Early in my mom’s tenure in assisted living, I noticed her monthly bill had a significant expense labeled as “medication management.” As someone who rarely takes any medication, I realized I needed to understand the process better. I’ll be dedicating several posts in near future to this topic, as I believe family involvement in medication management is critical.

Medication is a Major Issue According to a 2006 study by the three leading non-profits – ACHA, NCAL and MEFC, medication is often a major component of an older person’s life, making it a major issue for assisted living facilities. The role of medication and medication assistance (called “medication management” by assisted living administrators) is surprising:

77.5% of residents needed assistance with medications
Residents were taking an average of 13 medications
In an assisted living setting, residents rely heavily on staff to assist with the timely and correct delivery of medication. But in the United States alone, nearly two million Americans experience adverse drug reactions from prescription medication each year.

What can you do to protect your loved one? A better understanding of medication management can help.

Where to Get Medications Families have several options for filling prescriptions on behalf of loved ones. They are:

Mail order. Most health insurance and Medicare plans provide options for mail order delivery of medications. Prescriptions are usually filled in 90-day quantities. Price discounts are usually offered over that of pick-up or local pharmacies. Unfortunately, mail order makes urgent medications challenging.
Pick-up. You guessed it?! You or a family member pick up prescriptions and deliver them to the facility. For a small number of medications, this may be feasible. But it doesn’t work for multiple prescriptions on multiple delivery schedules.
Local pharmacy delivery. Prescriptions are filled and delivered by a local pharmacy 1-2 times daily. Since assisted living facilities usually contract with a single pharmacy, rush orders and other conveniences are widely available. I recommend this option for all but the most hands-on families.
Introducing the Med Room So where do they store all that stuff? It’s called a “med room.” The med room is a restricted-entry office that holds all resident medication, dosage records and prescription histories.

If you’re looking into assisted living for the first time, you should ask to see the med room. From an audit perspective, if you already have a loved on in assisted living, you should periodically ask to see the med room.

Your goal in visiting the med room is to validate the following:

Medication is stored in a well-organized manner like that seen in hospitals
Files are well-organized and clutter is at a minimum
The staff can quickly share with you your loved one’s medication and prescription history
There is a supply of pudding or apple sauce for those residents that have trouble swallowing pills
Contact information for your loved one’s doctors is readily available
The door is kept locked (verified by staff unlocking the door when they let you in)
Who Administers Medication Medications are provided to residents by a medical aide (called “med techs” by administrators). Med techs are responsible for the maintenance of the med room and for administering medications correctly and in a timely manner.

Med techs typically lay out all medications on a labeled delivery tray and deliver medication to each room. Their role is to ensure residents take their medications, although they will often leave medications with caregivers, if they are present.

In the unfortunate event of hospitalization, the med tech will also provide a copy of all current medications to paramedics or the individual taking your loved one to the hospital.

Keeping Track of It All As a family member, you should stay well informed of the medications your loved one is taking. The dosage record is the easiest way to do this.

A dosage record is kept for each patient and resembles the graph paper we all used in grade school. Along the left side of the page is a list of medications. Across the top are days of the month. Every time a medication is given, the med tech is required to sign the box corresponding to that medication and date.

The best way to spot-check medication management is to randomly request copies of the dosage report. Secondarily, ask the staff to notify you when medications are added or discontinued, so that you have a real-time understand of the medications being consumed.

Medication Management Works Medication management is a valuable service provided by the facility. Your involvement and periodic oversight will go a long way to ensuring your loved one is properly cared for. Your knowledge of their medication regimen will also better prepare you in the event of an adverse reaction.