Taking Residents Off Drugs They No Longer Need: The Quiet Work at Michal Voldiner's Pharmacy

The most useful thing a pharmacist can say about a resident’s medications is often that one of them should stop.

That cuts against the instinct most people have about medicine, where the answer to a new symptom is usually another prescription. In long-term care, where residents are older and often managing several chronic conditions at once, a medication list tends to grow on its own over the years. Every new addition gets reviewed. Far fewer people ever go back to ask whether the older entries still belong. At Michal Voldiner’s long-term care pharmacy, Ultimate Care RX, that second question is treated as part of the work.

Why Long-Term Care Residents End Up on Long Medication Lists

Older adults take prescription medications more often than any other age group in the country, according to the American Geriatrics Society.

Each drug is usually prescribed for a sound reason, often by a different provider, at a different point in a person’s history. The trouble is cumulative. Polypharmacy (the routine use of five or more medications, a common working definition in geriatrics) raises the odds of a drug interaction, a duplicate therapy, or a side effect that gets mistaken for a new problem and treated with yet another drug. The regimens that legitimately treat a resident’s conditions are the same regimens that quietly raise the floor for harm.

That risk is well documented. Adverse events are common in skilled nursing settings, and adverse drug events are the most frequent kind, per AHRQ’s patient-safety review of long-term care. The encouraging half of the same federal finding: physician reviewers judged about half of those events preventable. That puts the weight on process. The goal is to catch the problem before it reaches the resident.

What a Medication Review Actually Looks For

Every resident’s regimen is reviewed, and the value lies in how rigorously it is done. A pharmacist checks the dosing, screens for drug interactions and duplicate therapies, watches for medications that conflict with a resident’s other conditions, and flags anything that looks like it has outlived its purpose. As Voldiner puts it, the point is to “catch those issues before they ever reach the resident.”

The standard tool for the flagging part is the AGS Beers Criteria, updated in 2023, an evidence-graded list of medications that are potentially inappropriate for older adults. It sorts higher-risk prescribing into categories: drugs to avoid in most older adults, drugs that clash with certain conditions, drugs to use with caution, combinations that interact badly, and medications that need dose adjustment based on kidney function. The criteria trace back to 1991, when a UCLA geriatrician built the first version specifically to evaluate medication use in nursing home residents.

A Beers flag doesn’t make the decision on its own. The American Geriatrics Society is explicit that the list is a starting point, meant to be used alongside deprescribing resources and a clinician’s judgment rather than as a rule that overrides them. A flag is a prompt to ask a question. The pharmacist and the prescriber still have to make the call.

How Deprescribing Protects Residents at Michal Voldiner’s Pharmacy

When a review turns up a drug that no longer fits, the next step is deprescribing: the planned, supervised reduction or stopping of a medication that may be doing more harm than good.

It’s slow and unglamorous. It happens in conversations with the prescriber, not in a single dramatic moment, and it rarely registers as an event the way a new diagnosis does. The evidence supports the work without overselling it. Pharmacist-led medication reviews reliably reduce inappropriate medication use and improve the overall appropriateness of a resident’s regimen; the effect on harder outcomes like hospital readmissions is promising but still uneven across the research. The honest case rests on the first part, and it is enough: fewer inappropriate medications mean fewer of the interactions and side effects that send older residents to the hospital.

This is where a pharmacy that knows its residents does some of its most important work. Voldiner’s pharmacists get on the phone with providers when an order doesn’t look right. They explain the clinical reasoning and propose an alternative instead of simply filling what was written. None of it is visible to a resident or a family the way a new prescription is. A drug quietly comes off the list, and the resident is a little safer for it.

For Michal Voldiner, that quiet recommendation to stop a drug is the part of long-term care pharmacy she’d defend hardest and the part almost no one sees, made carefully on behalf of a resident who can least afford a medication that has stopped helping.