A friend of mine is a marketing manager in a massive facility that has an assisted and individual living center (apartments), and a nursing home. The place is massive, and the residents are across the spectrum as far as their daily needs are concerned. We had been taking one afternoon and we became embroiled about the pain management needs of residents in assisted living and long-term care. Before, people and facility staff used to be mortified at the idea of dispensing pain medication for fear residents would become dependent on the medication. However, as we discussed the matter, we determined there was a shift in the paradigm, and now facilities and pain management specialists are more accepting of the pain medication allocations. This is partially because as a person grows older pain can often times become chronic and sometimes debilitating. The new motto in the field appears to be “get under control quickly and keep under control.”

This new philosophy on pain management has reaped benefits such as a reduction in depression among geriatric clients, as well as the “non-will to live” in many patients. While I have not snuffed out the latest in empirical research on this as of yet, I think the correlation is a safe bet at a minimum. Having worked in facilities, I have personally witnessed the change from a person in absolute agony to one that has a manageable pain level. Activity levels, mood, attitude, and appetite increase in residents and patients that have manageable pain levels. Having happier, less pain-afflicted residents make your facility run more smoothly, increase staff tolerance, and reduces cost.

This is NOT to say that I am abdicating facility directors and nursing staff to run amuck through the facility with pills in PEZ dispensers. I am saying however that facility directors should be made aware of new computerized med dispensers (otherwise known as EMMA – Electronic Medication Management System Available) that are being used at many facilities around the country. Created by Mary Anne Papp, DO, director of the heart failure program at the Medical College of Wisconsin in Milwaukee, this dispenser adjusts dosages and dispenses prescription drugs automatically. Under the care of physicians and pharmacists, they can be utilized in an assisted living setting as well as nursing homes. The intention of EMMA was to aid aging patients, those with severe brain injuries, and persons that have complicated medication regimens. In a nutshell, EMMA works like this. There is a two-way communication software built into EMMA which allows for remote monitoring by health care professionals to ensure that the patient is adhering to their given regimen. The monitoring individual can change doses, and the patients or residents are made aware to take their medication by a series of vibrations and beeping noises from a wristlet worn on the arm. The screen on EMMA also flashes and is equipped with a touch screen so that even elderly patients can get their required medication in just a few touches to the screen. Even more cool, each wristlet has a special code that can allow access by another doctor (like the ER), to make on the spot determinations (via a secure website) for healthcare in case of an emergency. It also provides, according to Dr. Papp, “a true record of medications.” Now, these are not inexpensive machines, and for a facility that just cannot absorb this cost yet, there are other alternatives – alternatives that have been used for some time. Many facilities use improved application measures such as utilizing patches and creams that dose gradually so that the pain is mitigated more efficiently. Others include having non-cognitive patients utilizing the “Weber’s test” to signify pain levels in order to more effectively communicate with their caretakers. Another is having medications accessible on site, and then having the medications then back filled by the pharmacy.

Pain management will always be a challenge in the nursing field with the elderly population. The cost of utilizing something like EMMA can be expensive up front, but it will reduce costs and lighten the workload of staff, and allows for a more detailed monitoring of medication consumption and adherence, which in and of itself can save thousands of dollars a year for facilities and patients alike.

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