Assisted living facilities (ALFs) increasingly provide service to older adults who would have otherwise lived in skilled nursing facilities (SNFs), offering a more homelike and less restrictive residential option at more affordable costs. Due to multiple chronic health conditions, assisted living (AL) residents often need continuous monitoring and management. ALFs aim to provide their residents choice, privacy, autonomy, and the ability to age in place. Although ALFs are more affordable and their setting is less institutional, these qualities are compensated by less professional supervision and the possible risk for unfavorable health outcomes due to the need for more vigilant health monitoring. A crucial issue in ALFs is achieving the proper balance between freedoms and risks for residents, staff, and the residential settings themselves.
Frailty is prevalent among Assisted Living residents with various chronic health issues. Statistics show that over half are aged 85 and older, about 25% have significant cognitive impairment, and 77% need assistance with their medications. Moreover, several groups of high-risk medications in ALF’s (such as psychotropics, cardiovascular agents, and anticoagulants) are used prevalently. Unlike SNFs, where licensed nurses administer medication, medication management in ALFs are overseen by assistive personnel (UAP) who do not have a license, with little professional involvement. Exacerbating the problem are steep UAP turnover in assisted living settings and limited structures and processes to supervise quality in medication management. Medication management is one of the three most prominent quality of care concerns in ALFs.
The definition of a medication administration error is “any difference between what the patient received or was supposed to receive and what the prescriber intended in the original order.” There has been notable controversy in ALFs pertaining to medication administration because, in many cases, non-nurses are allowed to administer medications. Although the benefit of using these staff is that their services are less expensive than those of nurses, a potential negative consequence of using non-nurses to administer medications is that doing so could lead to more errors and jeopardize the health of already vulnerable Assisted Living residents. A recent study titled “We’ve Got Trouble: Medications in Assisted Living” revealed that, of 1,335 ALFs in Arizona surveyed in 2008, 62% were given a medication-related citation. The General Accounting Office reported medication administration to be the third most frequently cited problem in ALF’s and has voiced similar concerns.
A study that examined medication administration by nonurses in ALFs revealed an overall 28% error rate. Another recent study compared the rate of medication administration errors of licensed practical nurses (LPNs) and nonnurses working in ALFs. Nonnurses were regarded as medication aides (staff who completed a course, passed an examination, and was approved to administer medications) or others (who were differentiated by the amount of medication-related training they underwent). The results of the study had two major findings: (1) medication aides and LPNs have similar error rates, and (2) nonurses who are not medication aides perform significant medication administration, and make more errors than LPNs and medication aides. Errors were more prevalent among staff who went through less training. The results clearly show that all nonnurses who handle medications—even when assisting residents with self-administration—should be trained to the level of a medication aide.
In closing, ALFs are increasingly caring for frail and vulnerable older adults. Although these residents may not be as impaired as nursing home residents, they have multiple health conditions that require multiple routine medications (an average of ten medications), similar to nursing home residents. Furthermore, nursing home-eligible older adults who do not need skilled nursing services can often be served in ALFs and must receive the assistance they require with medication management. ALF staff who are given the responsibility to manage medications for residents must be trained, with an emphasized focus on medications likely to result in harm, to avoid medication errors that can threaten the quality of life and health of their residents.
If you believe that you or someone you love suffered or is suffering due to a medication error by assisted living facility staff, contact us today for a free consultation. We, at the Law Offices of Ben Yeroushalmi will fight to get you and your loved ones the justice you deserve. Not only will we advocate on your behalf, we will make sure that you do not have to handle this problem alone.