Pill bottles on shelf
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Assisted living and nursing home owners and administrators, as well as long-term care industry associations and others, should increase their efforts to address medication theft and protect residents’ rights to adequate and timely pain relief, recommend the authors of a newly published study.

The recommendation follows an analysis of Minnesota Department of Health investigation reports of substantiated “drug diversion” in those long-term care settings. The authors said that theft of controlled substances by assisted living and nursing home staff members is an overlooked form of elder mistreatment that needs more attention.

In an analysis of 107 state health department investigation reports involving “drug diversion,” the researchers found that an average of more than 30 tablets per resident were stolen, and 97.5% of them were controlled substances. The most common controlled substances stolen were opioids (94%), including oxycodone, hydrocodone, tramadol, hydromorphone and morphine. 

The study, published Monday in the Journal of Applied Gerontology, was the first to look at medication theft in long-term care settings, the authors said. The study identified the types of medications stolen, the number of victims, theft duration, types of employees stealing medications, reasons given for thefts, and the role of surveillance cameras in confirmation allegations.

“My hope is that the study will help raise awareness to this largely overlooked form of elder mistreatment and encourage meaningful action to prevent it in assisted living residences across the country,” Eilon Caspi, PhD, a gerontologist and dementia behavior specialist at the University of Connecticut, told McKnight’s Senior Living.

The majority of the tablets (85%) were stolen in assisted living, which had a higher number of victims (208 compared with 160 in nursing homes) and more medications stolen on average compared with nursing homes (130 tablets per assisted living resident compared with 52 tablets per nursing home resident). 

But the authors noted that there were almost twice as many assisted living beds compared with nursing homes beds in the state during the study period, 2013 to 2021. Minnesota had 1,206 registered assisted living residents and 372 licensed nursing homes in March 2017. The authors pointed out that the medication thefts identified in the study were substantiated in only a small subgroup of care settings in the state.

A single employee was identified as being responsible for medication thefts in 73% of cases, according to Minnesota public health authority reports examined by researchers, whereas the state assigned shared or sole responsibility for the thefts to the long-term care facility in 27% of cases. Surveillance camera footage provided evidence of theft in 26% of the reports, with most cameras in medication rooms or on carts.

The researchers concluded that more rigorous studies are necessary to examine whether assisted living residents are at higher risk of controlled substance theft compared with nursing home residents. Such findings, they said, could be used to develop policy and practice interventions. 

In comparing the settings, the investigators said that nursing homes have stronger regulations pertaining to controlled substance security, as well as stronger nurse staffing requirements. Assisted living communities on the other hand, they said, have a weaker integration of nursing and medical professionals, rely heavily on unlicensed staff and mostly are owned by for-profit businesses. 

“Centrally tracking these thefts in [assisted living communities and nursing homes] in all states and nationally could assist in efforts to identify their magnitude and generate insights for prevention,” the authors concluded. “Our hope is that the study will encourage researchers to examine [controlled substance] theft in [long-term care] homes, shed light on its prevalence risk and protective factors, healthcare costs, and develop and evaluate interventions to reduce it.”

In addition to long-term care trade associations and facility owners and administrators, the researchers called on lawmakers, regulatory agencies and law enforcement to increase and coordinate efforts to address drug theft and preserve residents’ rights to relief from pain.