Medication Management in Assisted Living

Medication management is a critical service offered in most assisted living communities. After all, 77.5% of residents in assisted living need help with medications, according to one recent study. That same study noted that, on average, residents took 13 medications, 3 of them on a daily basis.

Ensuring Your Loved One Receives the Proper Medication at the Proper Time
When your parent was first accepted into an assisted living community, their medication was included as part of an assessment of their needs for a care plan. However, even before the assessment, as the person responsible for their health, you should have been involved in medication management.

#1 Develop a list of medications.
Your loved one’s doctor most likely has a list of the medications they are currently taking. However, does that list include vitamins, herbal preparations or teas, and over-the-counter medications they commonly take?

While doctors are now asking patients to list these items, many seniors don’t consider them.

Your first step is to fill out a HIPAA (Health Insurance Portability and Accountability) release form for each physician. You can get additional information and download a blank form here. The HIPAA form permits you to access their health information so you can make a list.

Write down the name of the medication, the dosage, and how frequently they take it.

Your next step is to interview your parent or other loved one about what substances they commonly use. If they take aspirin on a regular basis, write it down. If they drink more than two cups of coffee a day, that may impact the effects of their medicines. If they love to relax in the evening with a glass of wine, that needs to be listed, too.

Also ask them and their doctor about any allergies and include them on the list.

Their list of medications and allergies should be given to their doctor first. Ask for an assessment to determine if they may be experiencing any interactions between medications or other problems. If the doctor approves of all their medications, make sure the doctor’s office or you give the assisted living healthcare official the list. Keep a copy of the list and ask the assisted living community to update you every time something changes.

#2 Get a compliance assessment.
Does your senior loved one have any problem taking one or more medications? Sometimes, a senior may have no problem remembering their blood pressure medication each morning, but forget their restless legs syndrome medication at night or be unable to apply topical medications effectively.

Ask them and their doctor so you have a good idea of whether they need help or not. Ask your loved one if they know the purpose of each medication. Present this information during the care interview at the assisted living community.

#3 Medication management
If your parent does not need help with medication management, do not ask for it even if it is offered. One of the biggest issues residents of assisted living and skilled nursing communities experience is loss of control, so if they can continue to handle their medication, it’s best for them. In most states, residents have the right to take their own medication.

If your loved one needs help with some medications, but not with others, specify them. You can also request verbal reminders for daily medications if you wish.

If you want your loved one to be able to have aspirin, cold medicine, or allergy medicine in their apartment, specify so. Otherwise, some assisted living communities will administer these substances only upon request.

If you bring in any medication or any substance that may affect your loved one, inform the staff so they’ll be aware of any potential negative effects.

#4 Medication administration
In most states, verbal medication reminders and actual medication administration may be performed by any employee on staff. Because MacIntosh communities also offer skilled nursing, we are required by law to have a nurse administer medication under the supervision of a physician. Verbal medication reminders are usually given by state tested nursing assistants.

Ask your assisted living community who administers medication and what training they receive.

#5 Preventing errors
Inform your loved one’s doctor and the assisted living staff that you want to be informed if their medication is changed. You can then observe if there are any negative side effects of new medication.

At most assisted living communities, resident interaction with healthcare professionals is minimal, so side effects may not be noticed or tracked. Because MacIntosh communities also offer long-term skilled nursing care, your loved one is observed by specially trained healthcare professionals, ranging from state tested nursing assistants to licensed practical nurses to registered nurses. Any behaviors out of the ordinary are observed, tracked and acted upon.

#6 Advocacy
You are your loved one’s advocate, whether they are at home or in an assisted living or skilled nursing community. There’s not a healthcare professional in this world who hasn’t witnessed the medication a doctor prescribes affect a patient negatively. This doesn’t mean the doctor is bad, but since every person is different, different medications affect people in various ways.

If you notice or a healthcare professional from the assisted living community contacts you about your loved one’s change in behavior after a new treatment or medication, act quickly. For example, some medications may change a perfectly rational, lucid person into someone who appears confused and demented.

You know what’s best for your loved one. Although the staff at the assisted living community, in all likelihood, have come to know and love your parent, they don’t know them as well as you do. It’s your responsibility to make the difficult decisions in your loved one’s best interest.

