The only small residence I have found does not do medication management. I’ll keep looking. I feel that if my mother returns to assisted living there need to be big changes: even the chair she sits in will trigger association with drinking (7 oz a night) and nicotine gum (20 pieces a day). If she goes back there, I am moving furniture around and she can go downstairs at cocktail hour instead of cocooning in her room with martinis.
There is another woman on the ward who also lives at the same assisted living facility. She is one of my tai chi students and I love this woman, who never married and has no kids. She tells me how lonely the assisted living is for her. I think SHE would be a perfect candidate for the residence I found and I am going to tell her about it.
Thanks all…you all have your sagas going on so hope you don’t mind my continuing posts!!
Can a demented person really use a medication dispenser? Last year, while at independent living, my mom had one Bp pill to take. That was it. I used a pill box, and put in one pill a day for each day of the week and put it at the spot she ate breakfast. We even set an alarm. Usually, no pills were taken when I showed up a week later. For dad, I finally convinced the doctor to please take him off all his meds as some days they would be taken and some days not. They both need someone to hand them the medications with a cup of water.
^ I’d say it depends on their level of memory loss for specific daily activities. My mom used to take her meds with water, on schedule, long after her memory affected other things like keeping her checkbook straight. Now, not only do I need to put hers meds and water in front of her, but have to stand close by to remind her several times to drink her water. Recently she started putting meds in her mouth, then complaining they were hard to get down, even though I had placed her water glass in front of her with instructions to take her meds and drink her water not 2 seconds before. It’s very difficult when each step of each task takes vigilant supervision. She would be utterly incapable of using a dispenser- she never knows what day it is, much less the need to follow the meds with water.
My mom’s short term memory is slipping, but she is still able to live independently. However, she was having an issue organizing her meds after 40 years of doing that for herself and my dad, and we think a hospital admission this past fall was related to her not taking her meds properly. She’s had cardiac issues for years necessitating multiple medications, so it was pretty upsetting for her to realize that she really needed help with this.
Her new doctor, a geriatrician, suggested we use a pharmacy that will deliver her meds on a monthly basis, individually packaged into daytime and nighttime doses. My sister found a great local pharmacy that does this, at no charge, and they worked with her, the insurance, and her doctors to get all her meds on the same renewal schedule. They now deliver (also at no charge) 4 weekly packs each month, with her pills for the morning and evening packaged collectively in individual units…they are like a blister-pak but instead of hard to open foil, each unit is covered by easily opened paper. For my neurotic mom, there is also a list of the medication included in each pak, together with a picture of each pill. Now, she can still remember to take the pills on her own, and this delivery method has, we hope, made it more likely that there will be a longer period of time before we have to take more custodial action with respect to this part of her life.
I do see by reading these threads that we are lucky that she, at 86, can still manage her own life with accommodations. I sometimes feel like I am dealing with my mom as I used to deal with my D’s learning needs…finding the appropriate accommodations that will allow her to achieve (or in mom’s case, live) to the best of her abilities. It wasn’t easy then, it’s not easy now!
I don’t think my mother could handle the dispenser or the prepackaged weekly packs from the pharmacy. She needs someone to hand pills and water to. The assisted living aides don’t wait long enough and sometimes I find pills on the floor! With the other methods, there would be a danger of taking meds more than once, since she gets mixed up about what day it is and also forgets she has taken them. Any system I set up (with checkboxes for instance) does not work because she doesn’t have the ability to focus and as soon as I leave forgets about the checkboxed.
I know this is extremely common and compared to some in the psych. unit she is still much better off than quite a few!
Question: does anyone have a parent who had to detox from alcohol? My mother drank alcoholically for many years but in the recent two decades is a controlled, “dependent” drinker meaning she has two drinks from 4:30 to 5:30 while watching the news, eats dinner and goes to bed.
The psych. unit did a three day taper with Ativan and I noticed a difference in her enough to make me ask if the Ativan had ended. She keeps asking me to bring her some gin!!!
When she returns to assisted living, which will probably happen mid-week, I am apprehensive…I am wondering what others’ opinions are about total abstinence, versus, say, two drinks of 1 oz each in the “pub” downstairs. Will that 1 oz times two make her want more?
I am rearranging her room to lessen fall risk: if she keeps falling the AL will move her out to memory care. The additional reason for rearranging is so that she doesn’t go back to the same chair in the same place that will trigger associations with drinking and cocooning at night.
Her life is going to be different and this is going to be a nightmare or requests for gin, threats to take a cab or steal from a neighbor, or return to the house she no longer owns!!! I anticipate many phone calls and am going to start not answering so much- I can listen to messages.
Anyway, anyone with experience with alcohol discontinuation or decrease in a case like this, would love to hear from you! (Lesser concern is 20 pieces of nicotine gum/day!)
@compmom my parents were used to drinking 2 glasses of wine at dinner. When I moved them to the board & care home, it was continued, but the staff noticed quickly troublesome changes of behavior after the wine and we decided just to stop. They have adjusted fine since no other resident drinks alcohol. However, from what you shared in the past, your mom is really drinking about 5 servings of gin per night (8 oz). I think she would do best not drinking at all since I can see the 2 oz quickly escalating to more. I suspect the alcohol is contributing to her falls, dementia, and bleeding issues.
