Administrators' Perceptions of Medication Management in Assisted Living Facilities: Results from Focus Groups
Objective: Assisted living (AL) residents are vulnerable to adverse events as a result of using numerous medications and frequently need assistance in administering medications. Very little is known, however, about the ways in which medications are managed within this level of care.
Design: AL administrators from the metropolitan Baltimore, Maryland area were invited to participate in focus groups to explore issues involved in medication management. Setting and Participants: Four administrators from smaller (15 beds or fewer) and six larger (more than 15 beds) certified AL facilities serving primarily older residents participated. Administrators must have served in their position at least six months.
Results: Administrators described interactions with residents, physicians, and pharmacists as well as the issues of state regulations and their enforcement. We uncovered themes concerning the challenges faced in negotiating competing needs of residents, providers, and regulatory bodies.
Conclusions: Administrators often feel torn between competing requirements of their position, and they experience some degree of conflict in allowing residents to retain autonomy in the face of demands of family, providers, and regulators. Small-facility administrators especially report being in a position to allow them to monitor residents' medication reactions and needs. Large-facility administrators sometimes find their actions hampered by decisions made at higher (ownership) levels. Administrators want AL facilities to remain at an intermediate level of care, with less stringent regulations than for those for nursing facilities, but would also like more consistency in enforcement of regulations. Qualitative assessment of medication-related issues in AL can help to guide policy in this area.
Abbreviations: ADL = Activities of daily living, AL = Assisted living, CMA = Certified medication aide, MAR = Medication administration record, OTC = Over the counter, SNF = Skilled nursing facilities, VA = Veterans Affairs. Consult Pharm 2009;24:513-23.
Design: AL administrators from the metropolitan Baltimore, Maryland area were invited to participate in focus groups to explore issues involved in medication management. Setting and Participants: Four administrators from smaller (15 beds or fewer) and six larger (more than 15 beds) certified AL facilities serving primarily older residents participated. Administrators must have served in their position at least six months.
Results: Administrators described interactions with residents, physicians, and pharmacists as well as the issues of state regulations and their enforcement. We uncovered themes concerning the challenges faced in negotiating competing needs of residents, providers, and regulatory bodies.
Conclusions: Administrators often feel torn between competing requirements of their position, and they experience some degree of conflict in allowing residents to retain autonomy in the face of demands of family, providers, and regulators. Small-facility administrators especially report being in a position to allow them to monitor residents' medication reactions and needs. Large-facility administrators sometimes find their actions hampered by decisions made at higher (ownership) levels. Administrators want AL facilities to remain at an intermediate level of care, with less stringent regulations than for those for nursing facilities, but would also like more consistency in enforcement of regulations. Qualitative assessment of medication-related issues in AL can help to guide policy in this area.
Abbreviations: ADL = Activities of daily living, AL = Assisted living, CMA = Certified medication aide, MAR = Medication administration record, OTC = Over the counter, SNF = Skilled nursing facilities, VA = Veterans Affairs. Consult Pharm 2009;24:513-23.
Keywords: Assisted living; Autonomy; Focus groups; Medication management; Polypharmacy; Qualitative research
Document Type: Research Article
Publication date: 01 July 2009
- The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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