What if she didn't have someone to advocate for her?

Ask the facility which pharmacy they use. Most doctors can send an e-script or call-in prescription to the pharmacy. Most facilities also have a fax machine or computer program that allows the doctor's office to send new prescriptions to the facility. Talk to the administration.

Mysteryshopper: My late mother wasn't in a nursing home long enough before she suffered an ischemic stroke, which ended her life.

I hear you. I ask the same thing to myself a lot, "what would happen if..."

As I'm finding out, the amount of involvement depends upon the level of care the person is receiving, the license of the facility, the level of the health of the person, what was signed on the contract with the facility, and federal and state rules.

With the first facility, Assisted Living, I authorized the facility to talk to the doctor and get medication. I was not happy with my decision. As it turns out, I wasn't notified that anything was wrong. They contacted the doctor and picked up the prescription. They did get the prescription from my preferred pharmacy. Then I got the bills. There was the time to communicate with the doctor (not covered by insurance) and the cost of the prescription was $35.97, 97 cents out-of-pocket after insurance, $35 facility service fee. The pharmacy was 22 minutes by car, less than 5 miles away. After you add in all the overhead, $35 was a fair charge, but it was still all out-of-pocket and not covered by insurance.

When I signed the papers for entry of my Mom to Memory Care, there was a signature for "allowing the facility to transport my Mom to the medical center". There was also another signature for "allowing at-center visits for wellness checks." I said NO to allowing my Mom to be transported, and did not sign or mark any option on the wellness checks.

In "allowing the facility to transport my Mom to the hospital", the transportation would NOT be covered by her health insurance. In addition, they could have sent my Mom to the hospital without consulting me first because the health of the patient takes priority over contacting people. So, whenever my Mom fell, they wanted to check her for concussion and wanted xrays (per medical guidelines). So not only could there have been transportation costs, there was the cost of someone accompanying my Mom to and while in the emergency room, until someone else showed up....$50 per hour, none of it covered by insurance (she didn't have a bruise from these falls.)

For the "allowing at-center visits to wellness checks", the wellness checks would be done by a medical group that was upstairs on another floor of the building. I was told it was things like blood pressure, drawing blood, etc. I looked up the name of the group that was referenced and could not find out anything about them. I did not sign the authorization. After repeated interactions for over a month and still no information, someone finally said they could send me information electronically. When I read what they sent, the agreement was to change her PCP (primary care physician) over to that group. At the next call, I declined the service.

Now I could understand doing this if my mother was under the constant care of a doctor, in palliative care or in hospice. However, my Mom is not in any of those conditions that requires constant medical monitoring.

So therein lies the dilemma:

If you gave the facility the ability to contact doctors and pharmacies upon your behalf, you probably will not get timely incident reports and you will incur potentially a sizeable amount of out-of-pocket costs that are not covered by insurance. In addition, the facility might not do things the way you think it ought to be done.

On the other hand, if you sign the papers so that you want to be notified before anything is done, then you also accept the responsibility to respond to the facility no matter what time of the day it is and potentially, need to find someone to do what they ask you to do. Worst of all, one will need to put up with the potential for conflicting processes.

For me, I want to be notified before they do anything. Maybe later, I'll be more "hands off". I told them that....

I truly understand your feelings. My dad was in and out of rehab in a snf for 4 months before the last time he went to rehab and then went to there ltc September 2021. I sware I should have just lived there 24/7 especially when he was in rehab. He had a pcp but used the va for some of his care. The second time he went to rehab when I got there they told me they were checking him for a dvt in his leg I told him he has 2 he is supposed to be on blood thinners. They said that information didn’t come over with his records and they didn’t have his records when he left the hospital with them. Then they wouldn’t give him his medicine the way va had said he should have it (he was in a private pay snf) I left a voicemail once with his social worker and told her if they couldn’t give him his medicine I would be more than happy to come give it to him whenever he was supposed to have it. Then once I kept trying to have them cut this one pill in half because it was to big for him to swallow whole he even told them he just wanted to take half at a time and the cna convinced him to take it whole. I kept getting the run around it has to be ordered by the dr that way and it was scored so it could be cut in half. The one thing I did finally find out when he went there the last time is apparently it’s up to the dr or np to handle all care and medicine they don’t consult with there pcp or any of there other doctors and all medications have to come through there Pharamacy. Then when he went to long term care it was easier because he went there on hospice it was still a battle on some stuff but not as bad as rehab. So unfortunately putting someone in a nh does not mean they are going to get the care they should have you have to stay on top of everything also unfortunately someone needs to go every day and others need to call it is definitely a lot of communication between everyone and frustrating. It’s like being a parent all over again except now you are having to advocate for your parents.

I do find that NHs fall down on the job. One faxed the records of one of their patients to my mother’s fax machine. They had the # off by one digit for where it was supposed to go. I called them. Said it was a HIPAA violation. They weren’t concerned. Said I would call the local newspaper which happens to be the Washington Post, even less concerned.

