Who can give your parent their medications at home

Reminders, setup, and administration

Minnesota splits help with medications into three jobs, and an agency may do different ones depending on how it is licensed. The three words sound interchangeable in conversation, but the rules treat them differently, so two agencies can answer the same question honestly and still not agree.

A reminder is a prompt. Under Minn. Stat. 144A.471, subdivision 6, an agency holding a basic home care license may give "verbal or visual reminders to the client to take regularly scheduled medication." Someone says it is four o'clock and points at the pillbox on the counter.

Setup is filling that pillbox. The Minnesota Department of Health describes medication setup in its home care guidance as arranging medications by a nurse, a pharmacy, or an authorized prescriber for later administration.

Administration is the hands-on part. It covers putting the tablet in your mother's hand and staying while she swallows it, giving the eye drops, and drawing up the insulin.

Most families mean administration when they call an agency, and plenty of agencies are offering only reminders. The three words sound the same over the phone, and the difference between them is set by the agency's license.

What the license lets an agency do

Minnesota licenses home care in two tiers, and the tier decides the answer. Under Minn. Stat. 144A.471, subdivision 7, a comprehensive home care license covers medication management services along with nursing, hands-on transfer assistance, and "tasks delegated to unlicensed personnel by a registered nurse." Minn. Stat. 144A.4792, subdivision 1a, states that medication management services may not be provided under a basic license at all.

So an agency on a basic license can remind your father about his pills, but handing them to him is outside what that license allows.

Ask on the first call which license the agency holds. That one question settles more than a list of services will, and any agency can answer it in one sentence. The same call is a reasonable time to ask whether what you need is personal care or nursing care, because medications tend to be the thing that decides it.

Why a nurse has to be in the picture

Minn. Stat. 144A.4792, subdivision 6, says medications may be administered by "a nurse, physician, or other licensed health practitioner" or by "unlicensed personnel who have been delegated medication administration tasks by a registered nurse."

The Department of Health is specific about the limits of that delegation. Its home care guidance on medication management says unlicensed staff may not administer medications unless a nurse from their own agency has set those medications up and has trained the staff member and checked their competency on the task. The same guidance states that neither family members nor a hospice nurse can delegate tasks to a home care agency's unlicensed staff.

If you have been filling your mother's weekly organizer yourself and assuming the aide could give the doses out of it, that arrangement does not hold up under the rule, whatever it looks like sitting on the kitchen counter. You were not being careless. This is one of the rules nobody explains until the week you are out of town. There is a version of the same arrangement that works, and it leaves most of what you already do in place.

What happens before anyone touches the pills

Under Minn. Stat. 144A.4792, subdivision 2, a registered nurse or licensed health professional has to do a face-to-face assessment before medication management services start. That assessment identifies every medication the person is known to be taking and reviews the indications for them, the side effects, the contraindications, and any allergic or adverse reactions. Compiling all of that is the nurse's job, and she does it during the visit.

What comes out of it is a written medication management plan. Subdivision 5 requires the plan to describe which services the agency will provide, how the medications will be stored, the specific instructions for giving them, which staff member watches the supply, which tasks the nurse is delegating to unlicensed staff, and how staff notify a nurse when something goes wrong. The statute also requires the provider to reassess when medication problems appear, and at a minimum once a year.

In practice the plan is where the small questions get settled. It covers whether the water pill moves to the morning so your father is not up at two, who calls the clinic when a refill has run out, and what a caregiver does on a day your mother says no. Minn. Stat. 144A.4792, subdivision 1, requires an agency's written policies to cover the rest of it too: resolving medication errors, disposing of unused medications, and talking to the prescriber and the pharmacist.

Families tend to underestimate how long this part takes. The first visit with a nurse runs long, and much of that time goes to reading labels and counting what is in the cupboard. Leave the cupboard as it is. Expired bottles and the duplicate from an old prescription are part of what she is there to find.

What you can keep doing yourself

None of the rules above govern you. Families in Minnesota give each other medications every day, and the statutes are written about what an agency's staff may do. If you have been managing your father's pills for two years, you may keep managing them.

The arrangement that does not work is the one split down the middle, where you fill the organizer and the caregiver gives the doses out of it. A caregiver can give only the medications the agency's nurse has set up. If you would rather keep setting them up yourself, the caregiver can prompt your mother, stay while she takes the dose, and call you.

You do not have to settle all of this today. A lot of families start with the evening doses, since those are the ones that get missed when a long day runs out at seven o'clock. They leave the morning routine alone for now.

