My 85 year old mother with Alzheimer's was admitted to a memory care facility in early August after breaking her right hip, then broke her left shoulder from a fall at the facility a few weeks later. Due to my dad's bad insurance that wasn't covered by the Doctor who visits this facility, she was not being seen on a regular basis. Her mental condition has advanced, most likely because of the traumas which included several hospital stays, several ambulance rides, several non-emergency transports and several different facilities until we found this one.
Since I have been visiting my mom more often than my two sisters, one who is two hours away and the other is a three hour flight away, I have frequently observed and experienced my mom's extreme anger, depression, agitation, and outbursts that cause disruptions to both the caregivers/aides and other residents. it is heartbreaking and deeply concerning to observe these incidents. My mom is normally a soft spoken, loving, caring, thoughtful, adorable person.
One of my sisters who lives a few hours away, who works in geriatric settings as a music therapist, supports my request to my dad, the doctor, the various nurses at the facility and Director of Nursing, and the executive director to prescribe a small dose of an anti depressant to help ease my mom's agitation and sundowning. Ativan was used a few times at the hospital and she responded fine. One facility prescribed Haldol which was a horrible experience for my mom,so I expressed my strong opposition to using this medication at her current facility, which they agree with.
since I visit my mom on different days of the week and at different times of the day than my dad and sister who is out of state, I see the most challenging side of my mom's behavior. When nothing was being done by the nursing staff at the facility nor any action taken by my father to pay out of pocket for the doctor onsite to address my mom's rash and swelling on her legs and her agitation/anger/outbursts, I made an appointment to a doctor who accepts her insurance program, who prescribed a medicine for her legs and Risperidone, which I thought was an antidepressant. that night my sister told me it was an antipsychotic drug similar to Haldol, is not FDA approved for elderly patients with dementia and can cause death .
So I called the facility and explained this to the night nurse, and asked if it could not be given until I spoke to the prescribing doctor and my father, who regretfully has POA. the nurse agreed.
At promptly 9am the following day I called that doctor's office which became a total three ring circus when I was told the dr was out of the office at medical exams, as well as the PA doing rounds at a hospital, so I was relaying messages back and forth between the inefficient receptionist and the PA.
I politely asked for a change in medicine to an anti depressant or ativan, which was initially requested, not an anti psychotic. The doctor, who relayed the information to the PA who relayed it to me, said no and that was beyond their "scope of services??" huh? but they can prescribe an antipsychotic like Risperidone?? It made no sense. After several agonizing hours of trying to get the PA to get the doctor to approve a prescription for something like celexa, the PA said the dr approved it and that she would call it in to the pharmacy right away. I waited two hours then called back and was told it would be called in by the end of the day. that was still three hours away and I had already missed my entire day of work.
Bottom line, it was a futile attempt, because the memory care facility finally convinced my dad to pay out of pocket for the doctor to evaluate my mom, which I thought would be the next day, which didn't happen until a week later.
After that evaluation, I found out that the Doctor still didn't prescribe an anti depressant, nor will my dad enforce it, which my one sister and I do not understand and are extremely distressed, confused and upset about.
Since my dad has POA, none of us are allowed to ask the nurses or staff why this decision was made and when I ask my dad, he blows up, gets very angry like he does with everything. I believe he is cognitively impaired.
I really need advice about what to do because my dad has POA and my sister who lives out of state supports his decision because she flies in to town for only a day or two and visits in the morning when my mom is in her best condition; they never go during meal times or afternoons or evenings when sundowning strikes.
I have called the ombudsman for the region and she did not offer any new options that I haven't already tried. It is heartbreaking, painful and very distressing to see my mom in this state, when I firmly believe that a low dosage of an anti depressant could alleviate her extreme depression and anxiety.
Does anyone have suggestions? I am at my wit's end, like my other sister and extremely frustrated/ depressed about all this
I'm so sorry you and your family are going through this.
I asked about a geriatric psych and there is not one assigned. I cant admit my mom to a behavioral hospital because my dad has poa. I tried to do that already.
I feel so guilty when I hope that she falls again and has to go to a hospital so that a psychiatrist can see her.
Someone suggested palliative care, would that override the facility's doctor's decision?
is there a facility licensing or a regulatory company that I can call for advice?
my sister and I believe that ignoring my mom's need for this medicine borders on neglect and elder abuse. would you agree?
this is truly gut wrenching and I have chest pains and fluttering every day.
