New York state has clarified its policies for the self-administration of medications by hospice patients who live in adult care facilities. The new guidance addresses times those patients are no longer capable of taking medications themselves.
According to a “Dear Administrator” letter from the New York state Department of Health, adult care facility (ACF) residents must be removed from their facility if they cannot self-administer, unless the resident has a caregiver who can ssist.
“An ACF resident may continue to reside in the ACF under hospice care when they can no longer participate or receive assistance with the self-administration of medication only to the extent that they have designated caregivers that may include family or other caregivers (paid or unpaid), available to administer their medications,” the department indicated in the letter. “If they do not have such supports or such supports are unavailable, the resident must be discharged to a more appropriate or higher level of care.”
No licensing is required for unpaid caregivers, such as family members, but paid caregivers must have a state license that allows them to administer medications, including controlled substances.
Only the resident or family can designate or hire caregivers; the hospice and the ACF cannot participate in that decision making process. Nevertheless, the hospice must have contingency plans in place should caregivers be unable to fulfill their roles effectively.
“As long as the resident’s end-of-life needs can continue to be safely managed through a combination of hospice staff and designated caregivers, the ACF will continue to provide personal care services, meals, housekeeping and housing,” according to the letter. “The ACF, hospice, family and designated caregivers must coordinate closely to ensure that the resident’s needs and goals are met as the resident’s condition changes.”
One goal of the revised policy is the prevention of drug diversion.
Drug diversion—the transfer of a prescription medication from a lawful to an unlawful channel of distribution or use—is a prevalent issue throughout the health care continuum. Hospice providers and other organizations that provide care in the home face unique challenges due to the potential easy access to the patients’ medications.
A study published in the February issue of the Journal of Pain and Symptom Management indicated that prescription medications in the home are a “well-known entry point” for family members or visitors to access potentially addictive substances. The risk is particularly high if people in the home have a history of substance abuse.
The scope of the issue is difficult to calculate. A 2017 report from Baltimore-based compliance analytics firm Protenus estimated that the annual cost of drug diversion for health care providers and payors exceeds $301 million. The report acknowledged that this was likely a low-ball estimate because the data was gathered through media reports. Costs include the lost medication themselves, as well as the time involved in developing prevention processes and the costs of regulatory compliance.
“Both the Hospice and the ACF share a responsibility to coordinate care and take steps to mitigate the opportunities for the diversion of narcotics,” the Department of Health’s letter indicated. “Providers should follow their policies on who to communicate any suspicion or concern that the hospice patient/resident’s narcotics may be subject to diversion by any party. If such concerns arise, the hospice plan of care must be revisited and revised as necessary.”