Here at MacIntosh, we’re accustomed to being advocates for our residents. Our blogs are designed to inform patients, residents, and their families, as well as healthcare professionals. If we can help you with more information, please contact us. We will be happy to help!


Make the Most of Your Virtual Visits

The Coronavirus pandemic has created many new unique challenges for families, particularly those who wish to visit and spend time with loved ones that reside in senior living communities. At MacIntosh, we fully understand nothing can replace face-to-face interactions but have made keeping our residents connected and reduce any feelings of isolation a top priority. Utilization of technology and services, such as FaceTime and Zoom, have been implemented in our communities to offer virtual visits and help bridge this gap while in-person visitation remains limited.

With new technology, confusion and frustration are likely to arise causing slower conversation and possibly discomfort during virtual calls so we’ve pulled together some helpful information and tips to help make the most out of your virtual visits.

Check Connectivity before Your Visit

Ensure your internet signal is strong so you won’t experience any interruptions or dropped calls. If using a service like Zoom, log in a little early to ensure your audio, device and video are working, this will help avoid any delays and allow you time to work through any possible issues. Also, make sure your device is charged to last through the entire visit and keep a charger close just in case.

Create an Uplifting Atmosphere

While the main focus during your call will of course be you and your loved one, a bright open area can ensure a positive uplifting conversation. Avoid sitting with sunlight behind you as it can cause some blurred and distorted picture. Lastly, make sure your camera is at eye level and that you are in a quiet space so there aren’t distracting background sounds.

Plan Your Conversation

Before your call, take some time to think about positive things that are going on or events that have happened in the outside world. It’s important to guide your conversation in a positive direction and find ways to keep them up to date without being the bearer of bad news. Reminisce about important or funny stories from the past, whether it be childhood, marriages, vacations or their favorite meals. Gather any materials or props you may want to show them beforehand so you don’t have to shuffle through trying to find things and potentially lose valuable time.

For those with loved ones that have dementia, use props like plants, flowers, pets or even a little tour of your home. We also suggest avoiding questions that your loved one may not be able to answer, for example, what they ate or asking what is significant about a particular day. Try giving them cues that will help them remember, “today’s Monday, I saw you were having your favorite lunch, soup and grilled cheese, I hope it was good!”

Include the Family

While talking to your children is wonderful, pull in those grandchildren for the ultimate beam of joy. Including grandchildren and even family pets can create a more wholesome feeling for your visit, after all grandparents love their grandbabies. This can also help ignite some additional lively conversation points.

Use a Variety of Communication

Video calls may be more efficient to getting in touch with loved ones in senior living communities but it’s not the only way to connect with them. We encourage you to use various forms of communication to stay in touch and lift their spirits. Families can send letters, pictures, drawings from the kids, by mail or email. Save on postage by using our MacIntosh Messaging email addresses! Drop off something special if you’re local, for example, make two photo books; give them one and keep one for yourself, then look through it together during your next call.

Taking any opportunity to connect with your loved ones and send them something special, not only brightens their day but also assures them you haven’t forgotten them and helps reduce the loneliness they may be feeling.

“They may not remember what you said or what you did, but they’ll remember how you made them feel.”

Hepatitis C Risk Increases

The aging of Baby Boomers is bringing great changes to this nation. Along with rising worries about safety nets and health care comes a concern about Hepatitis C. Boomers are 5 times more likely to have Hepatitis C than the rest of the U.S. population. 1 out of every 30 Boomers has Hepatitis C.

That doesn’t mean older and younger people can’t contract the disease. And although your parent may not notice symptoms of the disease when they were younger, the older they get, the more likely they’ll suffer potentially fatal effects.

Why Should You Worry?

The Hepatitis C virus, primarily spread by blood contact from an infected person, causes the liver disease Hepatitis C. The word “hepatitis” means inflammation of the liver.

Up to 25% of people infected are able to naturally clear the virus, but most can’t. Hepatitis C can be acute or chronic:

Acute Hepatitis C virus infection occurs within the first 6 months of exposure to the virus. It’s a short-term virus with symptoms that may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain or jaundice. However, about 20% of people with the acute infection never experience symptoms. Acute infection usually leads to chronic infection.

