Guidelines For The Administration Of Medications
In Michigan Assisted Living Facilities
I. INTRODUCTION
A. What is an assisted living facility?
"Assisted Living" is a fairly new concept across
the country, and may mean different things in different places.
In Michigan, assisted living was recently defined by a multi
disciplinary group of providers, government representatives,
and older adult advocates as "the business of providing
or arranging for supports and services freely chosen by an individual
or their representative(s) in order to maintain and/or enhance
cognitive and functional capacity, physical and mental health,
and personal autonomy."
For the purpose of these medication administration guidelines,
an assisted living facility will be defined as any type of congregate
housing that provides assisted living services. This definition
excludes assisted living services that are provided in private
homes or apartments, licensed nursing facilities or hospitals.
In Michigan, assisted living facilities fall into one of three
types: (a) facilities which are licensed by the state as Homes
for the Aged (HFA), (2) those licensed by the state as Adult
Foster Care (AFC) homes, and (3) unlicensed congregate care
apartment communities or other types of unlicensed assisted
living facilities that do not meet the statutory definition
of a HFA or AFC. See Appendix A for
further definitions of the three types of homes.
Assisted living facilities serve a wide range of resident populations,
including older adults with physical or mental impairments,
and persons of any age with mental illness or developmental
disability. Even within these populations, residents vary as
to their needs and their choices as to how their needs will
be met. Therefore, responsibility for seeking the appropriate
type of assisted living facility, evaluating the amount and
type of assistance that is needed, and monitoring the care that
is provided lies with the individual needing assistance, often
in conjunction with the family and/or other responsible party.
Licensed facilities are operated in accordance with state laws
and professional standards of practice as to the care, services
and protections that each facility is authorized and required
to provide. Based on these regulations, the operational standards
for licensed facilities include disclosure of certain information
in the rental agreement or contract signed by the resident/responsible
party and the facility. Written policies and procedures also
outline the care and services that are provided by the licensed
assisted living facility and those that are not.
In unlicensed facilities i.e., those that do not meet the statutory
definition of either an AFC or a HFA, there are fewer requirements,
no routine state inspections or consultation, and fewer consumer
protections. However, professional nursing standards still apply
to unlicensed facilities and marketing materials must not be
deceptive.
B. Why are guidelines for medication administration needed?
Current changes in the health care delivery systems have altered
the ways in which people seek and receive care. "Assisted
Living occupies an important niche in the continuum of care
between total independence in one's own home and the other extreme
of full dependence and round the clock medical support in a
nursing home. "(AARP Bulletin, February 2000). Assisted
living is predominately, a private pay industry, paid for by
residents and their families. The cost of operating these homes
is rather expensive, as they usually do provide 24 hour staffing.
This type of a consumer driven market relies on customer satisfaction
to determine care and services offered.
C. Who should use these guidelines?
These guidelines may serve as a solid basis for continuing
dialogue on how to address issues related to medication administration
in assisted living settings and are intended for use by:
- Administrators of assisted living facilities in developing
an appropriate organizational structure that specifies the
number and education of staff needed to administer medications,
the related policies/procedures and staff training necessary
for safe medication administration.
- Managers to help articulate to non-medically oriented administrators
or owners the basis for decisions about whether to allow unlicensed
personnel to administer medications within a facility.
- Registered nurses to use as a basis of dialogue with administrators
and peers regarding their own medication administration practices
and the practices of unlicensed personnel administering medication(s)
in settings in which they practice.
- Pharmacists to use in developing appropriate dispensing
and medication management systems in assisted living settings.
- Educators to ensure that the curricula used to train staff
contain the appropriate protocols for medication administration.
- Residents and their families may use these guidelines to
help in the decision-making process regarding whether or not
a facility is administering medications within safe standards
of practice.
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Administration Guidelines Index
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