Can staff give medications in a Tennessee assisted living facility?
Yes. A Tennessee ACLF may administer typically self-administered medications, but every drug must be administered by a licensed or certified health care professional acting within that license, such as a nurse or a certified medication aide (0720-26-.07(1)(a) and (5)(b)).
The rule separates two activities. Assistance with self-administration means reading labels, opening containers, reminding and observing; unlicensed staff can do that. Administering means directly giving a dose; that requires a licensed or certified professional. A medication aide who is passing medications may not be assigned other duties during the pass, except to respond to an emergency (0720-26-.07(5)(c)). Medications must be stored in a locked or closed container or room, and staff may not repackage them.
What medical services can a Memphis assisted living resident receive?
Any medical service a physician prescribes that could be provided to a private citizen at home, including part-time or intermittent nursing, therapies, podiatry, medical social services, supplies, durable medical equipment and hospice (0720-26-.07(1)(b)).
Those services can come from the facility's own licensed staff, its contractors, a licensed home care organization, another licensed entity or licensed nursing home staff (0720-26-.07(2)). Medicare-covered services must come from a Medicare-certified provider (0720-26-.07(4)). In practice that means a Memphis ACLF resident can receive Medicare home health visits from an outside agency after a hospital stay. Our home health and hospice roster lists the agencies licensed in the three counties.
What happens to medications when a resident leaves or dies?
On discharge, unused prescriptions are released to the resident, family or legal representative unless the physician prohibits it; on death, they are destroyed under the facility's written disposal policy unless the family requests them with a physician's written order (0720-26-.07(6)).
The disposal policy must follow current FDA or DEA guidance, be carried out by a licensed or certified professional with a witness, and be given to the family in writing before admission or before the contract is signed, whichever comes first (0720-26-.08(6)(k)). For hospice patients, the hospice disposes of prescription medication at death.
Must a Tennessee ACLF provide meals and a dietitian?
Yes. An ACLF must serve at least three meals a day with no more than 14 hours between the evening meal and breakfast, offer snacks on request or for special diets, keep a 48-hour food supply, and use a qualified dietitian on a full-time, part-time or consultant basis (0720-26-.07(7)(c) and .06(1)(a)5).
Therapeutic diets must be prescribed by the resident's practitioner, and menus must be planned a week ahead. For a parent with diabetes, swallowing problems or kidney disease, ask to see the therapeutic diet manual and a week of planned menus before move-in, and ask who modifies textures when a speech therapist orders it.
At a glance
| ACLF staff may | ACLF staff may not | |
|---|---|---|
| Medications | Administer them if licensed or certified | Administer them as unlicensed staff |
| Medication aides | Pass medications under nurse supervision | Do other chores during the medication pass |
| IV therapy | Continue for existing residents intermittently or on hospice | Start it for a new admission |
| Outside care | Bring in home health, therapy and hospice | Bill Medicare without a certified provider |
Sources include Tenn. Comp. R. & Regs. chapters 0720-26, 0720-21 and 0720-18, Health Facilities Commission and TennCare pages, CareScout and VA rate tables as cited above; see our editorial standards.
