MC added Antidepressants and psychotropic meds broke arm

MTonya

I had to place my mom in a MC unit. I did all my research a 5 star facility on medicare.com. 

The Facility that she was placed in put her on medication without notifying me. She was already on buspirone 15 mg twice a day and Trazodone 100 mg at night. January 4 they added depakote 250 mg twice a day and Lexapro 5 mg twice a day. 

The end of January I started noticing her having tremors.

February 2 she started needing breathing treatments also on the second I was notified that she was having swelling in her feet, it was around 10 AM. Around 7:30 PM I was called because she fell and was sent to the emergency room and broke her arm.  

Since breaking her arm she’s become depressed and incontinent. 

All these symptoms including the breathing treatment are found on the FDA’s website under adverse side effects from this medication.  

I found out about the medication when I took her to get the cast removed from her arm. When I return to the facility I told them to remove her from the medication and was a little confused why I wasn’t notified. I was a bit upset.  I got a call from the social worker at MC telling me I did not have a PhD and was hindering my mothers care 

I have a care meeting this afternoon..Not really sure what to do or what is going to happen

jfkoc

I did a check on the interactions;

https://www.drugs.com/interactions-check.php?drug_list=441-0,2228-0,918-484,1013-565

You can check the side effects individually. I know Lexapro is known to have a paradoxical effect on some.

I would want to know who made the addition, why the lexapro was added and what is the procedure for drugs being added.

 

King Boo

5 star Medicare ratings don't mean the facility is appropriate for your LO.

The data they use is very self reported by the facility and not verified.  For example : their staff ratio.

We received mediocre care from a 5 star facility, and excellent care from a 3 star.

However, if a facility is a 1 star and on their 'watch' list, stay away.

dayn2nite2

I very much question Depakote - why?  Lexapro at starting dose is fine.  And tell the social worker you don't need a Ph.D. to question what they're doing.  

The care meeting will probably be them telling you to toe the line and don't interfere.  If so, what was your 2nd choice facility?  Move her there.  The social workers alone would have me moving my LO.

5-star with that kind of interaction doesn't beat a 4-star that listens to me and informs me.

MN Chickadee

I hope you are able to get some clarification from the care meeting as to why these new meds were added, who prescribed them, and if they are really necessary. Your experience is not what mine was in the two facilities where we had my mom. I was always consulted on changes in her meds or care plan. I communicated directly with the visiting physician about medications and changes in her condition. I agree, the medicare rating can be a bit meaningless. It isn't really indicative of the good places in my area anyway. Their numbers are indeed self reported and can be inaccurate.  Word of mouth about reputation can be much better. I always advise trying to find some family members when touring places, either inside the facility or in the parking lot. They will often give you an honest assessment.

MTonya

Depakote I will be asking why?  I wishing I would have known about Medicare ratings. I have started calling other place to see what it takes to get her moved. I hope this care plan goes well. I will pst after the meeting what happen. 

DrinaJGB

AH, yes--welcome to the world of Western medicine.

  Throwing more pills at the patient when pills are not required.

  We went through that nightmare, too. Went to visit DH in the neuro rehab brain care facility on a Sunday morning. He was rocking back and forth, spitting on the floor, moving his arms violently around. I proceeded to have him transferred to ER.

  He spent 9 days in ICU being "washed out" of all the crap that was prescribed to him in MC. Then he had to learn how to walk all over again (having walked in the facility on admission on his own without assistance)---and spent another week on rehab floor.

It's a crying shame how Western medicine works. Sometimes a total disaster. I have lost a lot of faith in these past many years of dealing with this issue for sure.

MTonya

Good POA. Is golden.  The POA on my mom I retype from my cousin POA, had signed and notarized

Made the facility stop all Psych medication because I told them I did not want her on any psych medication, I did not know about. The negative side to this as they referred her out to go two different psych  hospitals they couldn’t take her because They had no beds availability. Wait on Monday nursing home social worker reevaluate her and decided she was okay.. 

OMG they will have the residence  psychologist reevaluate her on Wednesday.. and call me to recommend any new medication. 

Good bad idk 

MTonya

Should I be Positive and think they heard me or am I have just hopeless… 

I feel Lost………..