Chronic Hepatitis C virus infection is a long-term illness that occurs when the virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer. Up to 70% of people with chronic infection will develop chronic liver disease, up to 20% will develop cirrhosis over a period of 2 to 3 decades, and up to 5% will die from cirrhosis or liver cancer caused by the disease.

Hepatitis C Affects Seniors Differently

The Hepatitis C Association reports, “It is estimated that, each year, HCC (hepatocellular carcinoma) will develop in 1%-2% of patients with chronic HCV infection and cirrhosis. The risk of HCC increases significantly with age, probably owing to age-related changes in the ability to repair DNA and to the prolonged interval from the time of infection. The interval between infection and diagnosis of HCC may be shorter when the infection is acquired at an older age.

“Up to 30% of patients had psychological disorders, including depression, and up to 67% complained of fatigue. These symptoms may appear even in the absence of clinically significant liver disease. Age of >50 years was found to be associated with fatigue. Chronic HCV infection was associated with cognitive impairment, which was reported in patients aged 28-69 years with mild liver disease. The prevalence of cognitive impairment among older patients, who may have a higher susceptibility to this complication, has not been studied.”

My Parent Can’t Have Hepatitis C

No one knows why so many Boomers have Hepatitis C. However, it’s most likely the Boomers’ high incidence was caused by one of several factors:

  • Medical equipment or procedures before universal precautions were adopted in mid-1980s
  • Contaminated blood and blood products before screening procedures identified it in 1992
  • Tattoos before sterilization procedures were enforced, especially those obtained overseas
  • Sharing needles

Other causes include:

  • Being born to a mother with the disease
  • Needle sticks in a healthcare setting
  • Sharing razors or toothbrushes
  • Sexual contact with someone who’s already infected

The virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, sneezing or through food or water.

How Can I Tell if My Parent Has Hepatitis C?

You can’t. No one can without a blood test.

A hepatitis C antibody test looks for antibodies to the virus. The presence of antibodies indicates that someone has contracted the Hepatitis C virus at some point in their life.

A non-reactive or negative result means a person does not have Hepatitis C. A reactive or positive result means Hepatitis C antibodies were found in the blood. This does not mean a person has Hepatitis C, but it does mean they’ve been infected at some point in the past.

If the test is reactive or positive, an additional blood test is required to determine if a person is currently infected.

Is There a Cure?

There is a cure for chronic Hepatitis C. Current treatments are more effective and have fewer side effects than those in the past.

At MacIntosh, we’re accustomed to being advocates for our residents. Our blogs are designed to inform patients, residents, and their families, as well as healthcare professionals. If we can help you with more information, please contact us. We will be happy to help!

What Footwear is Safe for My Senior to Wear?

Dear Cheryl:

My mom and I are going to do some shopping for a few pair of shoes for her this weekend. Her medication has made her a little less steady on her feet, and I think having the right footwear will help keep her safe.

Do you have any advice on how to help an older adult find good footwear? We’ve never really worried about it before, so we aren’t sure how and where to start!


How to Shop for Safe Footwear for Older Adults

Dear Cindy:

Great question! Having quality footwear is important at any age, but especially so for older adults who may be at higher risk for falls.

Research shows that most older adults who experienced a fall were wearing only socks or slippers when they took a tumble. But it might also surprise you to learn that many seniors who were wearing shoes when they fell had athletic shoes on and not heels.

So what makes a shoe safer for a senior you love to wear?

  • Textured sole: This helps prevent a senior from sliding if the floor or sidewalk is slippery.
  • Broad, firm heel: Another feature of a good shoe for a senior is one with a broad, firm heel that helps prevent slipping.
  • Laces or Velcro closure: Laces or Velcro straps allow the senior to tighten the fit of the shoe according to the width of their foot. This helps prevent their shoe from flopping around and throwing them off balance.
  • Avoid wedges and narrow heels: Shoes that have narrow heels or wedged shaped soles may be tough on older, weaker ankles. They can be unstable, causing an older adult to turn their ankle and experience a sprain or break.

The same holds true if you and your mom will be shopping for winter boots to keep her warm during this central Ohio winter.

  • Look for boots with a sturdy, textured sole.
  • Boots that are tall enough to cover at least the lower part of the senior?۪s calf also offer ankle support.
  • Laces also help keep the boot in place when the senior is out and about on cold, snowy days.