Where this usually comes apart

The Centers for Disease Control and Prevention reports that adverse drug events cause more than one and a half million visits to hospital emergency departments in the United States each year. Most of the ones that happen at home start with one of five common situations.

• A hospital stay. Discharge changes the list, sometimes substantially, and the plan written three months ago is now wrong. Coming home after a hospital stay is a common moment for a medication mistake at home.
• Two lists. The clinic's list and the one taped inside the cupboard door stop matching. Bring the actual bottles to the assessment.
• As-needed medications. Pain medication, anxiety medication, and anything for constipation live in a different category, and the plan needs to say who decides and on what signal.
• Anything that is not a pill. Eye drops, inhalers, patches, and insulin all take more training than a tablet, and they are the tasks caregivers are most likely to skip.
• Refusal. With dementia, a refused dose is routine and does not usually need an emergency call. The plan should say what the caregiver tries, how long they wait, and when they call a nurse.

If you recognized two or three of these already, write them down and bring the note to the first visit. They are the parts a nurse will want to hear about from you.

Questions to ask an agency

• Which home care license do you hold, and can your staff administer medications or only remind?
• Who does the first assessment, and is that person a registered nurse?
• When a dose changes after a clinic visit, who updates the plan, and how soon?
• Who fills the organizer? What happens if I have already filled it?
• What do your caregivers do when my mother refuses a dose?
• What happens on a Sunday when the pharmacy is closed and a refill has run out?

There are more of these in the questions to ask a home care provider list. An agency that has thought about these questions before will answer them without much trouble.

If you want someone to look at the actual bottles

Abloom Senior Living provides in-home nursing and personal care in Woodbury and the East Metro under a comprehensive home care license from the Minnesota Department of Health, the tier that permits medication administration. A registered nurse does the assessment, writes the plan, and delegates what caregivers are trained to do.

If it would help to have somebody sit at your kitchen table with the bottles and sort out which parts of this need a nurse and which do not, you can request a visit at home, or come see the house in Woodbury and ask your questions there. If Abloom Senior Living is not the right fit for what your family needs, you will hear that plainly, along with a suggestion of where to look instead.

This article is general information from a care provider in Minnesota. It is not legal, financial, or medical advice. Rules change, and your parent's situation has details no article can account for. Ask your parent's prescriber or pharmacist about the medications themselves.

Frequently asked questions

Can a home caregiver in Minnesota give my parent their pills?

Only if the agency holds a comprehensive home care license and a registered nurse from that same agency has set up the medications, trained the caregiver, and delegated the task. Minn. Stat. 144A.4792, subdivision 6, allows administration by a nurse or other licensed practitioner, or by unlicensed staff who have been delegated the task by a registered nurse. An agency on a basic license may only give reminders.

Can I fill the pill organizer myself and have the caregiver hand out the doses?

No. Minnesota Department of Health guidance states that family members cannot delegate tasks to a home care agency's unlicensed staff, and that unlicensed staff may not administer medications unless a nurse from their own agency set them up. You can keep filling the organizer, but then the caregiver's role stays at reminding.

What is the difference between medication setup and medication administration?

Setup is arranging the medications ahead of time, which the Minnesota Department of Health says is done by a nurse, a pharmacy, or an authorized prescriber. Administration is giving the dose to the person at the time it is due. They are separate services under Minn. Stat. 144A.4792, and they are documented separately.

Does a nurse have to come to the house before medication help starts?

Yes. Minn. Stat. 144A.4792, subdivision 2, requires a face-to-face assessment by a registered nurse or licensed health professional before medication management services begin, covering every medication the person is known to be taking. The statute also requires reassessment when problems come up and at least once a year.

Who handles refills and calls to the pharmacy?

The written medication management plan should name this. Minn. Stat. 144A.4792, subdivision 1, requires an agency's policies to cover requesting prescriptions and communicating with the prescriber and pharmacist, and subdivision 5 requires the plan to identify the staff member responsible for monitoring the supply. Ask how it works before the first refill runs out.

Related reading

• How to choose a home care agency in Minnesota
• A dementia routine worksheet for families
• What to ask at a hospital discharge meeting

Sources

• Minn. Stat. 144A.471, Home Care Provider Licenses, Minnesota Office of the Revisor of Statutes
• Minn. Stat. 144A.4792, Medication Management, Minnesota Office of the Revisor of Statutes
• Minn. Stat. 144A.4795, Comprehensive Home Care Provider Responsibilities, Minnesota Office of the Revisor of Statutes
• Home Care Frequently Asked Questions: Medication Management, Minnesota Department of Health
• Medication Safety and Your Health, Centers for Disease Control and Prevention