5 Things to Know About Adult Family Home Medication Rules

When families move a loved one into an adult family home, they are often surprised by just how strict the medication rules are. Things that seem completely harmless at home, such as a medicated moisturizer, Vicks Vaporub, or even a herbal supplement, suddenly require a doctor’s order and a locked drawer or cabinet. It can feel like overkill at first.

Here's what's actually going on, and why these rules exist even when they seem excessive on the surface.

1. Almost everything counts as a "medication."

If your loved one has been managing their own routine at home, you're probably used to things like lotion, eye drops,  an antiviral cream for cold sores, or hydrocortisone for itchy skin just living on the bathroom counter or nightstand. In an adult family home, that changes.

Products like Amlactin, a common moisturizer used to help with dry or flaky skin, or Icy Hot for sore joints and muscles, all need a doctor's order (approval to use) before a resident can use them, even if they can apply on their own. The same goes for things that seem about as harmless as it gets, like artificial tears, saline nasal spray, or cough drops. If it's going into or onto the body, it falls under the same rules as a prescription medication.

2. The rules exist because the home is responsible for everything going into your loved one's body.

It's fair to wonder why a doctor needs to sign off on such common over the counter items. The honest answer is that some of these regulations go further than most people expect, even those who work in the field every day. But the reasoning behind them comes down to one thing: the adult family home is legally and medically responsible for your loved one's overall care, and that means the provider needs a complete picture of everything being used, just in case something goes wrong.

If a resident ends up needing hospital care, providers need to be able to tell medical staff exactly what's been used recently, on the body and in it. A daily aspirin that nobody mentioned, paired with a new blood thinner prescription, is the kind of small gap that can turn into a real medical problem. Same with some herbal supplements; these can interfere with prescription medications, therefore, it is important to know all that a person is using. Most adult family home residents need help remembering their own medications in the first place, which is part of why the home keeps such tight oversight on what's available to them.

3. Even approved products have to be locked up.

Getting a product approved by the doctor is only half the equation. Once it's allowed, it still has to be stored securely, usually in a locked bedside drawer or cabinet.

This holds true even in homes where every resident is bedbound and there's no real risk of anyone wandering off to find it. The rule isn't really about whether a particular resident might misuse something. It's about making sure no one else in the home, including staff, visitors, or other residents, can access medications or medicated products that aren't theirs.

A resident will have a key to their own locking drawer and may use the products they wish to use if approved by the MD and if the RN has assessed that they are safe to maintain these items and use them correctly. This then is documented in the care plan.

They may never use expired items, so at reasonable intervals staff may need to go through the items and remove items that are close to expiration,  or expired.  

4. Getting something approved is easy with the right doctor who understands the regulations that the AFH must operate under. 

If the resident uses the AFH’s visiting doctor or nurse practitioner, the process of approving personal use items is simple. The provider writes up a list what the resident wants to use, including the strength and frequency, and the doctor typically approves it if it looks safe. Home  Doctors deal with these regulations constantly, so they know exactly how an order needs to be written for it to work in an AFH setting.

If the resident has an outside doctor who isn't familiar with adult family home regulations, the same simple request can turn into a drawn-out back and forth. Even something as basic as approving Icy Hot or a cold sore treatment can take multiple faxes and a few follow-up calls before it's finally signed off.  Therefore, it’s another really good reason for using the Home Doctor that the AFH is already established with.

Have questions about what to expect when moving your loved one into an AFH? → I'm here to help.

5. Bring it up early, and make a plan together.

If you're touring homes or getting ready to move someone in, the best thing you can do is raise this topic before move-in day, not after.

Walk through your loved one's actual routine with the provider. If she likes to rub Blue-Emu on her knees, and she likes to apply this late at night before she sleeps, mention it. From there, the provider can get it approved by the doctor, set up secure storage she can access herself if she's able to, and document the whole plan so everyone, including you, is on the same page.

That care plan conversation is the piece that ties it all together. Adult family home providers are required to walk through it with the resident and family to confirm everyone agrees on what's being used and how. Elder care regulations in Washington are some of the strictest in the nation, and while that can feel frustrating in the moment, it's rooted in a real commitment to keeping residents safe.

You don’t have to figure this out alone.

Touring adult family homes and want to understand what to expect before you move your loved one in? I'm happy to walk you through it.