Objective: To obtain information about actual medication management practices in assisted living residences (ALRs). Design: An online survey; data were collected and reported as frequencies. Operational definitions were provided for "assist with" and "administration of" medications. Setting: All 50 states. Participants: Members of the key assisted living professional and provider associations. Results: More than half of ALRs (n = 547) administer medications to 80% to 100% of their residents. Almost half of ALRs use unlicensed assistive personal (UAP)/medication aides to administer medications, as permitted by state regulations. In those states where UAPs are not permitted, unlicensed staff may assist residents with their medications. More than half of ALRs have written policies regarding medication storage and documentation of administration. A slightly smaller percentage of ALRs have policies regarding medication administration by a UAP/med aide, quality improvement programs, and error reporting. As much as 30% of ALRs lack policies regarding drug regimen review and monitoring for adverse drug events (ADES). Conclusion: Intensive education for practitioners about appropriate prescribing is warranted, as is improved methods for assessment of an older adult's ability to safely self-administer medications. The role of Boards of Nursing in every state, and nationally, should take a leadership role in establishing the curriculum, training, competencies, and performance evaluation criteria of UAP/med aides. (J Am Med Dir Assoc 2009; 10: 107-114)
