In nearly all medical facilities at every level of care medication errors are major concern and source of increasing liability exposure. For the individual in assisted and non-assisted living medication non-adherence is a growing problem. The problem is well known in the medical profession and its ramifications are well documented in regard to patient care and professional liability. The consequences are not only costly but potentially deadly. Yet the problem persists and, in fact, is getting worse as a result of our, in no small part, increasingly aging population. Aging has multiple ramifications medically but in particular more people are being prescribed complex medication regimens for a host of chronic ailments and diseases and more people are being challenged by the natural attributes of aging such as mild cognitive impairments and short-term memory deficits. Unfortunately, when cognitive impairment becomes more than “mild”, or when medication regimens become increasingly complex, full time assistance with instrumental 1st Level Activities of Daily Living(1ADL), including the consumption of medications, becomes essential.
This environment, including the medication non-adherence issue, has been a significant contributor to the rapid growth in senior’s residences and assisted living facilities over the last thirty plus years. Additionally, as residents continue to age, their need for assistance continues to increase. Assistance with 1ADLs are complemented with assistance with 2nd Level Activities of Daily Living (2ADL). Indeed, some facilities “draw the line “ at the differentiation between these two service-levels and require clients to move to higher level care facilities when they require assistance with Activities of Daily Living.
It is worth noting that good medication adherence would certainly delay, if not prevent, the transition from 1ADL to 2ADL assistance.
(1) Instrumental activities of daily living (1ADLs) are the complex skills needed to successfully live independently. These skills include the following: Managing finances, transportation (driving or navigating public transit), shopping and taking medications.
(2) Activities of daily living (2ADL) are routine activities that people do everyday. There are six basic ADLs: eating, bathing, dressing, toileting, transferring (walking) and continence.