Understanding Medications Within RCFEs

Morphine is typically prescribed to individuals experiencing chronic or severe pain or those who are terminally ill.   In assisted living facilities, residents prescribed morphine are most often times receiving hospice services.  The intended use of morphine at the end-of-life is to maintain an appropriate level of comfort for the resident. 

Morphine can be administered in many forms.  The same rules that apply to administering other medications in the assisted living setting, apply to morphine.  Most notable is the requirement that residents must be able to self-administer medications or, if unable, medications must be administered by a skilled medical professional only.  For terminally ill residents, self-administration is often times not an option and, as pain can be unpredictable, the absence of an on-site skilled medical professional presents a challenge.  (Hospice nurses do visit residents, but are not available at the facility 24/7 to meet unscheduled needs.)

To address this, Title 22 (§ 87633) allows family members or friends (NOT receiving monetary or any other form of compensation for their services) to administer medications (including morphine) to hospice residents who are unable to self-administer, as long as the following criteria are met:

  • It is written in the hospice care plan.
  • The family  members have been trained by the hospice agency in proper administration.
  • It is recorded in the plan,  that if the family or friend is not available and/or fails to arrive at the appointed time, that a licensed health professional will be made available to attend to the residents needs and administer the medication.

A few other notes on morphine/medications:

Morphine pumps are permissible if:

  • The facility has received a Hospice Care Waiver

  • The hospice resident, hospice health care professional, or other appropriately skilled professional is administering the medication

  • The procedure is specified in the Hospice Care Plan

For medications that need to be pre-drawn into an individual syringe or oral dosing unit, the following shall apply:

  • Only a registered nurse may pre-draw the medication for later administration
  • The pre-drawn medication in the individual syringe or oral dosing unit must be labeled and properly stored
  • Medications may be set up in advance for a period not to exceed 24 hours

When administering lethal medications such as morphine, residents should be closely monitored.  More information about hospice care and morphine may be found here.  

Notes in italics represent the views and/or experience of CARR regarding this topic and/or regulation. 

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