Assisted Living: Psychotropic Medication Management

Psychotropic medications are often used in assisted living facilities. They affect the mind, emotions, or behavior. Examples include depression and anxiety medication.

When used correctly, these medications can improve a resident's quality of life. However, they can cause unpleasant side effects. They also can make other conditions worse. For example, they can cause:

• Drops in blood pressure when standing or sitting up (postural hypotension).
• Muscle movement that can't be controlled (dyskinesia).
• High body temperature (malignant hypothermia).
• Confusion and reduced awareness of one's surroundings (delirium).

Staff should closely monitor residents who take psychotropic medications. This can help staff see if a medication is working. It also can help them take necessary steps to reduce side effects.

Staff should consider the following when giving residents psychotropic medications:

• Start the resident at a low dose. Increase the dose slowly until:
  • The medication has a positive effect on the resident (it can take up to two months to see a good result).
  • Side effects occur.
  • The highest allowed dose has been reached.
• Watch for side effects. Remember, all drugs interact differently with other drugs.
• Use one psychotropic medication at a time. This helps see which drugs cause which side effects.

Unless the situation is an emergency, staff must get informed consent, or permission, from a resident before giving medication. To be "informed," residents must:

• Have the choice to accept or refuse medication.
• Receive information about benefits, side effects, and alternatives.
• Be capable of giving consent.

In some cases, someone appointed by a court can give consent for a resident.

Regulations

• Adult Day Care Center
  • Wisconsin Admin. Code. § 105.14(7)(d)1
• Adult Family Home
  • Wisconsin Admin. Code § DHS 88.03(5)
  • Wisconsin Admin. Code § DHS 88.03(5)(e)1
  • Wisconsin Admin. Code § DHS 88.07(3)(e)2
  • Wisconsin Admin. Code § DHS 88.10(3)(n)1
• Community-Based Residential Facility
  • Wisconsin Admin. Code § DHS 83.02(15)
  • Wisconsin Admin. Code § DHS 83.02(41)
  • Wisconsin Admin. Code § DHS 83.12(1)(a)
  • Wisconsin Admin. Code § DHS 83.32(3)(f)
  • Wisconsin Admin. Code § DHS 83.37(1)(h)
  • Wisconsin Admin. Code § DHS 83.37(1)(h)2
  • Wisconsin Admin. Code § DHS 83.37(1)(i)
  • Wisconsin Admin. Code § DHS 83.37(1)(i)1
  • Wisconsin Admin. Code § DHS 83.37(1)(i)2
  • Wisconsin Admin. Code § DHS 83.37(1)(i)3
• Residential Care Apartment Complex
  • Wisconsin Admin. Code § DHS 89.13(22)

Resources

• Alzheimer's Association – Treatments for Behavior
• Alzheimer's Association – Success Through Less
• Informed Consent for Medications F-24277 Series: Psychotropic Medications

Frequently asked questions (FAQs)

Does informed consent need to be in writing?

Consent must be given in writing when treating residents for substance abuse or developmental disabilities (Wis. Admin. Code ch. DHS 94). Otherwise, it can be given verbally.

Can assisted living staff put psychotropic medications in a resident's food?

Yes, if the goal is to help a resident take the medication and the resident has been informed and is aware.

However, staff cannot put medication in food and not tell a resident. There must be a court order to give medications without informed consent.