In-Home Care and Medication Review Keeps Patients Safe

In this episode, host Erin Albert, PharmD, JD, DASPL, chief of pharmacy relations, network, and professional affairs at Mark Cuban Cost Plus Drugs, interviews Hedva Barenholtz Levy, PharmD, BCPS, BCGP, director of HbL PharmaConsulting, about the role of in-home senior care pharmacy and medication reviews for older adults who want to safely age in place.

Levy, based in St. Louis, Missouri, has provided in-home medication review services since the late 1990s. She explains how visiting patients in their homes—sitting at the kitchen table, seeing how and where medications are stored, and understanding the daily routine—reveals barriers to safe medication use that are invisible in traditional clinic or pharmacy settings.

They focus on identifying and resolving medication-related problems (MRPs) using classic pharmaceutical care frameworks such as Hepler and Strand’s categories and tools like the Beers Criteria and STOPP for potentially inappropriate medications in older adults.

Levy discusses common MRPs she encounters, such as inappropriate drug selection, doses that are too high or too low, polypharmacy, adverse effects contributing to falls, cognitive decline, and poor adherence driven by confusion, lack of clear schedules, or not understanding why a medication was prescribed.

Furthermore, she outlines how she triages MRPs by starting with what matters most to the patient, then layering on clinical safety and effectiveness priorities. Levy also shares how she tailors communication to different levels of health literacy and cognitive capacity and how she involves family caregivers while still centering the older adult.

“There's not a patient with whom I would speak and not find multiple issues to help educate them on, be it nonprescription or prescription medication use, and ways to optimize that drug therapy,” Levy said. “Where there's a will, there's a way, and pharmacists are making it work as far as reimbursement, and we need to fill this need and be out there in the community setting.”

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