Background: As many of you know Empress Ellebud is not my favorite person. I could have lived my whole life without meeting her/talking with her/and/or having her anywhere near us. She is a bigot and a bore. HOWEVER she is a human being and is old and dying,
As some of you may recall the Empress decided that she wanted to die with her family and went across country to an Assisted Living facility. She was a challenging person and patient. She was moved to nursing care at the same place. We have visited 4 times in the last 11 months. While we weren’t thrilled it was ok. But the decision was made to bring her back to Los Angeles, we found a place and our waiting for a spot to open up.
BIL feels that the facility is medicating all the patients to keep them quiet and under control. The Empress is VERY difficult, but she is a human being. Other than going back and surprising them is this a “normal” concern? Is medicating patients the norm? Or is this paranoia and/or senility?
Overmedicating elderly patients is a genuine concern. But my understanding is that when patients are overmedicated, they are given medicines that they have prescriptions for. So I suggest looking at all the medicines prescribed for the Empress, together with the Empress’ main doctor. A lot of times with elderly people, different doctors are prescribing different drugs, and nobody is in charge of making sure that all the medicines make sense together. Having one doctor look at all the prescriptions can help.
Be suspicious of any antipsychotic that she is being prescribed.
Both my dad and my sister lived in nursing homes for many years before they passed. In both cases I did know what meds they were on. I was proactive and asked why certain medications were prescribed. They do not give meds just to dope them up as that would be unethical. In my sister’s case she had Adavan in the evening to help her sleep. In my dad’s case he was not under any mood altering drugs . You have a right to know if you are a health care proxy and you have a right to approve or disapprove any medications. The days of One Flew Over the Cuckoo’s Nest are long gone.
It is tough to find a place that you can trust to care for your elderly relative. We have been through the search process and landed an assisted living facility with low staff turnover, most staff have been there 10 years or more. Checked with the state agency to verify number and types of complaints. And I stumbled onto a childhood friend working in that agency that still lives in mom’s neighborhood and I trusted her recommendation of the facility we chose.
Even so, we found that the medication will be given exactly as written out by doctor. Mom was prescribed stool softener twice each day, and even when her “plumbing” was obviously overflowing and causing nursing staff extra work to clean up, they continued to give her the medicine. We had to get the doctors to rewrite the prescription to say “up to twice a day as needed”. (My apologies to those eating while reading this…)
And yes, there is a fine line between pain meds for my mom recovering from hip surgery and too much pain meds to keep her napping in bed all day. It took several months to get mom to a med regimen that allowed her to be awake and alert for good portions of her day. It took phone calls and visits to her doctors to confirm which meds she still needed, and which ones could be reduced or eliminated.
I live 4 hours away from my mom, and the confidence I have in the staff gives me comfort. They called my brother last Saturday to tell him “your mom is staring off into space and just doesn’t seem like herself.” Brother took her to urgent care and she was diagnosed with the flu. Staff knows me by name, even though I only visit about once a month.
If you can have someone consistently visiting and asking questions of the med techs, interacting with the doctors prescribing the meds, and noticing how often/how long relative seems out of it, you might succeed in reaching that exact spot of balancing pain and clear-headedness for your relative.
We are in a full pay facility, the medicaid places are worse. When mom was in rehab facility, it was hit or miss on care in general and on getting either too much or not enough medicine for her. Care workers seemed overwhelmed with the number of patients they were dealing with.
Feel free to PM me with questions. We feel mom has made good progress at her facility, despite her dementia.
Unfortunately Mr. Ellebud isn’t the one who is the medical proxy. Idiot BIL is in charge…oldest son. But I will tell him when he gets back home. THANK YOU! You have given us a starting place.
Is she capable of making her own decisions? Does someone have medical POA? You need to get a copy of the medications that she is on. Make sure the facility emails it to you with information about dosage and when they were started. It is good to have a written record. Look up the drugs and see whether they are anti depressants and/or antipsychotics. They are supposed to have informed consent for these types of powerful drugs. Express your concerns to the director of nursing, preferably by email so you have a written record. Find out who prescribed them and why and what other methods they have used to modify her behaviors. Unfortunately, I have been down this road.
Oh, God, no and completely illegal. My dh is a long term care consultant pharmacist and watches this stuff very closely.
IF you have ANY suspicions of such, call the licensing agency at once and voice your concern. There is so much documentation that must accompany any and all interventions like this. It is a hot topic. Please look into it closer.
Having one doctor look at all the prescriptions can help.>>>>
A nursing home is required by law to have a pharmacist review every month, assisted living every quarter. It is the responsibiltiy of the pharmacist to make recommendations to the physicians if they find problems.
I suppose this is standard advice. But…sometimes there are situations where you either have to drug the patient or the staff. I’m not really kidding here…I’ve seen this. It would get a smiley face if it weren’t so regrettable.
