I have POA for a friend who has advanced Alzheimer’s and has no living relatives. He asked me to help him long before he was gone mentally. I’ve witnessed memory care facilities use drugs on him to make him compliant and wonder if I have the right to say NO to specific drugs for him. I understand the facility’s concerns and liability issues for other residents safety but there’s other alternatives to immediately throwing serious antipsychotics at him. Can a doctor go around me and work with the facility directly and give him drugs that I don’t approve of. Where do my rights as POA stop? I do my best to research and understand the doctors recommendations but if I don’t agree with the dosage or with giving the facility PRN with drugs, do they have to abide by my wishes (which I know are also his)? I appreciate any input or suggestion of where to turn. A couple different attorneys have told me the laws in this situation are gray and suggested I talk to knowledgeable people in the medical field. Those I’ve talked with in medical field (including the Alzheimer’s org) suggested I talk to an attorney. :)
This is especially true for hospice patients which allows staff to do something like place a urinary catheter which usually needs a Dr's order. They are also allowed to use the medications where provided in a hospice comfort kit. This kit contains a very limited supply, just a few doses and further supplies have to be prescribed. It allows the RN to have immediate access to a medication when a patient develops severe pain or continuous vomiting.
I do not know if such standing orders exist in residential institutions.
As far as antipsychotic medications are concerned has anyone considered what happened in so called "lunatic asylums" before the invention of these drugs.
Psychiatriic hospitals are a very different place these days thanks to modern science as are all branches of medicine and many people who formally were confined can live productive lives these days in the community and hold responsible jobs
Everyone needs to be vigilant about their loved one's care, but try and look at both sides of the picture.
If you refuse medications and your loved one is uncontrolable and the facility discharges him are you prepared to control the behaviors at home without meds?
It is not enough to hide the knives, he could pick up that heavy lamp and hit you over the head, push you into the fire, set the house on fire. How about getting the garage and cutting off this feet with the lawn mower or maybe warming the cat up in the microwave when you thought he was heating water for tea.
There is no end to the things that someone with a damaged minds can do.
If you indeed have a medical directive POA, you should at least be included in the loop. I also found out after the fact (when the BILL came) that they ordered a mild anti-anxiety med for our mother when she moved into the MC unit. I was okay with the decision to do this, but I was not pleased for several reasons: 1) I was not consulted and 2) her insurance uses a specific pharmacy, which limits or eliminates copays! I inquired about this before committing to the place and they were okay with me continuing to manage her medications (BP only.)
I had to make a ruckus, because they also ordered her BP meds through this place, at ridiculous cost! Sorry guys, I provided a 90+ day supply when she moved in - what did you need to order that for right away?!?!?!? I had them send it back, but we still ended up having to pay a 'restocking fee'. After several phone calls to find out what the residual charge was for, and asking several times that they ensure NO orders are filled via them unless they talk to me, I finally sent the payment with a letter telling them I have advised the doctor's office, MC staff AND you to NOT fill any prescriptions and if you do so, I will NOT pay a dime, not even the restocking fee. Their cost for presumably one month was ridiculous, I want to say it was at least $150, whereas mom's plan now provides 3 generics at $3 each for 90 days! We would go broke just paying for medications with this other place!!!
That said, Alz org and attorneys do not have the facts and details. You will have to inquire with the nursing staff, and perhaps even better the doctor who ordered the prescription(s) as to what they are and what they are needed for. Once you have that information, you can better weigh the pros and cons.
As others have said, if these medications calm him down, preferably without making him semi-comatose, they might be in everyone's best interest. I am a proponent of less drugs being better, but if he is unruly, a hazard to himself or others, including staff, residents and visitors, they are likely a necessity. When residents are too unruly and cannot be "redirected" easily, you might find yourself in a situation where they will ask you to move him to another facility. THAT would be unfortunate. It is hard enough to find a decent place with available space and it is hard on the resident to have to move. I do know at least one resident where our mother is had to move (unclear if it was staff directed or spouse) - I believe he had fronto-temporal and was not easy to work with.
If you feel the medications are too strong, perhaps you can work with the staff and/or doctor to reduce dosage or try a change in medications.
My mom was kicked out because of behaviors that no combo of meds would help. Sometimes we, as caregivers, need to be more compliant.
Also keep in mind that the agitation is also very difficult for the patient. Delusions and hallucinations are difficult for the patient. Sometimes medication is for the patient's good.
If that doctor says the drugs are NOT necessary then you could have a law suit, if they continue to give them to him.
Yes, some workers in these facilities will over medicate to keep the patient compliant, whether or not the patient is violent or hurting himself. This should be uncovered and stopped, if it is happening.
However, it might be that he is aggressive and may either hurt himself or others, unless medicated.
I am a speech therapist that has worked in nursing homes for 20+ years. I have never seen nursing just “throw” psychotropic drugs at a patient just because they are a little difficult. I have heard patients screaming through a shower, refusing to let anyone bathe, dress or direct them. I have seen patients strike out physically at staff that are just trying to change their sheets.
I suggest you take some time and go spend the afternoon and evening with your charge and observe what is happening.
Nursing staff is not allowed to stop or start any medication without notifying the healthcare POA. However, they can refuse to keep caring for him if he is endangering himself or others and you refuse something that might help him. They do have some facilities that are for very aggressive patients, but they have lots of oversight with medications used for behavioral management. Well, all SNF’s have oversight for medications.
I am curious as to alternatives that you would like to try. It may be they would try them also.
It is a very difficult responsibility that you take on out of love and caring. None of it is black or white. And each person has their own unique situations. Comparing them is like comparing apples to zebras.
This is no responsibility for the faint of heart.
However, if they are medicating him to keep him compliant - what will be the ultimate outcome if he is not longer compliant? Will the facility put him out as too hard to handle?
It's definitely time to speak with the Administration and possibly an Elder Attorney.
If you have healthcare POA, then I think it is worth having a conversation with his doctor or neurologist and discussing the pros and cons of the medications. You need to fully understand the consequences of him taking or not taking the medication. Could he stay where he is if his behaviour is not under control? Is he a risk to himself, staff or other residents?
His wishes were made when he was of sound mind. His mind is not sound now. Would he have wanted to put other people at risk when he was of sound mind?
You mention alternatives, have you fully explored them with the MC and doctors? They may have tried them in the past with other residents and found them lacking, or they may be willing to try something new.
You are in a tough position.