For an industry called “long-term care”, there has been a dramatic change in the level of practice which occurs within its walls. There have been waves of change mixed with rapid evolution over the past decade alone. Higher patient turnover dictates the staff to work harder and faster. These changes bring on new pressures. Efficiency of existing processes must be scrutinized. Medication management has grown to the point of becoming a burden on staff. The decrease in the patient to nurse ratio can be directly correlated alone to the number of medications prescribed per patient. Unfortunately or perhaps criminally, the rewrite of F329 did not bring with it increased MediCaid funding to the facilities for the much needed increase in time for more pharmacist involvement.