Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Medication Administration


Several raised concerns about quality issues relate to medication administration.

  • There is a lot of concern about the administration of psychotic medications and medication errors. Some homes have nurse and pharmacy consultants; others don't. Daily supervision of medication administration is not there.

  • A facility I visited, which had mental health clients, put the residents' medications in the spoons on the dining room table that was set for lunch. There were no names by the spoons. When I asked about this, the staff told me that the residents knew which pills were theirs.

  • Many residents are cognitively impaired and the complexity of medication regimens has led to the need for medication management. The statute defining domiciliary care homes states that one of their responsibilities is to administer medications. But assisted living settings are exempt from the North Carolina controlled substances act based on the assumption that persons in domiciliary care homes are self-medicating.

  • There are lots of medication problems in North Carolina. Until a few years ago you didn't even need a competency test to do medications. One found medication error rates in the 20 to 40 percent range.

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