A growing body of literature documents multiple morbidities and multiple medication use among older people with intellectual disabilities. In Ireland in 2012, 8.6% of all medication-related adverse events were reported from the disability sector. To determine the level of medication use in a long term care centre that was home to 129 older people, the on-site pharmacist performed a base line audit. Results showed that 31,614 oral solid form medications (tablets/capsules) were administered in 28 days with an average of 1,129 administered per day. There was also widespread use of other medication forms, such as liquids, patches and eye drops. Although medication administration may seem to be a ‘simple’ nursing task, the combination of multiple medication use and medical complexity in this population means that it is often more complicated than fully realised by the staff involved in the process. Pharmacists who serve older people who have intellectual disabilities need to be aware of, and sensitive to, the unique medication needs and vulnerabilities of this population. Medication use is a major therapeutic intervention in this population and it is important that all nursing, medical and pharmacy personnel, service provider management and policy makers are aware of the complexity of the medication use process.