What can I do if the doctor at my Mom's memory care facility will not prescribe an anti-depressant and my Dad will not enforce it?

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coloradoproud Asked November 2014

What can I do if the doctor at my Mom's memory care facility will not prescribe an anti-depressant and my Dad will not enforce it?

My 85 year old mother with Alzheimer's was admitted to a memory care facility in early August after breaking her right hip, then broke her left shoulder from a fall at the facility a few weeks later. Due to my dad's bad insurance that wasn't covered by the Doctor who visits this facility, she was not being seen on a regular basis. Her mental condition has advanced, most likely because of the traumas which included several hospital stays, several ambulance rides, several non-emergency transports and several different facilities until we found this one.

Since I have been visiting my mom more often than my two sisters, one who is two hours away and the other is a three hour flight away, I have frequently observed and experienced my mom's extreme anger, depression, agitation, and outbursts that cause disruptions to both the caregivers/aides and other residents. it is heartbreaking and deeply concerning to observe these incidents. My mom is normally a soft spoken, loving, caring, thoughtful, adorable person.

One of my sisters who lives a few hours away, who works in geriatric settings as a music therapist, supports my request to my dad, the doctor, the various nurses at the facility and Director of Nursing, and the executive director to prescribe a small dose of an anti depressant to help ease my mom's agitation and sundowning. Ativan was used a few times at the hospital and she responded fine. One facility prescribed Haldol which was a horrible experience for my mom,so I expressed my strong opposition to using this medication at her current facility, which they agree with.

since I visit my mom on different days of the week and at different times of the day than my dad and sister who is out of state, I see the most challenging side of my mom's behavior. When nothing was being done by the nursing staff at the facility nor any action taken by my father to pay out of pocket for the doctor onsite to address my mom's rash and swelling on her legs and her agitation/anger/outbursts, I made an appointment to a doctor who accepts her insurance program, who prescribed a medicine for her legs and Risperidone, which I thought was an antidepressant. that night my sister told me it was an antipsychotic drug similar to Haldol, is not FDA approved for elderly patients with dementia and can cause death .
So I called the facility and explained this to the night nurse, and asked if it could not be given until I spoke to the prescribing doctor and my father, who regretfully has POA. the nurse agreed.

At promptly 9am the following day I called that doctor's office which became a total three ring circus when I was told the dr was out of the office at medical exams, as well as the PA doing rounds at a hospital, so I was relaying messages back and forth between the inefficient receptionist and the PA.
I politely asked for a change in medicine to an anti depressant or ativan, which was initially requested, not an anti psychotic. The doctor, who relayed the information to the PA who relayed it to me, said no and that was beyond their "scope of services??" huh? but they can prescribe an antipsychotic like Risperidone?? It made no sense. After several agonizing hours of trying to get the PA to get the doctor to approve a prescription for something like celexa, the PA said the dr approved it and that she would call it in to the pharmacy right away. I waited two hours then called back and was told it would be called in by the end of the day. that was still three hours away and I had already missed my entire day of work.
Bottom line, it was a futile attempt, because the memory care facility finally convinced my dad to pay out of pocket for the doctor to evaluate my mom, which I thought would be the next day, which didn't happen until a week later.

After that evaluation, I found out that the Doctor still didn't prescribe an anti depressant, nor will my dad enforce it, which my one sister and I do not understand and are extremely distressed, confused and upset about.

Since my dad has POA, none of us are allowed to ask the nurses or staff why this decision was made and when I ask my dad, he blows up, gets very angry like he does with everything. I believe he is cognitively impaired.

I really need advice about what to do because my dad has POA and my sister who lives out of state supports his decision because she flies in to town for only a day or two and visits in the morning when my mom is in her best condition; they never go during meal times or afternoons or evenings when sundowning strikes.

I have called the ombudsman for the region and she did not offer any new options that I haven't already tried. It is heartbreaking, painful and very distressing to see my mom in this state, when I firmly believe that a low dosage of an anti depressant could alleviate her extreme depression and anxiety.

Does anyone have suggestions? I am at my wit's end, like my other sister and extremely frustrated/ depressed about all this

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score 1 · Answer 1

I have taken Celexa for years. I am 71. Celexa is for depression with COPD---not Alzheimers! A person can't MAKE doctors prescribe medications. They have to be a lot more careful with older patients. Medications don't always fix the problem. There is no cure for Alzheimers----it just gets worse. Maybe you could find a support group for families of Alzheimer patients. Any confusion over insurance pay outs--talk to someone from social security, and they'll explain why medicare always pays FIRST and is PRIMARY. Same with the SECONDARY insurance(talk to the insurance company) that you have besides medicare. A lot of this information is online.

