ST. PAUL — Swapping oxycontin for Tylenol, forging paperwork, stashing bubble packs inside a waistband — these are some of the ways at least 5,917 pills were stolen from residents of assisted living facilities in Minnesota.

The majority of the drugs taken were narcotics, like opioids, used to treat pain, said Eilon Caspi, a University of Minnesota School of Nursing research associate, who studied five years of state reports of confirmed drug thefts between March 2013 and September 2018.

“You are depriving residents of their right to remain free from pain,” Caspi said. “Elders who are frail and vulnerable have the right to remain safe and have their personal belongings, including their medicine, protected.”

Drug theft is another example of crimes against seniors and vulnerable adults that is both underreported and not adequately investigated, said Caspi, a member of Elder Voice Advocates. Caspi recently reported similar findings concerning financial exploitation.

In the 51 substantiated reports Caspi reviewed, 131 residents of assisted living facilities were victimized with the average person losing 45 doses of medicine. A thief was caught on camera in a quarter of those incidents.

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Patti Cullen, president of Care Providers of Minnesota, acknowledged that drug theft is an ongoing problem in the assisted living industry. Providers are always working to stay one step ahead of the ever-evolving ways people steal medication, she said.

“Every year there is a new and creative way for someone to steal drugs,” Cullen said. “It’s almost like chasing a turning wheel.”

In August, leaders of Minnesota assisted living facilities will gather at the Wilder Center in St. Paul to learn new ways to prevent medication theft in long-term care. Industry officials also routinely review reports similar to those Caspi investigated to better understand the changing ways drugs are taken.

“Each time there is an occurrence, you need to ask yourself: Is there more we need to be doing?” Cullen said.

Investigative challenges

Advocates say drug thefts, like other types of abuse against seniors and vulnerable adults, can be challenging to investigate.

Jennifer Segal, a registered nurse who has worked in numerous long-term care settings, says that’s because, unlike a hospital or nursing home, there are unlicensed workers at assisted living facilities that have easy access to patients’ medicines.

While doctors, nurses and pharmacists have to administer drugs, aids and other workers often come into contact with medicines in clients rooms or in other parts of assisted living facilities.

“I think it is way underreported,” Segal said. “Especially (with) in-home care and assisted living, because it is so easy to do.”

Assisted living facilities need to have strong safeguards in place in order to protect seniors’ medications, said Lindsey Krueger, director of the state Office of Health Facility Complaints. Without those protections, uncovering and prosecuting thefts is tough.

“It can be difficult if the (suspected) individual denies the allegations and there are multiple people with access to the medication,” Krueger said. “Then we look at the facility’s policies and procedures. We may not be able to hold an individual responsible, but if we feel there are insufficient policies and procedures we can hold a facility responsible.”

Segal says the increasing presence of video cameras, throughout assisted living facilities and in residents’ rooms, is making gathering evidence easier and should help cut back on thefts.

“Otherwise, where’s the proof?” she said. “I’m very pro-video monitoring. It’s much safer for me.”

Cullen, from Care Providers of Minnesota, says many facilities are looking more closely at how technology can help them prevent thefts and better prosecute those that do occur. In addition to cameras, facilities are considering machines that dispense medications, like those used in nursing homes and hospitals.

Increased focus

Until 2014, the Minnesota Department of Health classified the theft of medicine from seniors — what the state calls “drug diversion” — as a form of financial exploitation. That essentially treated stealing drugs like the theft of cash, jewelry or credit cards.

Krueger says the state changed its classification as the opioid crisis grew and the theft of drugs from seniors became a growing problem.

“(Now) we have data for future prevention and provide that information to providers and consumers,” she said.

In 2018, state investigators were able to substantiate 71% of allegations of drug thefts. Another 24% of the investigations were inconclusive.

That’s an improvement from the reports University of Minnesota researcher Caspi examined. He cautioned the data had limitations, but says about 57% of allegations between 2015 and 2018 were proven and 32% were inconclusive.

Sean Burke, the policy director for Elder Justice Minnesota, says it is important to remember that drug thefts are not just depriving patients of their medicines; they can have serious medical implications. He noted how several confirmed theft reports involved switching out pain medications with other types of pills.

“That’s not just financial exploitation, that’s maltreatment,” he said.

Burke noted that advocates plan to push state lawmakers to update the state’s Vulnerable Adults Act, on the books since 1980. He says rules around drug safety and how drug thefts are prevented, investigated and prosecuted should be reviewed and possibly updated.

Changes in the law

New protections are already on the way. In May, the Legislature passed a widespread reform of rules governing assisted living facilities. Those include licensing facilities for the first time beginning in 2020 and allowing residents to put cameras in their rooms.

These changes were driven by the revelation in 2016 that few complaints of abuse, neglect and other types of maltreatment were properly investigated. A root cause of that failure was found to be dysfunction at the state agencies responsible for oversight.

State health officials say the new licensing law will give a “cleaner, more efficient accountability” system for assisted living facilities. That includes investigating drug thefts.

Krueger says friends and families of residents can also play a role in protecting their loved ones. She says complaints of pain or missing medication should be taken very seriously, especially from residents who may suffer from memory problems or other cognitive issues.

People who want to steal drugs will “focus and gravitate toward” residents they don’t think will be able to adequately report a theft.