I recently wrote about a change in how Nursing Homes are being evaluated and are being downgraded by Medicare Compare ratings for using antipsychotic and other similar medications (Read more: Change in Nursing Home Compare Ratings). Christine73 commented on how her mother, upon placement, was taken off of her dementia medications and described the struggle her mother went through and the battle she had to fight to get her mom back on the medications she needed.
When we place our loved ones in a facility, we trust that the doctors and staff will do what is in the best interest of their patients: First, do no harm. As advocates for our loved ones, ideally we work with the facility to ensure our loved ones are safe, pain free and content. That has been my goal from day one, when mom chose placement back in 2005. Although the incident I'm about to describe was in 2010, I feel it is relevant to the current changes being implemented in nursing home ratings.
It has been my experience that medication management is an especially difficult task when dementia is in the picture. Every person reacts differently to medications, so doctors and caregivers try to find the right balance through trial and error. What works for one individual may cause harm to another.
I am not a big fan of medications, however they sometimes become necessary to treat the symptoms that go along with dementia.
In 2010, my mom was going through some depression and was put on prescription medication for it. During one visit, I noticed that Mom was off-balance and could barely speak, she seemed to be overmedicated. I went to the chart and discovered that her Xanax had been increased to a very high dosage. I was not notified of the change, which was not the norm. I spoke with the nurse in charge and her reaction was that mom likes the attention and was faking it.
Three days later, mom broke her arm due to a fall. A meeting was called with the administration and we asked that mom be taken off the medication. The psychiatrist decided to stop the medication cold turkey, sending mom into withdrawal symptoms. It was the saddest thing I've ever witnessed. My sister and I then took mom to see a few other doctors, as this doctor no longer wanted to treat her. When the other doctors saw who the original doctor was, they told us that they were not going to go against his recommendations.
So I had to get mom out of the area. Luckily, I had worked in health care in another county and was able to bring her to a psychiatrist who recommended that she attend a geriatric behavior center. She ended up staying there for ten days while they weaned her off all of her medications and then slowly added the right ones back in. The results were miraculous; we got mom back.
We knew that the nursing home was no longer the right facility for mom, but she was now listed as combative and most places did not want to accept her. We eventually did find a place that would take her and we moved her out without notice.
Change is very difficult on a dementia patient. Mom hasn’t been the same since she had to make that move; she has advanced further into the disease. But I feel confident that she is well cared for at her new facility. We do have a good relationship with the staff and we do our best to work together to do what is in mom's best interest. The irresponsible behavior of one doctor negatively changed the course of mom's journey.
The government's new procedure on grading nursing homes definitely has its pros and cons. I do believe it will reduce abuse of medications, however it is important to factor in each patient's individual needs so that their best interest comes before how many stars the nursing home receives during an evaluation.