Can nursing homes change a patient's medications?

I agree with Stargazer. The resident doctor of the nursing home would likely be the person who took her off the meds. If this is just an insurance issue, he or she should be able to push it through the insurance (or the neurologist could). Sometimes it takes several tries.

Try to have a talk with the resident doctor and let him or her know why the neurologist prescribed this medication. See if you can get some cooperation between doctors. I know this shouldn't be your problem, but sometimes this happens. Good luck,
Carol

Their resident doctor must have pulled her off it. Try tracking him/her down and having a personal talk. Let that doctor know you want her on the med and that her SPECIALIST wants her on it. Say something like, "I don't think either of us wants to get lawyers involved in this." Make it clear that you want to be involved in ANY changes of medication and you want to have final approval.

The nursing home is responsible for paying for her meds. As such, the doctor for the nursing home may try to pull crap. As soon as they know you're watching, they change their tune.

It's Medicare who is picking up the tab, correct? If state funds are involved, try contacting the person in Michigan who oversees the nursing homes and get the real story.

Been here : ( Be strong. Be a fearless advocate! You'll be surprised how people back down when they know you're up for a fight ; )

I am an RN. While I recognize that Stargazer is sincerely offering advice in a difficult situation, I don't agree with using intimidating statements about "specialists" or threatening with lawyers unless a situation genuinely calls for litigation.

The doctors I've worked with have been some of the most ethical people I ever met. And yes, billing issues do play a part in medical decision-making-- maybe not the best thing about American medical care, but it is our current situation.

Assume your MD is doing his or her best. First, ask why a change was made. If you still disagree, respectfully seek another opinion or ask the internist to speak with the specialist.

There's nothing wrong with getting a second opinion. In fact, I periodically encouraged patients to get a second opinion (or sought one myself) on my own decisions. And you know what? It wasn't unusual for the second opinion to disagree with me, the patient would agree, and we would all go in that direction.

My point is, if you disagree with a doctor thats fine, or even great in that it means you care and are diligent. But, when you address the issue, assume that the doctor is sincerely trying to do his or bes.

On the "outside" it is unusual for a physician to change in medication without a call to the prescribing physician. However, in the ALF, the house Dr. becomes the attending physician and is responsible for the patient within those quarters. I once had a similar situation with my mother but in that case I was glad that the attending had changed her meds. She was becoming agitated at night on her old meds so the doctor modified some things.

In this case, you are right. It sounds like it is just about the money. Seroquel has not been covered by Medicare unless it is for treatment of a bipolar disorder. It is specifically contraindicated for treatment of insomnia.

Assuming it is within your means, I would write a letter to the facility and the attending physician(s) stating that unless it is an emergency, you do not want any of her medications changed without prior authorization from you. You may wish to state that if the item is not covered by Medicare, you will pay for it as long as you are giving reasonable notice of the situation and the cost.

Pharmacy laws are done by state. Depending on where you live, it might be possible to provide the medication to the ALF for them to dispense. In Maryland, this is not possible as the laws specifically require medication to be dispensed in a blister pack under controlled circumstances.

Some Medicare part D plans have covered Sarah quell. However, there is now a movement from the Obama administration to limit the use of several medications citing improper use and high cost. There was an article in the New York Times on February 21, 2014 about the subject.

I had a patient on Seroquel whose insurance stopped paying for it. Through a series of phone calls and a whole lot of stress she was able to get the generic of Seroquel which is Quetiapine. This wasn't a case of her Dr. taking her off of it but a matter of her being able to pay for it.

Dr.'s in nursing home are elusive creatures. You never see them. They don't evaluate the patients in person, you can't catch up to them if you're there while they're there and if you'd like the Dr. in the facility to know someone you have to tell the nurse (not an aide but the nurse) and then follow up to make sure a notation was actually made in the chart. Dr.s in nursing homes are like smoke....or unicorns. No one can ever really get their hands on one.

But I agree, it's the Dr. that you have to talk to. And if the state is discontinuing psychotropics that's going to be one lively facility.

The nursing home ( rehab) where my Dad was for 2 weeks gave him the wrong medications. We didn't find out until I filed a complaint against them and in investigating discovered it! I was irate!

In Arizona, the resident physician has total control of the patient and a private specialist would lose their involvement, unless the family wanted to arrange the resident to be taken to the private neurologist on their own. My Dad has both a geri psychiatrist and staff AND a residential medical internist on his case, but his historic private MD and Neurologist cannot be involved, because I live out of town, and my 88 yr old mother is unable to transport him to appointments. I do have it written in his care plan that meds cannot be changed without consulting me, because I am a retired RN, and other family members still see the same neurologist, so I can ASK, informally, what his thoughts are about planned med changes and relay his thoughts to the geri psych Nurse Practitioner...but all orders for meds come from the docs who are affiliated with the facility.

To everyone who would like to assume the best intention of the NH doctor, I lived this and I can tell you it is not always the case. I did exactly as I suggested and got control back over my mother's medications, but only after he had pulled her off Warfarin and she had a stroke.

Sure, have a nice talk first, but make sure they understand you mean business and you're watching closely.

In Texas & again it is different in each state & probably even different in different NHs as to what their corporate rules are, but in Texas you can take your loved one out to any doctor that is not on contract with the NH for a check up, labs, anything except the NH is not under any obligation to follow any of that MDs orders (even a specialist) because the physician is not on contract with the facility. Since you mention the state when speaking of payment of the med I am assuming she/he is in the NH on NH medicaid (not medicare). In TX & on dad's Part D, only medicaid would pay for a psychotrope while Part D would pay for non-psychotropes. Don't know about narcotics. When they say that the state won't pay for it I am assuming that they mean since their contract MDs did not order or prescribe it then no insurance is going to cover the cost of it. No NH I have known would be able to fill a prescription written by an outside MD (even a specialist). Now what I have seen done is in the interest of Aricept (non-psych) the resident MD did go ahead & order the prescription because my outside Neurologist had ordered it & I brought the orders from the Neurologist appt. & usually from what I have seen the resident MD wants to follow a specialist's orders because it is a step above theirs. Usually they won't write a script for an outside md if it is a GP like them even though it has been a more thorough office visit. Who in Michigan pays for psyche meds I don't know but I do not think the NH is over-stepping their bounds since they wouldn't get covered unless of staff one wrote the script. I am surprised to hear that any NH anywhere sided against a psyche med. Most jump at the chance to have them on one. I know it is a tough situation because they are truly impossible to meet or speak with. If your NH has more than one doctor to choose from, speak with the DON & ask to switch doctors. Every patient (POA) has the right to choose their own MD. Only problem there is if the other doc doesn't want to take a patient from the current doc then you can end up w/o a doc & the NH cannot keep the patient living there. I would tread lightly on that one & try first to ask for a phone call for the current doc with your phone number rather than trying to meet them. When he calls the number will be blocked. If he doesn't call, call each day & speak to DON. Finally say, I have to request a new doc since this one won't call. You will hear from current doc pretty quick. When he calls just ask why he didn't want to prescribe it. Maybe he thinks the side effects are too dangerous & she is behaving okay. The only times I have consented to a psyche med was when I had to to keep them from throwing my parent out. I don't care for them. I had one MD that simply would not prescribe them for anyone in a NH because of dangerous side effects. Loved her.

If they wouldn't write the script at the NH & you are POA the way they over-stepped was by not calling you & informing you the MD wouldn't prescribe. Now again on NH medicaid the MD is only to see a patient once a month. I don't know when the MD saw her but he also may be having trouble prescribing a psyche med when only an assistant saw her or he had already seen her. Psyche meds are thought of differently & I don't know the state rules on them.