Medication Management in Long-Term Care: Data, Staffing, and Real-World Impact

Medication management in long-term care is more than a checklist—it’s a high-stakes responsibility that affects lives, safety, and the future of care. In this episode, we break down the latest research, legal trends, and real-world stories to help you understand what’s at stake and what needs to change.

Who Is Abt Associates and Why Did CMS Choose Them?

Abt Associates is a global research and consulting firm specializing in evidence-based solutions for health, social, and economic challenges. Their proven track record in healthcare systems and long-term care led the Centers for Medicare & Medicaid Services (CMS) to select them for critical research. Over this collaboration, Abt submitted three major reports, culminating in the 2024 Nursing Home Staffing Study, a cornerstone for current policy decisions.
https://www.abtassociates.com | https://www.cms.gov
Links are for informational purposes only; no endorsement is implied.

Why Is the 2024 Abt Associates Nursing Home Staffing Study Important?

Abt’s comprehensive data and analysis revealed:

• Structural Failures: Weaknesses in staffing models and operational practices.
• Alarming Outcomes: Safety risks and quality-of-care concerns tied to inadequate staffing.
• Transparency: Their research uncovered what was “behind the curtain,” giving policymakers and stakeholders a clearer picture of the challenges.

Key Findings: Staffing Ratios—Abt vs. CMS

HPRD = Hours Per Resident Day
Source: Abt Associates & CMS Final Rule 2024

The Role of LPNs/LVNs

LPNs/LVNs are most commonly found in long-term care settings, providing essential hands-on care and medication administration. RNs often serve in leadership roles, overseeing clinical operations and ensuring compliance.
CMS states:

“We are not setting a minimum staffing standard for LPNs/LVNs.”
LPNs/LVNs can be used to meet the remaining 0.48 HPRD beyond RN and nurse aide requirements.

Beyond the Numbers: The Human Side

Inside every long-term care setting are the hands, hearts, and minds of those providing care. It’s time to look at data from a new perspective—one that optimizes safety for everyone. Nurses, LPNs/LVNs, RNs, and Medication Technicians: let’s unite to identify what works, spark change, and share best practices.

Medication Management: Real-World Observations

• Pre-Preparing Medications:
  During site visits to 31 nursing homes, Abt researchers observed licensed nurses often pre-preparing medications—organizing doses ahead of scheduled times. While this saves time in understaffed environments, it raises safety and compliance concerns.
• Workarounds:
  Nurses reported pre-prepping was sometimes necessary to manage large caseloads and time pressure, especially during peak medication pass times. These workarounds are a direct result of staffing shortages and unrealistic expectations.

Time-Consuming Clinical Care Tasks

Licensed nurses perform multiple time-consuming tasks during medication passes, including:

• Medication administration
• Resident assessment
• Monitoring for adverse reactions
• Documentation and communication
  These often overlap with vital sign checks, especially for high-risk medications (anticoagulants, insulin, opioids), making the process more complex and time-intensive.

The Hidden Workload: Indirect Care

Nurses also handle indirect care tasks—care planning, nutritional planning, coordinating with doctors, managing appointments, updating documentation, and communicating with families and vendors. These responsibilities, often away from the bedside, are essential for resident safety. The true workload—and its impact on medication management—may be underestimated.

The Daily Struggle on the Front Lines

Nurses and medication aides in assisted living and memory care facilities face immense challenges:

• Managing 25+ residents per shift
• Overseeing nurse aides
• Documenting care under time pressure
• Rushing through medication passes to meet regulatory demands
• Evaluating changes in conditions with timely follow-up
  These pressures, compounded by unattainable staffing regulations and chronic shortages, force nurses to make difficult choices and increase the risk of errors.

The Scope of the Problem: Legal Risks and Real-World Cases

• 800,000 preventable medication-related injuries occur annually in U.S. long-term care facilities.
• Lawsuits for medication errors often cite negligence, inadequate staffing, poor training, or failure to follow protocols. 
  • Case 1: LPN responsible for 28 residents, morphine overdose, $390,000 settlement, loss of license.
  • Case 2: Missed diabetes medication doses, hospitalization, $2.34 million verdict.
  • Case 3: Missed chemotherapy dose, fatal complications, $7.6 million settlement.
  • Case 4: Wrong medication administered, resident death, $390,000+ settlement.
  • Case 5: Medication transcribed onto the wrong resident’s chart, wrong resident received medication.

What Needs to Change?

Medication management is a complex, high-stakes responsibility. When the system fails to support nurses and administrators, the consequences are not just numbers—they’re lives. Let’s work together to drive transparency, advocate for realistic standards, and transform care for everyone.

If you’re a nurse or administrator, what changes have worked for you to prevent errors? Share your stories in the comments or connect with us!

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References & Credits

• References
• Abt Associates. (2023). Nursing home staffing study – Comprehensive report. https://www.abtassociates.com/insights/publications/report/nursing-home-staffing-study-comprehensive-report
• BMJ Quality & Safety. (2019). Medication errors in nursing homes: A systematic review, 28(2), 103–110. https://qualitysafety.bmj.com/content/28/2/103
• Centers for Medicare & Medicaid Services. (n.d.). State operations manual, Appendix PP – Guidance to surveyors for long term care facilities. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf
• Nursing Home Abuse Center. (n.d.). Medication errors in nursing homes. https://www.nursinghomeabusecenter.com
• Office of Inspector General, U.S. Department of Health and Human Services. (2014). Adverse events in skilled nursing facilities: National incidence among Medicare beneficiaries (OEI-06-11-00370). https://oig.hhs.gov/oei/reports/oei-06-11-00370.pdf
• Rosewood Nursing. (n.d.). Legal cases and verdicts. https://rosewood-nursing.com
• Skilled Nursing News. (n.d.). Recent litigation and staffing challenges. https://skillednursingnews.com
• Agency for Healthcare Research and Quality. (n.d.). Medication reconciliation. https://psnet.ahrq.gov/primer/medication-reconciliation
• AI Tools: Copilot (script assistance- errors may occur),  
• Artlist AI (image generation), 
• Runway ML (animation),       
• Canva (design).
• Research Sources: CMS, ABT Associates, BMJ Quality & Safety, AHRQ.
• Ethical Use: AI applied for creative support; all outputs reviewed for accuracy.