Today is my moms Happy Birthday not sure it was happy

dayn2nite2

My opinion is they’re not listening and will pile up opinions showing they are right and you should butt out.  Find another facility that is in tune with you.

jfkoc

What answers did you get???

MTonya

 They are going to reevaluate her medication and this time I will be informed.

It was kind of concerning they lied about her medication. I know they lied because before the meeting, I check on her medical insurance website and can see when the medication was filled how often it was filled in for how many pills. 

SusanB-dil

Good for you for being on top of things like that!  After these incidents, if possible, would still look into other options. just my opinion, but I wouldn't be able to trust them any more.  She is blessed to have you watching out for her.

towhee

We are often told that when we put our LOs in a facility we no longer have to worry, that the professionals will handle everything. Sometimes I think this advice does us a disservice. When everything is fine, this advice works. But when problems do occur, we are ill-informed and unprepared to deal with them. Lost at sea with no compass and a broken oar so to speak.

The following is some basic general info about how medical services work in a facility, based on my experience with AL, MC and a SNF. It might not apply to every facility, but I hope it will be helpful.

How Do Facilities and Doctors Work Together, Who Is Responsible For What?

Many facilities these days outsource the providers that come into the facility to provide medical care. The group of doctors, or doctor, that provides in house care can be under contract, not directly employed by the facility, a completely separate organization. The facility has little control over the policies of an outside medical provider. Also, since doctors that will work in facilities are not plentiful it is in the best interest of the facility to maintain strict role separation. So doctors/medical providers prescribe treatments/medications and facility staff administer same.  Facility staff can however notify medical providers of perceived problems, both physical and behavioral.

HINT- Determine where the problem occurred, don't waste goodwill by blaming the wrong entity.

Medication Changes in Facilities: When, Who, Why

Medication changes can occur as soon as the second day in a facility, so you need to be prepared.

When your LO enters a facility you get a choice- keep your current medical provider (PCP), or change to a medical provider that visits the facility.

1--Using provider that visits facility--These providers usually have some training in geriatric medicine and/or palliative care. Their medical philosophy and perspective might be different from that of your previous PCP. One of their first goals is probably to do a medication review, often using the Beers Criteria for Potentially Inappropriate Medication Use In Older Adults. They will probably:

*Weigh risk vs benefit of medications from a geriatric perspective

*Attempt to reduce total number of medications (the more medications, the more chance of medication interactions, side effects and medication errors) (also called avoiding polypharmacy)

*reduce pill burden for patients (some patients have trouble taking medications) (this can also be seen as reducing pill burden for the facility, as reducing medications means the medtech/LPN has more time and is less likely to make an error)

This review often happens at the first medical provider visit. If there are changes, it is usually best if they do not all happen at once. These are some medication changes that I have heard about in the last couple of years.

Stopped vitamins-common---stopped Aricept-common---stopped neuropathy meds--stopped antidepressant--stopped anti-anxiety meds-- reduced arthritis pain med--changed blood pressure med--changed as needed meds to regular daily schedule--added memantine-- etc.

Even medications prescribed by specialists can be changed. Unfortunately, a med can be changed to one that is "better" without the medical provider knowing that the "better" med was tried five years ago and has an intolerable side effect. That information is buried deep in the medical records and the patient can't tell the doctor because the patient has dementia. Oops! The medical provider knows medications, but a patients medication history is a different matter. So, if there is someone who knows the medication history it is of benefit for that person to consult with the provider before changes are made.

The medical provider will also check with staff re physical problems, sleep issues, and issues with person refusing care/behavior. Depending on facility input and doctor professional opinion meds may be added, possibly including anti-depressant, anti-anxiety, anti-psychotic, and anti-seizure meds used for sleep or behavior. The facility staff is now part of your LOs medical team and may contact the medical provider when they feel it is needed.

HINT--It is much easier to have your input listened to before changes are made than to convince a provider to change meds back. 

2--You keep your current PCP.  There will be fewer medication changes, however facility staff may also contact this physician with concerns and he may prescribe medications.

*Emergency/Hospital visits can also lead to multiple medication changes. Checking for errors every step on the way is safest.

