How Do Medication Aides Affect Care Quality?

Several states have allowed skilled nursing facilities (SNFs) to hire medication aides to administer medications to residents. Medication aides have less formal training than registered nurses (RNs) or licensed practical nurses (LPNs), and some observers have voiced concern that the use of medication aides would lead SNFs to employ fewer RNs and LPNs, reducing quality of care for residents. A study in the Gerontologist examined medication aide use, RN/LPN staffing, health outcomes, and other quality of care measures among SNFs in eight US states, three of which allowed medication aides and five of which did not, between the years 2004 and 2010.

The authors looked at reported staffing levels and inspection reports available in eight states in the southeastern United States. States in which medication aides were allowed did not see any decreases in overall staffing, and saw decreases in pharmacy deficiencies and medication error rates, and no significant changes in resident health outcomes. The authors hypothesize that medication aides may allow licensed nurses to devote more effort to other crucial care and supervisory tasks that could improve quality of care.

While overall number of staff did not decrease when medication aides were introduced, there was a decrease in the staffing level of non-medication aides. The use of medication aides was associated with a greater need among residents for help with activities of daily living and increased incontinence, but did not otherwise appear to affect care quality.

The authors acknowledge that the study’s findings may not be generalizable to other regions or other periods of time. While efforts were made to consider relevant variables, the possibility cannot be ruled out that other changes to policy, standards, or patient and workforce population would influence these outcomes. Further, while the study examined data collected over a period of six years, it remains to be seen how an increased prevalence of medication aides might affect the larger workforce. For instance, a shift toward lower-skill and lower-cost direct care staff may discourage skilled individuals from entering the SNF workforce, decreasing care quality over a longer span of time than reflected in the study. Despite such caveats, the findings suggest that the use of medication aides may not lead to a reduction in RN or LPN use, and may enhance the quality of medication administration, particularly if accompanied with sustained levels of RNs and LPNs.


Walsh JE, Lane SJ, and Troyer JL. Impact of medication aide use on skilled nursing facility quality. The Gerontologist. (2013). DOI: 10.1093/geront/gnt085

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