And, just in case you will be shopping for some cozy winter clothes when you and your mother hit the mall this weekend, you might find these tips for purchasing comfortable and fashionable clothing for a senior helpful.

I hope you and your mom enjoy your shopping trip, Cindy!

Kindest regards,

Cheryl Beckman

Make the Most of Your Insurance

Many seniors struggle to work their way through the options and make an informed choice regarding their health insurance. Below is a brief breakdown for each option to help you make the best decision for your healthcare needs.

Traditional Medicare

Let’s start with traditional Medicare. It is made up of several parts. Here’s what you should know:

  • Medicare Part A will help pay for the expenses associated with inpatient care. It might be a hospital stay or a rehab stay at a skilled nursing center.

  • Medicare Part B covers outpatient care including physician office visits, preventive care (flu shots and screenings) and outpatient rehab services.

  • Medicare Part D is designed to help with prescription drug expenses. While all Medicare Part D plans must meet federal standards, not all plans are the same. It’s important to review each plan and compare it with your list of prescriptions.

Traditional Medicare generally covers 80% of seniors medical costs, and the senior is responsible for the other 20%. It is important to note that there is no limit on out-of-pocket costs for Medicare Part A and B expenses. You can purchase a supplemental insurance plan to help with this gap in coverage.

Medicare Replacement Plans

A Medicare replacement plan is legally obligated to cover the same services that a senior’s traditional Medicare would. In some cases, these plans actually provide broader coverage such as a health club membership or vision assistance.

The downside is that these plans usually limit which providers you can see. This can be especially problematic if you and your husband are one of Ohio’s many snowbirds who head south during the winter months.

Utilize the Medicare Plan Finder to search by zip code for plans that meet your criteria. You can review which providers are included in the plans and how each plan is rated based on a 5-star performance rating system.

Patient and Family Communication in Rehab

Dear Kara:

My mom will need inpatient rehab after she is discharged from the hospital. Her physician feels like she needs it to continue her recovery. This whole area is new to us. We aren’t quite sure how communication is handled or what to expect next and at each stage of her rehab.

Can you please share more information with us on the process of transitioning to a short-term rehab center and how we will know what progress she is making and when she will be discharged?


Patient & Family Communication at a Short-term Rehab Center

Dear Meeghan:

Good question! And one many families ask when a loved one is hospitalized for an illness or an injury or is planning for a surgery.

Here is an overview of what you should expect when you choose Whetstone Care Center for short-term rehab and how we handle communication:

  • Preadmission: While your mother is still in the hospital, we are busy working with her care team to make sure we are ready for her arrival. This means we talk with them about the type of care your mom needs so we can have everything in place for her arrival. From durable medical equipment to medication and any special dietary needs, we will be prepared for her arrival.
  • Admission: On the day she moves from the hospital to Whetstone Gardens, we work hard to ensure the transition goes smoothly. Each of our management team members will stop in and introduce themselves to your family. This helps you know who to contact if you have any questions throughout your mother’s stay. We will review the daily schedule with you and your mom, as well as help her get oriented to the features and amenities in her room. Finally, we will have a care conference with your family and our key care team members including the therapy manager, social worker and nurse unit manager. At that time we will review the plan of care, talk about her therapy goals and her therapy schedule, answer any questions about insurance coverage and begin to discuss her discharge plan with you.
  • During Rehab: Throughout your mother’s rehab stay with us, I will maintain contact with her and with your family. I will relay details about her progress in therapy, discuss nursing care needs, update you on any changes in insurance coverage, and more. We will also work with you to schedule another care conference.
  • Discharge Plans: Once a discharge date is determined, I will notify you and your mom. Then we can start discussing and making arrangements for any durable medical equipment she might need at home, talking about home care and outpatient therapy options, and coordinating plans for the actual day of discharge.
  • Post Discharge: After your mother has safely transitioned home, I will continue to check in with her to make sure she understands her discharge instructions and is able to follow them. We can also talk about any questions or concerns your mom or the family have as she adjusts to being independent and on her own again.

I hope this information is helpful to you, Meeghan. You are always welcome to contact me with any additional questions you or your mother might have.

