Medication Management in Senior Living: What Families Should Monitor

Medication errors in senior living are more common than most families realize. Here is what to watch for, what questions to ask, and how to stay informed about your loved one's medication management.

Medication management is one of the areas of senior living care where errors are both most consequential and most frequently underreported. Seniors in assisted living and memory care communities often take multiple medications with complex interactions, and the systems for administering those medications vary significantly in quality across facilities. As a family member and advocate, you do not need clinical training to ask the right questions and notice the signs that something may be wrong with your loved one's medication management.

Know what medications your loved one is taking and why. This sounds basic, but many families have only a vague sense of their loved one's medication regimen. Request a complete and current medication list from the facility and compare it to what the prescribing physician has on file. Discrepancies between what a doctor ordered and what a facility is administering do occur. Having both lists and comparing them is a simple but important check.

Understand the difference between medication administration and medication assistance, because it matters for what staff are legally permitted to do. In Arizona, only licensed nurses can administer medications, meaning they can independently prepare and give a medication. Medication assistance, which is what unlicensed staff can provide under certain conditions, involves helping a resident take a medication that is pre-packaged and labeled. If your loved one has complex medication needs, ask specifically whether nurses are involved in their medication management or whether it is handled entirely by unlicensed caregivers.

Ask about the facility's system for managing medication refusals. People with dementia sometimes refuse medications, and how a facility handles that situation says a great deal about their training and ethics. Crushing medications and hiding them in food without disclosure, using coercion, or simply skipping documentation are all problematic practices. A well-run facility has a protocol for medication refusals that includes documentation, notification of the prescriber, and alternative strategies when appropriate.

Watch for behavioral and physical changes that could indicate a medication problem. Sudden changes in alertness, new confusion, unexplained falls, significant changes in appetite or sleep, unusual agitation, or a decline that seems too rapid to be accounted for by the underlying disease should prompt a direct conversation with the nursing staff and, if necessary, the prescribing physician. Medication side effects and interactions are a leading cause of falls, hospitalizations, and declining function in older adults.

If your loved one is prescribed a psychotropic medication, such as an antipsychotic or benzodiazepine, ask what the target symptom is, what the prescribing physician's reasoning was, and what the plan is for monitoring the response and evaluating whether the medication continues to be appropriate. Antipsychotic medications carry a black box warning for use in older adults with dementia and should only be used when other behavioral strategies have been exhausted and the benefit clearly outweighs the risk.