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\u27 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

Association of Antipsychotic Use With Hospital Events and Mortality Among Medicare Beneficiaries Residing in Long-Term Care Facilities

Objective—Antipsychotic (AP) utilization has grown significantly in long-term care (LTC) settings. Although a growing literature associates AP use with higher mortality in elderly with dementia, the association of APs with hospital events is unclear. The authors examine prevalence and trends in AP use by Medicare beneficiaries residing in LTC and the association of APs and other drug use variables with hospital events and mortality. Design—Retrospective analysis using sequential multivariate Cox proportional hazards models. Setting—Medicare Current Beneficiary Survey linked to Institutional Drug Administration and Minimum Data Set files. Participants—A total of 2,363 LTC Medicare beneficiaries, 1999–2002. Measurements—Trends in LTC AP use overall and by type and duplicative use; association of AP utilization and two outcomes: hospital events and all-cause mortality. Results—AP use rose markedly from 1999 to 2002 (26.4%–35.9%), predominantly due to increased use of atypical agents. After controlling for sociodemographic and clinical factors, AP use is not related to hospital events (hazard ratio [HR] = 0.98, 95% confidence interval [CI] = 0.82–1.63 p = 0.7951). AP use is associated with reduced mortality in unadjusted and intermediate models, but loss of significance in the final model (HR = 0.83, 95% CI = 0.69–1.00, p = 0.0537) suggests that disease and drug burden factors may confound the AP-mortality relationship. Conclusion—This study provides no evidence of increased hospital events or mortality in LTC residents who use AP medications. Findings contribute to a growing body of evidence that APs, particularly atypical agents, may be associated with reduced mortality in LTC residents