Kind Regards,

Kara Beamish


The Perks of Recovering in Rehab

Dear Jeremy,

My mother-in-law will be having hip surgery in a Columbus area hospital later this month. Her physician has recommended she transition to a short-term rehab center to continue her recovery after she is discharged from the hospital.

Unfortunately, she is fairly stubborn and refuses to even consider the idea. She thinks she can come to our house and have us care for her. My husband and I both work full-time and there would be no one around to help her during the daytime. In addition, our home is older and has a lot of stairs. The bathtub seems like it could be especially challenging to get her in and out of every few days.

I have visions of her falling during the day when we are at work or when we are trying to help her take a shower and injuring her new hip.

Do you have any suggestions that might help us change her mind? Her surgery is getting close!


The Advantages of Recovering in a Short-term Rehab Center

Dear Tina:

It sounds as if you and your husband are in a tight spot! But you are right to be concerned that your home environment might not be the best for someone recovering from hip surgery. A fall could definitely have devastating consequences.

One barrier we sometimes run into with older adults is that they have outdated ideas about what a skilled nursing and rehab center is. They may have been in one several decades ago and still cling to old-fashioned ideas about nursing homes.

Today’s short-term rehab centers, like Whetstone Care Center, offer many perks. A few include:

  • The comfort of a private room that has a phone, Wi-Fi access, and flat screen television with cable
  • Hospital style beds
  • Delicious, chef-prepared meals and snacks
  • A café to allow family and friends to join patients at mealtime
  • Variety of opportunities to socialize with other older adults who are recovering
  • Outdoor walking paths to enjoy sunshine and fresh air
  • Personal bathing choices
  • Beauty and barber shop services onsite
  • Access to other services such as a dentist or a podiatrist


One more advantage is that all of your mother-in-law’s medications will be covered during her short-term rehab stay.

My final suggestion is to try to get your mother-in-law to agree to come with you and visit us in person before her surgery. We can take her on a personal tour and introduce her to the rehab team that will help her get back on her feet again after surgery. I’m confident you will both like what you see!

Please contact us to arrange a time that is convenient for you to stop by. The two of you can even stay for lunch.

Kind Regards,

Jeremy Evans

Top 10 Must-See Romantic Movies

Dear Hope,

My mother used to be very active and social before my father passed away last year. Now she’s withdrawn from a lot of her favorite clubs and pastimes. It’s tough to even get her to leave the house for her grandkids’ birthday parties!

I am concerned she is on the road to depression or to a health crisis of her own.

I thought Valentine’s Day might be a good time to help her host some of her old friends — many of whom are also widows — for a movie night.

Do you think that will help?


Hi, Dayna:

I think that sounds like a great idea! Valentine’s Day might be a tough night for her to be alone and the same may be true for her friends.

You are right to be concerned that her isolation may lead to health problems. Isolation among seniors is considered to be a very serious health risk. It makes older adults more likely to develop diabetes, obesity, depression and heart problems.

Planning a Movie Night for Older Adults

Helping your mom organize the first movie night might be just the spark she needs to re-engage with her friends and favorite activities. If she hasn’t done something like this on her own since your father passed away, her confidence may be a little low. But your support might help her overcome her insecurity.

Hosting a movie night at home can be an inexpensive way for her friends to gather once a month. Since February is Heart Month and Valentine’s Day, maybe help your mom track down a romantic comedy. If she doesn’t have access to a streaming service like Netflix, she might be able to find a DVD at her local library or discount store.

Top Ten Romantic Comedies

According to a survey done by Rolling Stone magazine, the all-time top 10 romantic comedies are:

   10. There’s Something About Mary

   9. Notting Hill

   8. Eternal Sunshine of the Spotless Mind

   7. You’ve Got Mail

   6. 50 First Dates

   5. Say Anything

   4. Love Actually

   3. The Wedding Singer

   2. Annie Hall

   1. When Harry Met Sally

Heart-Healthy Snacks for Movie Night at Home width=

If you need some suggestions for heart-healthy snacks you and your mom can make together for movie night, here are a few that receive high marks from the American Heart Association:

  •    Angel food cake
  •    Frozen grapes
  •    Hummus and fresh vegetables
  •    A fresh fruit, nuts and bagel tray
  •    Baked apples
  •    Unsalted sunflower seeds mixed with raisins

Good luck with movie night, Dayna! I hope all goes well and your mom and her friends enjoy themselves!

