Impact of medication aide use on skilled nursing facility quality.

PURPOSE OF THE STUDY A number of states have begun to allow skilled nursing facilities to employ medication aides, who have less formal education than registered nurses (RNs) or licensed practical nurses (LPNs), to administer medications. If this results in fewer RNs or LPNs, quality degradation may occur. We evaluated the effect of regulations allowing for medication aides on subsequent medication aide use and the effect of changes in medication aide use on other nurse staffing, deficiencies, and Nursing Home Quality Initiative (NHQI) health outcome measures. DESIGN AND METHODS Staffing levels and inspection deficiencies from the Online Survey and Certification and Reporting System and NHQI data from 2004 to 2010 for facilities from eight southeastern U.S. states are used in instrumental variables models with facility fixed effects. RESULTS Facilities in states allowing for medication aide use increased medication aide use with no statistically significant reduction in RN or LPN use. Medication aide use decreased the probability that a facility received a deficiency citation for unnecessary drug use or having a medication error rate greater than or equal to 5% and had no effect on deficiencies for significant or harmful medication errors. Increased medication aide use was associated with fewer pharmacy and total deficiency citations and decreased use of physical restraints; in contrast, more use of medication aides was associated with an increase in the percentage of residents needing help with activities of daily living and losing continence. IMPLICATIONS This study provides support for state policies that allow skilled nursing facilities to use medication aides.