The nurses view their role as the clinical oversight of all residents, including admission and discharge, coordination with physicians and nurse practitioners, training, delegation, supervision, error management, monitoring and record keeping.

Assisted Living Facilities provide oversight for distribution or administration of medications under the health care supervision of a licensed physician.

95% of them assist residents with their medications by offering a central location for storage.

Do you or other staff assist residents with medication by providing a central location where medications are store prior to administration?
Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

75% of assisted living facilities offer 91% of residents to manage, supervise, store, or provide assistance with self-administration of medications.

What percentage of the residents do you manage, supervise or store medications or provide assistance with self-administration of medications?
Responses of don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

The Keys to Medication Management

Education and communications are the keys to medication management in the assisted living facility. The biggest issues are coordinating multiple pharmacies, verifying physician orders; managing OTC (over the counter) drugs vs prescribed meds vs supplements, working with hospice ad managing medications that require blood level testing. So, residents are sometimes not permitted to order medications from the pharmacy of their choice.

The bulk of medications given in assisted living are low risk and routine and very few errors pose harm. Medication aides generally do well with the training and preparation they receive.

Pharmacies aid to reducing medication errors by packaging them to specific resident and dosage. Pre-packaging allow for timely adjustments of dosage, promotes a safer delivery of liquids and as needed medications and lastly, streamline documentation for great efficiency and accuracy.

Do you or other staff assist residents with medication by delivering pre-packaged unit 2 doses?
Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

5 Signs of a Quality Medication Management Program

  1. Residents receive the right medications at the appropriate dosage.
  2. Residents are given medications on time, and the dispensing of medicine is well-documented.
  3. Residents' medications are cross-referenced for specific allergies and adverse drug reactions.
  4. If a drug reaction occurs, prompt attention is given and intervention plans are immediately enacted to prevent harm to the patient.
  5. The medication management program is routinely reviewed and if needed, improved in a timely manner.

Most residents of assisted living programs take several medications and visit more than one prescribing doctor. This makes medication management a challenge, but assisted living homes should have precautions in place. Request an outline of the facility's medication management policies.

Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.