Taking prescribed medicine seems like a no-brainer. The instructions are right on the packaging and you create a habit of taking it at the same time every day- perhaps with a meal. That certainly is manageable for someone who takes one pill daily and needs no reminders. But add multiple prescriptions medications, taken at different times of the day and add cognitive impairment to the mix, and you can understand how this can be a very complicated problem to resolve for older adults.
In my current Ask Nancy column ,Laura S of Miami, FL expressed her frustration at trying to manage her mother’s multiple medicines saying it was turning into a full time job. My first piece of advice involved working with her mother’s physician to see if her long list of medications could be simplified. Dr. Marie Savard offered some wise guidance on how to do this and I encourage you to read what she has to say. The second recommendation involves creating a sustainable daily routine and that’s what I want to delve into here.
Laura’s mother has 24/7 care, implying that her caregivers work in shifts. Whether it’s professional aids or family caregivers rotating shifts, do whatever you can to encourage consistent, quality communications. Maintaining a medication log can serve as a reminder to helpers so that medications are taken on schedule.
I'm also a fan of large white board, where notes can be kept for all to see. They can be purchased at an office supply store, or on Amazon ( I've also seen special paint called Escreo White Whiteboard Paint that converts the wall into a space where you can easily write and erase right on the wall). Using simple descriptions on the board to positively portray what each medicine is for will often help the caregiver and your mother as well. For example, instead of saying “water pill” say “pill to prevent heart failure or hospitalizations.” Link the medications to what your mother or parent cares about and wants most.
Medications should be organized so that the caregivers can dispense them accurately. In Florida, and most states, paid caregivers from agencies are not permitted to physically give medications. They are licensed solely to provide reminders and place a prepackaged pill in front of the patient.
Thus, in order for the caregivers to dispense the medication they must be stored in a way that they can assist your mother in taking them without physically touching them. (Some agencies can send a nurse to complete this task as well as be responsible for refilling the prescriptions).
There’s always the multi-compartment pill storage box, which come in all sizes and can be filled weekly and placed in a protected area. It’s an inexpensive and simple solution. But there’s a downside if the patient is cognitively impaired. If the pill box is left on a table, patients often play with the medications and re-sort them based on color, size, or shape. Some patients will discard all of them fearing they are causing troubling side effects.
What’s worth trying is a service such as Pill Pack, an online pharmacy that organizes and pre-packages medications by the time and day that they should be taken. Pill Pack accepts most insurances . Many independent local pharmacies and some CVS, Rite Aid, Target, and Walgreens offer similar services for complicated drug schedules. Check your local pharmacy to see if they offer this type of service.
Medication management Apps is another solution to research and there are many to choose from. Some such as Carezone, are better for patients who are cognitively impaired, and others such as Medisafe are better for independent people, who want to create their own medication reminders. They work well once you input all the appropriate information. I like this additional level of reminder because caregivers are busy all day long, and relying on their memory for this can result in an important medicine getting missed. To learn more about the pros and cons of each, I suggest you start with this review by Tech Enhanced Life.
Finally, consider an in-home medication dispenser that works in conjunction with a phone APP. You enter the name of the medication and the schedule in an APP and the dispenser provides a cartridge for you to fill with pills, which are then inserted into the appliance. Medications are dispensed into a cup for easy use for the caregivers. Most in-home dispensers can store up to 10 medications for one month and some companies can refill prescriptions as an additional service. Examples of these are Hero Health and Pillo Health .
Medicine dispensers can be pricey -- I’ve seen them cost as much as $500 in addition to monthly fees. But if you’re a family caregiver with a full-time job and a busy family life, they offer advantages that you may consider worth the expense.
For more information on medication management I encourage you to visit Dr. Marie Savard's website, Ask Dr Marie: Treat What Matters, where you can learn more about medication management, and follow her blog.