Assisted Living Medication Management: Psychotropic and As Needed (PRN) Medications

Psychotropic medications are drugs that affect the mind, emotions, or behavior and are frequently prescribed for residents. When used appropriately and judiciously, these medications can enhance the quality of life of residents who need them. However, all psychotropic drugs have the potential for producing undesirable side effects or aggravating problematic signs and symptoms of existing conditions including:

  • Postural hypotension
  • Dyskinesia
  • Malignant hypothermia
  • Delirium

Maximizing the resident’s well-being while minimizing the hazards associated with drug side effects are important goals of psychotropic drug therapy. In reviewing a psychotropic drug regimen there are several rules of thumb:

  • Start low and go slow. If needed, psychotropic drugs should be started at the lowest dosage possible. To minimize side effects, doses should be increased slowly until there is a therapeutic effect, side effects emerge, or the maximum recommended dose is reached. It may take 6 to 8 weeks for effective results, or as determined by the practitioner.
  • Each drug has its own set of actions and side effects, some more serious than others; these should be evaluated in terms of each user’s medical status, including interaction with other medications.
  • Consider the effect of one psychotropic medication at a time.
  • Remember that any drug, prescription or non-prescription, can cause problems in some residents.

In non-emergency situations, physicians and/or service providers must obtain informed consent before giving a person psychotropic medications. To be “informed,” consent must be:

  • Voluntary;
  • Based on specific information about benefits, side effects, and alternatives; and
  • Provided by a person who is competent to give the consent or by a court-appointed guardian.

Relevant Regulations

Adult Day Care (ADC):
Certification Standard I.F.(3)(3)

Family ADC:
Certification Standard I.D.(3)(e)

Adult Family Home (AFH):
Wis. Admin. Code § DHS 88.03(5)
Wis. Admin. Code § DHS 88.03(5)(e)1
Wis. Admin. Code § DHS 88.07(3)(e)2
Wis. Admin. Code § DHS 88.10(3)(n)1

Community-Based Residential Facility (CBRF):
Wis. Admin. Code § DHS 83.02(15)
Wis. Admin. Code § DHS 83.02(41)
Wis. Admin. Code § DHS 83.12(1)(a)
Wis. Admin. Code § DHS 83.32(3)(f)
Wis. Admin. Code § DHS 83.37(1)(h)
Wis. Admin. Code § DHS 83.37(1)(h)2
Wis. Admin. Code § DHS 83.37(1)(i)
Wis. Admin. Code § DHS 83.37(1)(i)1
Wis. Admin. Code § DHS 83.37(1)(i)2
Wis. Admin. Code § DHS 83.37(1)(i)3

Residential Care Apartment Complex (RCAC):
Wis. Admin. Code § DHS 89.13(22)

Resources

FAQs

1. Do assisted living facilities need to obtain informed consent prior to administering psychotropic medications?

All residents have basic rights in assisted living facilities. These rights include being informed of their care and having the opportunity to refuse that care. In assisted living a specific written form for informed consent is not required however unless Wis. Admin. Code ch. DHS 94 applies. DHS 94 applies situations where treatment is for substance abuse or developmental disabilities. Please refer to DHS 94 for details.

2. Can assisted living facilities put psychotropic medications in resident’s food?

Residents have basic rights to be informed of their care. If facilities are putting medication in food to ease with swallowing and the facility is telling or showing the resident the medication is in the food, then in that instance, putting the medication in the food is fine. If however, the facility is putting the medication in food to hide it from the resident so that the resident will take in instead of refusing it then that can be a rights violation. In order to administer medications in that manner a court order is typically needed.

Last Revised: September 28, 2018