Who Has Legal Authority Over Your LOs Care? Guardianship, Healthcare Power of Attorney, Hipaa release etc. (caveat, I am not a lawyer, general info only)

Guardianship- If you are "guardian of the person" as opposed to just being guardian of the estate, then you make medical decisions for that person. End of story. Doctors have to talk to you and you can insist on the facility informing you of changes.

HCPOA - stand alone document- This gives the medical provider permission to talk to the person holding the HCPOA and gives the holder the power to make medical decisions for their LO. But, unless the attending provider or a previous physician has declared that the patient is not competent to participate in medical decisions, the document may not be considered to be in force/currently valid. If so, than the provider does not have to talk to you. Neither does the facility have to notify you of changes. What, you say, my LO can't even remember her own name half the time! How could they consider her competent? And the facility might say "well the doctor saw her and she seemed to know what was going on and agreed to take the medicine" This by no means happens all the time. Most facilities and doctor groups try their best to work with families, but some do seem to specialize in non communication. In my cynical opinion this happens because of time, money and inadequate staff.

HINT-if possible get a letter from your LOs dementia specialist that they are not competent to make medical decisions before your LO enters a facility. Try your best to be present at that first in house doctor visit. Express to the doctor the facts about your LOs condition. Get it on record. Ask that "medications are not to be changed without consulting the HCPOA" be put on the front of your LOs chart. (You might have to ask both doctor and facility to do this)

HCPOA within a regular DPOA- I know some states do this, I have no experience of it. How the document is written determines how it can be used. 

HINT- read your documents, if you have any questions at all consult a lawyer

Hipaa release-gives the doctor/facility permission to discuss patient care with the person who holds it. You can sometimes receive physical documents about medical care. Does not give the right to make medical decisions. Your doctor or facility may in rare cases refuse to honor it entirely or in part, they may say they only have to respond to your LO, not an additional person.  Your LO who has given you the Hipaa release is assumed to be competent to make their own medical decisions. If the doctor believes they are incompetent then the Hipaa release is invalid. A HCPOA may be able to give someone else a HIPAA release, I am not sure about this.

No documents at all- even if you have no legal documents you can be involved in your LOs care. Most facilities give someone the status of "main contact" or "family caregiver". If your LO gives verbal permission for you to be at a doctor visit, or they allow you to be with facility staff when treatments are done, you can usually discuss patient care. 
But it is up to the doctor and facility.

Your LO refuses for you to be present, no documents- All you can usually do is give information, not receive it.

Who Do You Ask About Medication Changes?

On an on-going basis, I found it was easier to check with facility staff than with the medical provider. Among facility staff, the medtech will usually know the least. The medtech is provided with a list of medications that are to be given on their shift. If a medication has been discontinued it should not show up on their list, and while their list might show a prescription fill date, they rarely know whether it is a new med or a refill. Plus they are giving medications for 20 to 30+ people. A LPN in a nursing home might have access to more information, but your best bet is a facility nurse (AL /MC) or a supervisory nurse, unit administrator, or Director of nursing (SNF). You can usually get a copy of the Medication Administration Record for several days (this lets you know when medications were given, and whether as needed meds were given), as well as either a list of current medications or a medication history. It is best to get these on a regular basis. You can usually doublecheck whether these are correct by looking at the pharmacy record/bill. 

HINT--Ask how the facility handles such requests during the admissions process.

HINT--Make it clear upon admission what level of involvement you expect to have with your LOs medical care. (There are families that do not want to be involved at all) Learn by what method you can communicate with the medical provider. Often there is no phone # or e-mail you can use. Sometimes you can only ask a nurse to leave a message for the medical provider "in the book" and hope. Get information in writing about the facility policy on informing you of medication changes, and the medical provider policy of consulting with you.

A good facility and doctor group will notify you of medication/treatment changes twice. The medical provider will contact you before they change the orders, and the facility will call before the changes are carried out. 

MTonya, you are being a good advocate for your mom. 

You might want to get a description of your moms physical issues and their timing to the psychiatrist before her visit.

Don't be surprised if your mom needs to go back on some of her medications. Taking her off everything at one time for more than 24 hours might cause some problems.

SusanB-dil

Wow Towhee!  thank you for some interesting information for very thoughtful consideration. Will be looking into that paperwork.