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Recently my mother moved to an assisted living facility. The facility requires that they distribute residents' medications. They do this to the tune of adding $782 each month for medication management. During the move in process my mom, a retired nurse, was told it would be possible for her to do it herself after they could assess she is capable. That 'glimmer' of cutting out that almost $800 monthly charge was snuffed when the executive director said it would be nearly impossible for a resident to take this on for themselves. She said the issue was the strictness and high expectations of the State of Maryland. Saying that a resident would need to keep all their medications in a locked box, in their original containers, Not be able to use a pill organizer and if the State of MD audits the facility, the resident would need to be able to state precisely the dosage of each medication, name, and purpose. I have not been able to find any info supporting this explanation. Can you help?

It appears that assisted living programs do have a duty, as noted in , to assess within 14 days of admission and quarterly thereafter if a resident 鈥�(1) Is capable of self-administration of medication; (2) Is capable of self-administration of medication, but requires a reminder to take medications or physical assistance with opening and removing medications from the container, or both; or (3) Requires that medications be administered by the assisted living program staff or by a spouse or domestic partner of the resident in accordance with 搂F of this regulation.鈥� 鈥淪elf-administration of medication鈥� does require that 鈥渁 resident having the cognitive and physical ability to take medication as prescribed by an authorized prescriber:

(a) At the correct time;

(b) By the correct route; and

(c) In the correct dosage.鈥� (COMAR 10.07.14.02(B)(70))  

 

This may be what the facility is referring to regarding the State requirements for self-administration, but does not seem to match their requirements (that the resident 鈥渂e able to state precisely the dosage of each medication, name, and purpose鈥�) exactly. Additionally, regarding any lockbox requirements, the Code specifies that:

 

(c) "Administration of medication" does not include residents who have the cognitive ability to recognize their medications but only require assistance such as:

(i) A reminder to take the medication;

(ii) Physical assistance with opening a medication container; or

(iii) Assistance with removing medication from the container.鈥� COMAR 10.07.14.02(B)(3) (emphasis mine)

While there does not appear to be any right to appeal of this assessment, nor is there a required reassessment if the determination is that the resident is not capable, the resident should request documentation and an explanation of the initial assessment and/or any reassessment that addresses the requirements above (assessment timing, as well as any requirements beyond medication timing, route, and dosage). Simply needed assistance to open or remove medication from a lockbox does not seem to disqualify the resident from self-administration, strictly speaking. The facility can hopefully point to additional regulations or guidance and/or an internal policy that matches their verbal explanation.