title: Administrators' perceptions of medication management in assisted living facilities: results from focus groups.
abstract: 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.
  
  
  METHODS
  AL administrators from the metropolitan Baltimore, Maryland area were invited to participate in focus groups to explore issues involved in medication management.
  
  
  METHODS
  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' 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.
authors.affiliation: Department of Pharmacy Practice, School of Pharmacy, Butler University, Indianapolis, Indiana, USA.
authors.forename: Pricilla T
authors.initials: PT
authors.lastname: Ryder
authors.forename: Melanie
authors.initials: M
authors.lastname: Joseph
authors.forename: Marni
authors.initials: M
authors.lastname: Zuckerman
authors.forename: Ilene H
authors.initials: IH
authors.lastname: Zuckerman
mesh_terms: D000328:Adult; D000368:Aged; D040561:Assisted Living Facilities / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D015142:Baltimore; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006270:Health Facility Administrators / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D054539:Medication Therapy Management / Q000458:organization & administration*; D008875:Middle Aged; D016134:Organizational Policy; D026684:Personal Autonomy
references.citation: J Am Geriatr Soc. 2002 Jun;50(6):1001-11
references.pmid: 12110058
references.citation: Arch Intern Med. 2004 Oct 11;164(18):2031-7
references.pmid: 15477439
references.citation: Nurs Outlook. 2006 Mar-Apr;54(2):74-80
references.pmid: 16597525
references.citation: Geriatr Nurs. 2007 Mar-Apr;28(2):83-9
references.pmid: 17430743