Like many older adults generally, assisted living residents often take medication throughout the day to treat (or prevent) a host of medical conditions.  An assisted living facility should know of and have appropriate responsibility for medication.  For one thing, the medication should be documented: at a minimum, each facility should have a list of a resident’s prescription drugs along with instructions for when the drugs should be taken.

While some residents can manage a medication routine just fine by themselves, others need varying degrees of assistance. The term “medication administration” refers to the way in which medication is taken by residents. For example, one resident may store and take his medications himself; another resident may have someone else “assist” her by reminders. A third resident may need someone to actually put the medication in his mouth or at least stand by to ensure that it gets into the mouth.

Self-Administering Medication

An assisted living resident generally has the right under state law to administer her own medication. This right applies only if the resident is mentally and physically capable of self-administration. Such a resident generally will be permitted to keep medications in her own room, unless safety is a factor – for example, if the resident has a roommate who could misplace or mistakenly swallow the medication.

Identifying Who Administers or Assists with Medication

Residents and family members frequently assume that nurses administer medication in assisted living facilities. Although this is generally true in hospitals and nursing homes, it generally is not true in assisted living.  Most medication administration in assisted living is performed by non-nurses.

State assisted living laws assume that most assisted living facilities cannot afford to hire full-time nurses. Consequently, state laws in various ways allow medication to be dispensed without a nurse present. Most medication administration in assisted living is done by “medication aides” or by facility employees with little or no medication training. Here are some terms used in reference to the non-nurses who administer medication or “assist” residents with self-administration:

Medication Aides. These are facility employees who receive extra training to qualify them to administer  medication. State assisted living law increasingly allows medication aides (they are called various things, depending on the state) to administer medication in assisted living facilities

Delegated Authority. In this model, an aide in an assisted living facility is presumed to have received specific training and supervision from a nurse in order to administer medication. In reality, the supervision may be minimal or nonexistent – the nurse will not be present when the aide administers medication. “Delegated authority” in some cases is limited to a specific resident, but more frequently the aide may administer medication to any resident in the facility.

Unskilled facility employees. Because a nurse is not required when a resident is able to self-administer medication, some states broadly define “assistance with self-administration” so that non-nurses can provide the necessary assistance.  For example, “assistance with self-administration” has been defined to include opening a medication container, pouring medication, guiding a resident’s hand (with medication) to her mouth, or even placing medication on the resident’s tongue.

Documenting Medication Administration

Generally, an assisted living facility must have a procedure for documenting medication administration, including a procedure to follow should an error occur.

Looking Out for Yourself or Your Loved One

The following situations are common in assisted living. Ask the suggested questions to better determine whether the facility’s medication administration is adequate.

1. It is unclear who administers medication. Ask whether medication is handled by nurses, trained medication aides, or regular employees.  Inquire about the type of training the workers receive.  What qualifications are required?
2. A staff member vaguely tells you that medication is self-administered when possible, and “assistance” will sometimes be given to residents who self-administer medication.  Request a clear explanation of what is included under “assistance.”  Is assistance defined narrowly to simply mean help with opening up the medication bottle or is it defined more broadly?  Is it still a form of “assistance with self-administration” when medication actually is guided by a staff person into the resident’s mouth?
3. You are told that medication aides meet with supervising nurses. Inquire about the extent of interaction between aides and nurses.
4. It is unclear how medication is stored.  Ask where and how medications are prepared.  Medication generally should be prepared and stored in a secure place accessible only to appropriate staff members.
5. You know that accurate, up-to-date medication records are vital for health and safety, but you don’t know how the facility tracks and records medication administration. Ask who keeps the records and where they are kept. Feel free to review those records periodically. Ask whether or not a nurse or pharmacist reviews the medication records, and if so how often.