The medicine dispenser I used for my mother was electric, with a battery backup; if anybody is interested, I will look up the brand name. It could be set for 1,2,3, or 4 times per day; at the preset time it would turn to the dispensary “slot”, blink and squawk for 3 1/2 minutes or until the door was pushed back to show the pills. I had several extra trays and kept them preloaded for a month at a time; my mother took pills four times a day, so the tray lasted a week. She always knew that squawk, I guess like Pavlov’s dog.
So much variation in memory/cognition challenged elders: especially in the pockets of competency that endure and the rate at which certain skill sets are lost. Over years, I learned to casually assess my father’s capacity for daily life, (in no way he would notice). Often changes in routine (his best friend moving from their AL to receive more care or an illness recovery phase), revealed vulnerabilities and how important his routine was in reducing stress, allowing him to live on “auto-pilot”. Pull away the grounding cues and wow, there was not much memory left to work with.
Staff reported that he helped his friend find her way to every meal; after she left, I was helping him find his way to her in another part of the building that required going by the dining room first. He couldn’t quite get my explanation that I would follow him to the dining room and then show him the way to her. It taught me to assume nothing without verifying it regularly, as sometimes getting it was a one-off. Since the target is moving and the stakes can be high, regular monitoring became invaluable. The AL staff was also good at noting changes.
It was a relief for both of us to have him in more comprehensive care. He was a social guy and could no longer make plans to see people in AL. In the skilled nursing level of memory care, activities and companionship were built-in; he enjoyed those until his death.
Exactly this! When FIL was moved from his home of 50 years, WOW! The inability to function was stunning, especially given his ability to BS the family into not forcing him to move sooner. He had so much routine in his lifetime home that he could fake higher level functioning. When we saw him in IL/AL, we could not believe how much he had hidden from us.
My Dad drank a lot his whole life. His brother died of alcoholism. In fact we didn’t notice the dementia at first because we attributed his symptoms to his drinking. He was doing all right until his wife of 30 years (my stepmom) left him. I think that without the rhythm of the house things spiraled out of control. I was in the ER with him twice when his blood alcohol was 0.28! When he finally got diagnosed with dementia and sent to the psych hospital for two weeks we thought for sure he would go through withdrawal and to our shock he never did. Alcohol is not allowed in his Memory Care. When we have him to my house we give him Non-alcoholic beer or wine and he doesn’t notice. I did allow him a beer at his best friends funeral and he did fine.
I have transitioned several residents into taking medication with apple sauce or apple thickening, whole or crushed depending on their ability. Some medications cannot (should not) be crushed. When a resident has to take one pill at a time, I just don’t have the nursing time; so I encourage how much better they go down. For some, it is a loss (esp for the men who want to maintain their abilities and see it as a loss). But I am pretty cheerful with them, encourage them, and make it a positive experience.
My FIL/MIL both 88, have their 7 day pill boxes; others help load them. FIL is like clockwork, and he reminds MIL about taking the medication.
There is difference of opinion among staff at the psych. unit on abstinence versus having a little alcohol at the AL “pub.” My brother and I think we will try abstinence at first and then see if she needs a ritual replacement, so to speak, which might mean the “pub” for non-alcoholic or a couple of 1 oz drinks. We removed the chair she drinks in to change the environment (and the smells!)
We met with the nurse practitioner who may suggest memory care unit versus AL apartment. He is afraid she will try to take a taxi to get gin and get lost or hurt. He is trying gabapentin (Neurontin) if her kidneys can take it, along with an SSRI, probably Lexapro, in the belief that she may drink to cover up depression and certainly suffers from anxiety. She is a speed demon with her walker and falls because she gets up too fast- everything fast fast fast.
I looked at a small facility in a private home near the ocean yesterday. But it seems as if it offers even fewer supports than the AL. Very nice, cookies baking, nice women but in better shape than my mother for sure.
The NP said aides at AL retreat when my mother refuses help, because it reduced their workload. I just never thought of that!!! The aide at the geriatric psych. unit keeps trying and between the two of us we got her to music once and to take a walk in the halls.
Her dementia is so much worse from the move from AL to the unit. She has no idea where she is and doesn’t really remember she has an apartment at the AL. My brother visited and got pretty frustrated at all the confusion and endless repeated conversations.
The NP recognized without anyone saying anything that I am doing most of the AL work so basically all of the caregiving and gave me a lot of ideas and support, which I appreciate. He did say that he and his siblings gave up on AL aides and did showers for their mother, but they took turns.
I am going to ask to see the social worker and maybe look at some other memory care units. I only want to move her once. I am also going to ask about hospice. That may be another way to get help that is covered.
My father was on gabapentin, but for nerve issues. After his stroke, he began having “jumpy” feet and the gabapentin settled the nerves. The side effect was that it made him quite sleepy, so since it was “as needed”, we gave it to him at night. Why is it being prescribed?
My dad was given gabapentin for chronic pain. It made him high as a kite. I am pretty sure that it’s one of those painkillers whose effects are definitely multiplied with alcohol.
My mother,too, now 88 years old, when she was 85 fell ( wind blew her over ) broke pelvis in multiple places.
Developed shingles after 7 weeks -
Put on gabapentin - I think it was suggested to take at night which might help with sleep.
Also, family practitioner suggested 900 mg a day- a family member experienced with gabapentin for RSD- said no way- so we did much much lower doses.
Don’t know about alcohol mother didn’t drink, but was using nicotine patches to help her quit smoking.
As soon as shingles resolved we weaned her from medication - she is doing well now.