Kind Regards,


Transportation Options for Seniors in Central Ohio

Dear Linda:

My aging parents live in the Columbus area. My mother was always a nervous driver in traffic, but lately it seems like my father is no longer confident in his driving ability either. Now that winter weather is here, I’m concerned that it is time for him to hang up the keys.

Because I live a little over two hours away in northwest Ohio, I don’t get to their house as often as I would like to. I know that if I talk with my Dad about giving up driving, his argument to me will be that they have no other means for transportation. Many of their friends have either moved away to be closer to their adult children or moved into assisted living communities where transportation is provided.

Do you know what local options for transportation there are that might work for my parents? I’d like to have a few suggestions for him when I initiate this conversation.


Columbus Area Transportation Providers

Dear Alysha

It sounds like your plan for beginning this conversation is a smart one. Knowing what options your parents have for getting to the grocery store, to physician appointments and other necessary destinations will likely make the talk go more smoothly.

From what you’ve described, it sounds as if your father may be ready to give up driving already.

Here are a few options to investigate in the Columbus area:

  • Private duty home care aides can help provide transportation. Most will give clients the option of using their private vehicle or riding with the aide in theirs (a mileage fee will usually be assessed for the last option). Your parents can cluster their stops to keep their costs down.
  • Ambulate services can be another solution, especially if one or both of your parents have mobility problems. These are different than ambulance companies which are used to transport people in emergency situations. Ambulates can be used to transport seniors to physician appointments, physical therapy appointments and more.
  • Central Ohio Transit Authority (COTA)is the public transit provider for Columbus and central Ohio. Your parents can even call to arrange trips to special locations not on COTA’s regular bus routes. Central Ohio adults over age 65 can obtain a Senior ID that will entitle them to half-price fares.
  • Uber Columbus and Taxi Services can also provide your parents with flexible, last minute transportation options. Apps like Taxi Finder can help you and your parents find local taxi service and estimate what the fares will be.

One last recommendation is to call the Central Ohio Agency on Aging. They may have other options that will meet your parents’ transportation needs.

I hope this information helps you and your parents better plan for this transition, Alysha.

Kind Regards,

Linda Nicholson, Social Services


Helping Your Senior Beat Depression

Dear Edward:

My parents were married for almost 60 years before my father passed away last year. My mother is really struggling. I think her grief has turned into a true case of depression. I’m trying to find ways to help her through this, but I’m not having much success.

I know you help seniors through challenging times every day. Do you have any advice for me?


Dear Diane:

The loss of a spouse—especially after such a long marriage—is difficult to overcome. I’m sure it is equally difficult for you to watch your mother struggle.

While it is common for a senior who has lost a spouse to spend more time alone, it is important to help seniors avoid becoming isolated. We now know isolation is considered to be a serious health risk for older adults. It contributes to a variety of problems ranging from high blood pressure and obesity to diabetes.

Here are a few suggestions I think might be of help:

  • Explore the opportunities for her to get involved in local community organizations. It might a local senior center or a seniors group at her church or synagogue. Look for events and activities that are geared toward older adults. She will likely find peers among those groups who have also lost a spouse.
  • Help her get up to speed on social media. If you or one of her grandchildren can assist her in setting up a Facebook page, she may be able to connect with family and old friends she has lost touch with over the years.
  • Volunteering is another great way to overcome the blues. There are proven health benefits for older adults who volunteer including lower incidence of depression. Hands-on Central Ohio and Volunteer Match are two organizations you and your mother can use to find a volunteer opportunity near her home.
  • If your mother is able to care for a pet and can afford the expense, consider adopting an older dog or cat from a local shelter. Older animals often have a long wait before they are adopted, but can be the ideal companion for a senior.

My final piece of advice is to seek professional help if you are concerned your mother doesn’t seem to be finding her way through her grief. It isn’t unusual to need a little professional help to get through such a life-changing experience.

I’m sending my very best wishes to you, Diane. I hope your mother’s health and well-being turn around soon!

Edward Beatrice, Administrator