This was way before COVID, so that could not be an excuse. I threw it in the recycling. It wasn’t like the poor lady was going to be alive much longer.

During my mom’s NH years we frequently advocated and intervened to have everything in place for her care. Those in the NH who didn’t have advocates were cared for and kept safe. But they undeniably they received more minimal attention. It’s not fair or right

I agree with you. It shocked me how many gaps in communication there can be when someone is in a facility, and how we have to facilitate better communication, care, etc. My mom was in memeory care for all of a week, (she then came to live with us). When she was in Memory Care, the doc had faxed a change to her meds, but it went to the nurse's fax machine, and she left at 5, so the information wasn't received until the next day. There were nurses there round the clock, but the fax machine was in the nursing supervisor's office, who worked 9-5. Unbelievable. I had to double check and follow up on everything. My husband's mother was in assisted living for over a decade, and he'd often swing by there after work, and he had to intervene a lot on her behalf. If she wasn't particularly hungry at dinner, for example, he'd convince her to eat or drink something when he was there. Covid restrictions brought to light the importance of unofficial caregiving provided by family and/or friends, to suppelment the care in facilities. We were lucky in that we dealt with things pre-Covid. Before we faced those situations, I had no idea how much we'd need to intervene for our moms. I know some people have hired additional help to sit with their moms several hours a day while they were in facilities, but that can be prohibitively expensive. Caregiving responsibilities for Hubby and me (and so many others) became a second job. For us, it was the aggravation associated with back and forth phone calls, mis-communication, being put on "hold," (or sometimes "ignore"),etc., that added insult to injury. It was a relvelation as to how our lives would be impacted by all of this, sort of like an impacted wisdom tooth: it hurt, (but we attained wisdom along the way).

I used to work at Social Services, and at least in Minnesota, social workers can intervene and ask for a patient to become a ward of the County if they are unable to advocate for themselves and have no family. It isn't a perfect system, and we desperately need a better one, but it's much better than having no one to speak for you. It does require a court hearing, however.

Mystery, If it were me, I would ask the providers who take care of the residents at the facility what you should do. Ask them how to get Rxs from other providers filled and started at the nursing home. It will be interesting to hear their answer.

Another option is to have the neuro doc send the prescription to the pharmacy the nursing home uses, and then email the Director of Health Services and cc the Director of the facility to tell them the new script has been sent to the pharmacy. Then insist they notify you when the medication has been received and has started being administered to your LO.

OR, if your LO has to use a pharmacy other than the one the nursing home uses (my mom has military benefits and has to use a different pharmacy than her AL uses), have the pharmacy deliver the new dose to the NH, and then email the Directors, as described above.

I, too, am finding out that I have to do a LOT of legwork for the place where my mom lives. I have no idea what we would do if I lived too far away to do it. I KNOW she would be in a worse situation if that were the case. It might require hiring someone else to do the legwork and the following up.

I think, like many situations, they try to delegate the work to family/friends. People are always trying to shove the work onto other people, so there's less work for themselves to do. If there's no family, they would have to find another solution -- or ignore the problem and do nothing.

DEA controlled drug prescriptions at one time had to be hand delivered. They were not allowed to be faxed on emailed. I thought that had been changed. Its been almost 20 yrs I worked for a Pharmaceutical company and the Pharmacies who dealt with us had to mail or send with the driver any prescriptions filled. We actually had a "cage" that the drugs were kept.

Mysteryshopper, anytime I need a new med script, my doctor forwards it to the pharmacy.

Find out what pharmacy the nursing home uses, then all scripts can be sent there, and will be delivered directly to the nursing home.

I wish I could use Beatty's expression here: "There will be no solutions as long as you are all the solutions".
But in reality, our elders would pass more quickly without us almost certainly. As it is they go on some years longer. The quality of those years I myself question.
This new script? We can't know how good she would do without it. Many people say "I am sick of dialysis and am stopping it; I will be gone in a few weeks". But that isn't always the case. Many keep on living quite some time. Many do not.
I have seen seniors die DUE TO medications, especially blood thinner types. So there is also that. I have seen a dosage of blood thinners increased the consequent demise from brain hemorrhage more often than I care to think of. I have seen seniors die of having blood pressure meds increased because pressure was up in office but normal at home--consequence? Low BP and falls that are the beginning of the end.
So who can know. Overall our seniors are living longer. A LOT longer. I don't think most are living with family now, but have no idea the stats on that either. I just remain uncertain whether that living long counts on the happy side of the full ledger at the final summing up.
Your supposition that your elder would be without this med until at least Monday is almost certainly true on this holiday weekend. Without great medical followup the script would likely not have even been changed at all. You don't say what the medication is; so likely your senior would be just fine for that three day period on current dose.
Your questions is valid for sure; but brings up a whole raft of other questions. There are so many seniors with no family at all. Are they really dying so much sooner? Who can know.