The never ending Geri psych saga

clarinetist

My DH will hopefully get out of his Geri psych unit next Monday. The APRN switched him to Risperidone, which seems to be working well, with no side effects yet.

I had found a new geriatric psychiatrist that was supposed to do a telehealth visit in a week so my DH could continue on his new medication. Today I found out that doctor canceled his visit because he doesn’t have a contract with my husband’s memory care facility. I tried to protest that decision, but got nowhere. I’m feeling like a very poor advocate for my DH.

Now the search for a new Geri psych starts over. The APRN at his current unit will provide 30 days of his new meds, but after that I have no one to prescribe it. His geriatrician won’t prescribe psychiatric medications. Without the medication he’ll have another hospital readmission (he’s had two admissions in the past month and all these new environments are very hard on him).

I called all the hospitals (general and psychiatric) in the state, and no geriatric psychiatrists are accepting new patients. I called all the doctors on the Alzheimer’s Association community resource finder; no joy. Tomorrow I’ll start calling out of state, and looking further afield for telehealth doctors.

Thanks for listening to me whine; I feel better just typing these words.

M1

This just doesn't make sense-why will no one at his facility prescribe the medication if it is clearly working? I would take that question to the director of the facility....

ImMaggieMae

It was a hospital psychiatrist who first prescribed Risperidone for my DH. I don’t recall that he was a geriatric psychiatrist. When we finally got into a neurologist, he took over prescribing it. The first antipsychotic med that he took, months before that, was Seroquel. It was prescribed by his PCP. Aren’t those drugs both in the same class? Do you live in the U.S.?

clarinetist, it seems absurd that they are making you jump through all of these hoops to get a prescription for something that is already working. It’s not a controlled substance. Please let us know what’s happening with this.

clarinetist

Thanks for your support, M1 and MaggieMae. I am going to speak to the director of his memory care, hopefully today. His facility does have a consulting Geri psych, but he has been MIA for the last 2 months and no one has been able to contact him. If this doctor does have a contract with the memory care, it would seem he’s in breach of it.

I hadn’t thought of getting the prescription from a neurologist, but getting in to see one could take months. I’ll check, however, and it could well be worth it to get the process started.

M1

Is there a general medical doctor who comes to the facility? They could prescribe it for Pete's sake....

easy23

When my husband was in MC, I gave them a list of medications. The geriatrician there prescribed what was on the list. Risperidone was one of the medications.

ImMaggieMae

clarinetist, there were many months between the time the hospital psychiatrist prescribed it and we were able to get a neurologist’s appointment. I know there were several refills on the prescription, probably from the hospital psychiatrist. If not him, it would have been his PCP that prescribed the refills. I don’t recall because it was never a problem.

Why is the MC facility restricting your choice of doctors that your DH can see? Is that a common thing with MC facilities? That doesn’t seem right. Is it because the doctor would be seeing him on the premises? Is it possible to take him to a doctor off site? It’s just wrong that they are making this so hard for you.

ButterflyWings

If he is a veteran, the VA can prescribe a 90-day quantity and refills. Maybe another Dr will also prescribe more than 30 days worth.

it would be worth trying to get him approved for hospice given his instability of the last several months— the hospice doc can prescribe his meds as well. *Edited to remind that your LO can be in hospice temporarily until he is stable in MCF, and then graduate off.

I agree with the advice of the members above. This seems worth writing a short note to MCF management regarding patient safety and cc’ing anyone who regulates care and MCF’s in your state.

housefinch

I agree with everyone above. Why won’t a geriatrician or memory care MD just continue prescribing the med? This is just ridiculous and probably guaranteeing him another admission in a month when his medication runs out. I also wonder what is going on with the geripsych consultant who is MIA. Typically you can’t just leave your patients without a clear transition of care plan documented and, at least in my state, a letter sent to each patient with contact information for the doctor who is assuming their care. Otherwise I think it’s considered patient abandonment. Very odd and frustrating situation.

Dio

Does your husband have a PCP or psychiatrist who can prescribe medication?

SDianeL

My DH is in a VA Memory Care facility that has a doctor on staff who prescribes all his medications including Risperidone. Prior to him being moved to the VA facility, he was in another facility that did not have doctor on staff so I was responsible to getting his meds refiled. Any Neurologist or PCP can prescribe Risperidone. Does not have to be a Geriatric doctor.

clarinetist

Thanks so much for your replies and suggestions. This morning I was able to find a PA who can see my DH in July and prescribe his medications. The APRN at his current Geri psych will send him back to the memory care with a 30-day supply of his new meds. So the immediate crisis should be resolved.

in a surprise twist this afternoon the MIA geriatric psychiatrist for my husband’s memory care turned back up after a 2-month absence. He can see my DH in June, so my husband will have one final visit with him, and then I’m switching my DH to the PA. I need a medical professional I can count on.

I also talked to the director of my husband’s memory care today. She agreed that the current situation is a problem (facility geriatrician who won’t prescribe psychiatric meds and an unreliable geriatric psychiatrist), but said it’s a statewide problem that is currently unresolved. There used to be a pool of doctors that the facilities in the state could use, but it was dissolved a few years ago. I’m considering contacting my state legislator about this.