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New York Updates and Clarifies Policies Regarding Medication Administration for Hospice Patients Residing in Adult Care Facilities

On February 12, 2020, the New York State Department of Health (DOH) issued a Dear Administrator Letter clarifying DOH’s policies for hospice patients residing in adult care facilities (ACF) when those ACF Hospice Residents are no longer capable of self-administration of medications.

As per the Dear Administration Letter, an ACF resident who is eligible for hospice services (Hospice Resident) may receive hospice services in the ACF when the ACF, hospice, resident and family agree that the Hospice Resident’s needs can safely be met in the ACF. 

DOH Requirements for Hospices and ACFs When Servicing Hospice Residents Who Can No Longer Self-Administer Medications

An ACF is responsible for the storage of the Hospice Resident’s medications so long as the Hospice Resident is able to self-administer the medications. At the point that the Hospice Resident is no longer able to self-administer the medications, there must be one or more designated caregivers (family or other individuals who may be paid or unpaid) who will assume responsibility for the administration and storage of the medications. If the designated caregivers are not paid, then no licensure is required. However, if the designated caregivers are paid, they must have appropriate New York State licensure permitting them to administer medications, including controlled substances.   

The Hospice Resident or family is solely responsible for the designating and hiring of caregivers, and neither the ACF nor the hospice are permitted to be involved in the hiring, coordinating or provision of paid caregivers. However, the hospice must ensure that there are back-up plans if the designated caregivers are unable to fulfill the duties and responsibilities since the ACF staff is not permitted to do so. If no designated caregivers are identified or the Hospice Resident cannot be safely managed in the ACF, the ACF must discharge the Hospice Resident to a more appropriate or higher level of care. 

The designated caregivers must be identified on the hospice plan of care, and consistent with the hospice plan of care, the hospice will assume the responsibility for the administration, record-keeping, and disposal of the medications upon the Hospice Resident’s death, through the use of the designated caregivers. The hospice plan of care must include specific delineated information regarding the medications and must be signed by the Hospice Resident, if the Hospice Resident has capacity, or by a guardian, health care agent, or authorized representative if the Hospice Resident does not have capacity.  It also must be signed by the ACF and the hospice nurse. The hospice may only order a maximum of a five-day supply of controlled substances, and at each visit, the nurse must review the medication administration logs and count the remaining medications. 

The Hospice Resident’s medications  may be stored in the Hospice Resident’s living quarters or with the designated caregivers. If the medications are stored with the designated caregivers, the number of such designated caregivers should be as few as possible, without compromising the Hospice Resident’s ability to access medications as needed. The ACF staff will no longer have access to the Hospice Resident’s medications, and the hospice staff and designated caregiver(s) will be the only personnel with access to those medications.

The designated caregivers must coordinate with the hospice’s interdisciplinary group and ACF staff to manage the Hospice Resident’s needs at the end of the Hospice Resident’s life. The hospice must provide and document training of the caregivers regarding medication storage, administration, and disposal of medications to the designated caregivers, and the designated caregivers must agree to accept the training. The designated caregivers must also agree to be responsible for the custody of the medications, as well as to document the administration of the medications. The designated caregivers are responsible for the disposal of the medications, but if requested by the designated caregivers, the hospice nurse may dispose of the Hospice Resident’s medications upon the Hospice Resident’s death. 

Different Rules Apply to Enhanced Assisted Living Residences 

DOH permits an Enhanced Assisted Living Residence (EALR) to have more involvement with a Hospice Resident. If the Hospice Resident resides in an EALR, consistent with the EALR policies, DOH regulations, and staff availability, the EALR employed or contracted nurses may perform some or all of the medication administration functions. Additionally, if there are residents residing in an assisted living residence or special needs assisted living residence co-located within the EALR, the EALR nurse may perform some or all of the medication administration functions for up to two residents.

New York ACFs, EALRs, and hospices should review their policies carefully to assure they comply with the new Dear Administrator Letter requirements.

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