Medication Management for Assisted Living Hospice Care

The state of California permits an assisted living community the ability to obtain what is known as a hospice care waiver. In basic terms, a hospice care waiver permits an assisted living facility the ability to have a set number of residents in hospice care at any juncture in time.

An assisted living facility cannot provide hospice services itself. Rather, an assisted living facility needs to partner with a hospice provider to tend to the needs of a resident in hospice care.

What Is Hospice Care in Assisted Living?

Hospice care is defined as:

Hospice care is a type of health care that focuses on the palliation of a terminally ill patient’s pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life by reducing pain and suffering. Hospice care provides an alternative to therapies focused on life-prolonging measures that may be arduous, likely to cause more symptoms, or are not aligned with a person’s goals.

Hospice care in assisted living is simply the same type of care and assistance provided to an individual who has been certified terminally ill that is given to a person in the same position who is living at home or who enters into a hospice care facility. Approximately 2 million people in the United States access hospice care each year across the country.

The American Cancer Society has developed a meaningful statement about the purposes of hospice:

The hospice philosophy accepts death as the final stage of life. The hospice philosophy affirms life but does not try to hasten or postpone death. Hospice care treats the person and symptoms of the disease, rather than treating the disease itself. A team of professionals work together to manage symptoms so that a person’s last days may be spent with dignity and quality, surrounded by their loved ones. Hospice care is also family-centered – it includes the patient and the family in making decisions.

What Is Assisted Living?

When discussing medication management in a situation involving an assisted living resident who is in hospice care, a definition of assisted living itself is also necessary. A basic definition of assisted living is:

An assisted living facility is a senior living option for those with minimal needs for assistance with daily living and care. Its purpose is to help adults live independently in a safe environment.

Administration of Medication to Resident in Assisted Living Hospice Care

Medication management is always a paramount issue in an assisted living community. There are a variety issues associated with medication management more generally in assisted living. 

Assisted living staff can assist with medication management. However, assisted living staff cannot administer medication to a resident. Administration of medication is the responsibility of assisted living staff.

Basic Regulations Regarding Medication for an Assisted Living Resident in Hospice Care

California regulations require the following when it comes to medications provided to a patient in assisted living hospice care. These regulations include:

  • A current and complete hospice care plan shall be maintained in the facility for each hospice resident.
  • The plan shall specify all procedures to be implemented by the assisted living community in regard to the storage and handling of medications and other substances.
  • The plan shall include the name or job function of the hospice agency staff who will control and supervise the storage and administration of all controlled drugs for the hospice resident.
  • Morphine pumps are permissible if the hospice resident, hospice health care professional, or other appropriately skilled professional is administering the medication and the procedure is specified in the hospice care plan.
  • In caring for a resident’s health condition, facility staff, other than appropriately skilled health professionals, shall not perform any health care procedure that under law may only be performed by an appropriately skilled professional.
  • As specified in the hospice care plan, hospice care agency staff can train a relative or friend of the hospice resident (provided no compensation is provided to that relative of friend) to administer medications.
  • Only an appropriately skilled professional may pre-draw medication for later administration by the resident which is administered through an individual syringe or oral dosing unit.
  • The pre-drawn medication also must be labeled and properly stored.
  • As in the case for all residents, a medication record of centrally stored medications must be kept for each assisted living hospice resident.
  • Prescription medications left behind when a resident either or dies must be returned to the issuing pharmacy.
  • In the alternative, prescription medications left behind can be disposed of or destroyed by the assisted living facility. 
  • The destruction of left behind medications must be done in compliance with local, state, and federal laws.
  • A record must be made of the destruction of the prescription medication.
  • Medication destruction records must be maintained by an assisted living facility for at least three (3) years

Medications Commonly Used in Assisted Living Hospice Care

The most commonplace medications that are utilized to treat a resident of assisted living in hospice care are:

  • Morphine (to treat pain and shortness of breath)
  • Ativan (to treat anxiety, nausea, or insomnia)
  • Atropine (to treat wet respirations, which are also known as the death rattle)
  • Levsin (also to treat wet aspirations or the death rattle)
  • Haldol (to treat agitation and restlessness)
  • Compazine (to treat nausea and vomiting)
  • Phenergan (to treat nausea and vomiting)
  • Dulcolax (to treat constipation)
  • Senna (to treat constipation)

Considering Assisted Living

If you are considering assisted living, or if you are the adult child of a parent who may soon be in a place that assisted living becomes an option, you will want to familiarize yourself with all aspects of service provided by a particular facility. This includes ascertaining whether a particular assisted living community has a hospice waiver. In addition, you will want to find out how many residents in hospice a specific assisted living facility can have at one time. An ancillary question is whether or not an assisted living community has ever had all hospice spaces filled at the same time.