I’ve seen a situation where a combination of failing short-term memory and OCD coupled with dementia was extremely difficult for a staff to deal with. Each situation varies, and can do so day by day. I think there is probably something to the studies that say there is a tendency to overmedicate, but most of the people who’ve written those studies haven’t seen some of the most difficult cases.
In the case I’m familiar with, there was a visitor four times a week for an hour plus each time. We had a lot of sympathy for the person in the nursing home, but also for the staff.
Life doesn’t always give you the option of the choice you would prefer. Visit fairly often if you can, and you’ll get a feeling. There is a variance among caregivers, but you can’t assume that its private pay vs medicaid. Its more that some people don’t belong in the elderly care business. (As an aside, I don’t think there is anyplace that is pure private pay. The rates are so inflated that they drain the patients assets with a year or so, and everyone ends up on medicaid.)
An assisted living center is not the same as a skilled nursing facility. The assisted living may not require a drug regimen review by a consultant pharmacist. Might try hiring a senior care pharmacist. Google senior care pharmacist and check ASCP website. I’ve no idea of the cost but it would be a way to get an unbiased review of the meds.
Thank you so much for your help. Not pulling punches but I don’t like this woman. Somehow she raised my husband and I can’t let hersuffer. I am gathering the information, and then Mr. Elllebud will talk to his brother with a plan.
bevhills - You’re so very thoughtful - I do know what it is like to not like your MIL… I hope I do not ever have to make the decisions you are making, but if I do, I will remember your thoughtfulness. I do have some experience with nursing homes with my grandmother and my aunt. The caregivers were always very careful about medications, but I agree with others that it would be wise to have one doctor AND a pharmacist review all prescriptions she is taking. Wishing you and your H the best.
No… medicating patients is NOT the norm; I assume you’re talking about sedatives, etc. The rare instances that it happens are for reasons suggested above - they have tried every other treatment tool with no relief for major symptoms. I spent a lot of time in assisted living facilities/nursing homes while working with hospice, and what you’re talking about is frowned upon seriously.
That being said, yes, it helps to have family members who regularly ask and be provided with this information. If she is in an assisted living facility, the information might be coming from her internist who sees her there, as opposed to the facility itself. When in assisted living, residents are often given the option of administering their meds themselves (if they are able to), or having the staff administer them. They cannot do a combination of both… it’s either the resident does it alone, or the staff completely handles it.
My mom is now in a nursing home/assisted living. And she was in a nursing home for a while before. She has her bad periods; dementia does that.
As to medication, as noted, there is a list of what she gets. In our case, trying to add a bit, if not for the mood enhancer, well … it helps. And I asked for her to be put on that. In other words, there’s “sedation”, which is probably a criminal offense as well as a licensing violation, and there’s stuff that makes people feel better and thus perhaps more compliant and social. I tend to doubt facilities dispense more than asked for because they watch costs and they won’t get paid for things that aren’t prescribed.
I have nothing to add, except that as another woman with an impossible MIL, you have my sympathy, and I think your MIL is blessed to have you. Even though no one will thank you, you are doing the right thing by looking into her care.
Apologies but I am a little confused. If she is on a waiting list for a spot in LA, where is she currently? Where is BIL? Is he concerned about the place she is currently living or the place she is about to go to? Is he concerned about the arousal level of all the residents in general, or specifically about your MIL? Does she seem overly sedated? Or is she generally alert and aroused, and not causing a ruckus? When was the last time he saw her or these other reportedly sedated residents? I guess what I am confused about is, is there a real reason for concern, or is he simply responding to his impression of the facility? And if he is the medical proxy, why isn’t he handling this if its his concern?
MIL is currently in the upper East Coast. BIL lives a few miles from us. BIL found this place because a cousin worked (at one time) at the company that owned this place. Has she caused a ruckus? She was never a nice person. Now she doesn’t have filters…so she is an avenging b…BIL was the “favorite” child and he never has worked for a living. We have visited 4 times in 11 months. Is this enough? Don’t know. We have hired a woman who visits 3 to 4 times a week to listen to her talk. She sees nothing suspicious…and she is employed by us.
I can’t save the world. But I do not want Mr. Ellebud to blame himself with the what ifs.
Your title and first post confuse me. Is she going to move to an assisted living facility in LA or a nursing facility?
In your first post, you said she is currently in nursing care.
I am assuming she will be in a nursing care facility. My H who is a physician said every dose of medication given to patient in nursing facility has to be documented and you and her physician can look at the records any time. Some patients who have Sundown Syndrome(very common in elderlies) may require strong medication like Ativan to get them to sleep at night. It’s not a bad medication for those who really need it.
I am glad you will hire someone to visit her 3 or 4 days a week. The staff pays more attention to those who have regular visitors.
My friend whose husband is in a facility for early Alzheimers, visits him nightly and hires someone to be with him 4 hours a day to exercise him and keep up with hygiene.
Good luck.