Reader Q&A: Who Should Manage Medications?

One of our readers, Lynn, posted a comment to our article on why you need to understand medication management. It’s a good question, and it makes sense to share the answer with the broader audience. Lynn asks:

Ryan, my parents are now in an Assisted Living Community. I’ve been told that they must turn over administration of their meds to the Nurse. Problem is, that there is constantly problems with the meds given by the nurse, ie. meds from another patient, not given at proper time, cannot identify the pill, not all prescriptions given. They tell me that this is a Federally mandated law that my parents cannot self administer, is this true?
We live in Tennessee.


General Guidelines

The National Senior Citizen Law Center offers guidance regarding medication management in assisted living and what should be expected from the assisted living facility.

Many assisted living residents are able to self-administer medication. This means that the resident can take the medication with no assistance from facility staff.

In some states, a licensed healthcare professional must first assess each resident to determine whether self-administration is appropriate. Usually, the resident must demonstrate that he or she can correctly identify medications (for example, by color or shape) and have the ability to question changes in medication routines.

Some assisted living residents are unable to take their own medications, due to physical or mental limitations. They may need help with opening medication bottles and taking out the medication, or in figuring out what pills to take at what time. Facility staff can help if the resident is able to self-direct medication administration. This means that the resident is aware of what the medications look like and knows when they should be taken, but the facility staff can assist by reminding the resident to take the medication, opening the bottles, or reminding the resident when a prescription needs to be refilled.

If a resident is unable to self-administer or to self-direct medication administration, the assisted living facility staff is responsible for administration. In some facilities, the person assisting the resident with medications may not be a nurse or other trained, licensed health care professional. Some states allow facilities to hire a licensed healthcare professional who “delegates” the medication responsibilities to facility employees who are not nurses.

Regardless of who is responsible for medication administration, the medications must be given in accordance with the resident’s service plan. Generally, the facility must provide a procedure for documenting the medication administration, including the procedure to follow should an error occur. The facility may be required to keep medication records that contain some or all of the following information: the resident’s name; the name of the prescribing practitioner; the medication name; the time, dose and dates administered; the method of administration; and signatures of the person who administered the medication. Some states require that the medication record contain a list of possible side effects and reactions, or any precautions that should be taken when administering.

The resident who self-administers medications may be permitted to keep the medications in his or her own room, unless safety is a factor (for example, the resident shares a room with someone.) Otherwise, all medications are required to be stored in a locked, central storage area for safety reasons. If the medications are locked in a central area, the facility must provide each resident timely access to the medications.

The facility usually must have a procedure for returning medications to the resident if the resident moves or is discharged, in addition to a procedure for destroying medications that are unused and outdated.

Tennessee Rules

In Tennessee, the rules are similar. The Tennessee Department of Health’s Standards for Assisted-Care Living Facilities (page 17, Section 1200-8-25-.06 PERSONAL SERVICES) require:

  1. Personal services must include protective care of the resident, responsibility for the safety of the resident when in the facility, daily awareness of the resident’s whereabouts and the ability and readiness to intervene if crises arise.
  2. Medication shall be self-administered, or administered by a licensed professional operating within the scope of his/her license who is employed by the ACLF or a licensed home care organization.
  3. Self-administration includes assistance in reading labels, opening dosage packaging, reminding residents of their medication, observing the resident while taking medication and checking the self-administered dose against the dosage shown on the prescription.
  4. All medications shall be stored so that no resident can obtain another resident’s medication.
  5. All drugs and biologicals must be administered by, or under the supervision of, nursing or other personnel in accordance with federal and state laws and regulations, including applicable licensing requirements.

Escalate Your Concern

Lynn, if you do not believe your parents are receiving the level of care described above, you should speak with the Executive Director of the facility. Ask if their “med-room” team has been trained and if they can be trained again.

If the situation doesn’t change, you should file a complaint with the Tennessee Department of Health.

Hope this helps and thanks for the great question.

  • Jonathan Rosenfeld

    You make some excellent suggestions regarding medication errors. Unfortunately, some recent studies suggest that medication errors occur as frequently as 50% in some nursing homes and assisted living facilities. Problems with the administration of the wrong medication, over medication, or medication administered at the wrong time interval can have serious consequences. Medication errors are not something to take lightly. As you suggest, if you suspect an error, it is best to report it early on so necessary changes can be made. Thanks again.

    Jonathan Rosenfeld
    Chicago, IL

  • Ryan

    Jonathan -
    Thanks much for the added information. You’ve added some great information on the topic on your site.