If there are other associations or patient/family advocate organizations that I can contact, can you please let me know? thank you again for answering. i'm so grateful.
Has anyone said that the reason why a certain drug isn't being prescribed is because it would react badly with other medicines the patient is taking? Has the facility checked the patient for an urinary tract infection which can cause the patient to act out, be angry and disruptive?
Is the health insurance the one your Dad had when he retired from work? If he is like my Dad, he will refuse to change insurance companies because if said insurance is good enough for the company he worked for, it's good enough for retirement. My parents think their secondary insurance is pure gold.
He has neglected my mother and her Alzheimer's condition for several years, would not buy healthy nutritious food, not allowed my mom to go to an adult day care facility for social activities, did nothing to improve my mom's lack of showering for many months and her hygiene, and chased away four home health care agencies that I had researched and who were helping my mom. The list of my dad's incompetency's are lengthy.
Unfortunately my sister in Washington D.C. supports my dad, for reasons I and her twin sister do not understand.
I have been told by doctors, home health care directors and my mom's out of town sisters who are hearing about the rapidly declining condition of my mom and my dad's poor choices, that my dad is inhumane, crazy, unreasonable, neglectful, and mean for doing this to my mom. I should have called social services when mom was still at home, but my dad has an interesting way of acting very different around professionals and would have covered up the reality of his neglect. I firmly believe that my mom wouldn't have fallen at home and broken her hip if there was a home health care aide in the home. but maybe this needed to happen to get my mom out of the neglectful environment and into a facility with better care.
It would be me and my nearby sister against my other sister in D.C. if we tried to get guardianship. this is what tears apart families and it is heartbreaking.
maybe I should set up a meeting with my supportive sister and an elder mediator??? do you know how I can find one? thank you again
Agree that you need a united family front and perhaps pursue guardianship. I can only imagine how frustrated you must be.
Agree with
I appreciate and respect your points. In fact, if the Doctor or Director of Nursing or Executive Director or my dad explained to me and my sister that "the reason why a certain drug isn't being prescribed is because it would react badly with other medicines" then I would let this all go and accept it.
but no one has said that, which is what leads me to believe that my dad just won't request it with the doctor. I asked my dad last week, 'has the doctor finally prescribed something for mom's depression'? He answered in his usual angry and defensive manner, so I hung up.
Your question: Has the facility checked the patient for an urinary tract infection which can cause the patient to act out, be angry and disruptive?" is a great one and yes they did. she did not at the time, nor does she now.
Your question about the health insurance--it is not the one your Dad had when he retired from work. He chose Freedom because it was the cheapest but none of us understand why Medicare is not their Primary. I pray he will change to Medicare as their primary during this enrollment period.
I am trying to accept that the best solution right now is to 'let go and let God' and to honor the Serenity Prayer that says: God, grant me the serenity to accept the things I cannot change,
Courage to change the things that I can,
and Wisdom to know the difference.
I am trying to trust the doctor's decisions and all of the staff involved.
it's just hard when they won't communicate.
thank you again.
Now it is Mom's turn to get some care, and Dad is now clueless about what to do. He's is baffled because his job probably was to go to work and fix things around the house.... he cannot *fix* Alzheimer's. The poor fellow is so overwhelmed.
When my Dad [93] was in the hospital for a recent fall, I told him that Mom [97]should be here with us because she is his POA for medical.... but Mom wouldn't come to the hospital because she is almost blind and very hard of hearing so she wouldn't understand what the doctors were saying. Therefore, I told Dad that he might want to consider someone else to be the POA or co-POA with Mom. I shouldn't be making his medical decisions for him.
Normally a POA who fails to act in the best interest of the person can be removed. The POA document itself should specify duties. It sounds like you have documentation. I would think that any legal system would have to have more respect for the sisters who are there and seeing what is going on than the one who is far away and not experiencing anything first hand. I hear your worry about tearing apart the family, but at this point, its already torn if your mom has to spend the last of her life in misery that you know could be prevented. See an eldercare attorney with the facts you have shared with us and see what they say before you give up all hope of making things better.
Now really - if nothing can be done, it is not your fault, and your plan to just be there as much as you can is a good one, as long as Dad does not decide on a whim to restrict your visits...he might feel guilty that you see her more or be afraid it makes him look bad in some way, so that would be the obvious and selfish solution.