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score 3 · Answer 2

First of all, dear daughter, you do not have any power over this situation, and you had better get used to it. You are trying to manage a terminal person who has given her POA to her husband. The fact he does not want her medicated speaks more to the age category when the 80s generation just "pulled themselves up by the bootstrap" mentality and did not resort to pharmaceuticals. You will save yourself a lot of time and efforts by calming down and letting the professionals do their jobs. You do not say you are a doctor or have any medical education, so you cannot prescribe medications because you do not have a license to do this. Therefore, your father is in control of your mother's situation. He chooses not to medicate, has told the doctor his wishes and your mother is never going to get any better. Her falls are from either osteoporosis or dementia (the brain not getting the right messages to her muscles). She will continue to get worse, and pretty soon I suspect her behaviors will settle down with the outbursts (everyone is a little different exactly when), but YOU have got to realize you will not change this terminal diagnosis. Stop trying to when you do not have the authority. Just visit and love your mother for the time she has left and settle down or you may wind up with so much stress you have medical problems. I have already had my mother's Alzheimer's progression, am going through my husband's and took care of hundreds of patient's in my nursing practice. Just accept her diagnosis, and you will be much healthier. My best wishes for your family in this trying time. Get together for a Thanksgiving celebration where you can love each other.

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score 0 · Answer 3

These stories just tear me up...I know and know of men like this who misrule and oppress their families, maybe because that's what was modeled to them by their own fathers, and a few generations back that was totally acceptable behavior and almost an expectation. But, it is wrong.

Normally a POA who fails to act in the best interest of the person can be removed. The POA document itself should specify duties. It sounds like you have documentation. I would think that any legal system would have to have more respect for the sisters who are there and seeing what is going on than the one who is far away and not experiencing anything first hand. I hear your worry about tearing apart the family, but at this point, its already torn if your mom has to spend the last of her life in misery that you know could be prevented. See an eldercare attorney with the facts you have shared with us and see what they say before you give up all hope of making things better.

Now really - if nothing can be done, it is not your fault, and your plan to just be there as much as you can is a good one, as long as Dad does not decide on a whim to restrict your visits...he might feel guilty that you see her more or be afraid it makes him look bad in some way, so that would be the obvious and selfish solution.

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score 1 · Answer 4

It has been my experience that Medicare is always the first place they go to for reimbursement, then to the secondary. Part D of Medicare pays for the meds. I have been under the impression that Ativan for the elderly was not prescribed at all.

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score 1 · Answer 5

Ww, I have to say that at least 5 years ago, my mil was able to have medicare declared secondary. She would decline to give her ssn. In retrospect, a sign of mental impairment, I believe.

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score 1 · Answer 6

Assuming that both of your parents have either medicare (or Medicaid)---------Medicare ALWAYS PAYS FIRST------IT IS ALWAYS PRIMARY!! There is no choice if the person has other insurance as to which one is primary!! Medicare pays 80% of the bill. Then if there's other insurance involved such as insurance from work or say Medigap--then they pay! Doctor's office staff, hospital staff, nursing home staff--whatever that handle the billing KNOW that MEDICARE is primary. I'm 71 and I have Medicare, and I also have plan f medigap insurance that pays 100% of whatever medicare doesn't pick up. It is expensive but worth it as long as I can afford it. You didn't mention whether or not your mom had part D prescription drug coverage?! If your mom is on medicare, and your dad has insurance from where he worked that covers her( or she has insurance coverage from a job) ---MEDICARE is still PRIMARY!! I think your family needs to get the facts straight on insurance, and bone up on it. It's helpful to have a computer so a person can compare the part D prescription plans all at once on www.medicare.gov . There's a big difference in prices! There isn't a cure for alzheimers, and just a few? meds for it. I'm sorry for what you and your family are going through---I had a couple of relatives in nursing homes with it. Sometimes POA's should change as situations change. May GOD be with your family, in your time of challenge.

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score 2 · Answer 7

Carol, something else. My mom, whose older siblings fought in WWII, pointed out to me that those couples were separated, very much incommunicdo, for several years during the war. They seem to have a need to be with each other that may transcend the typical. You can only do so much. Know that you have loads of non-judgmental support here. Let us know what is going on.

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score 2 · Answer 8

dear freqflyer, wow you are so totally right on the money with your answer! he has no clue what it means to be compassionate, empathetic or to take action. he is overwhelmed in every aspect of his life now without mom to badger, bully and demean. you probably detect some negative family dynamics here and well, yes while I admit my father has always been an angry, demeaning, critical, bullying, pessimistic and hostile husband/father/person, his characteristics have become more pronounced as he ages and I/ my one sister, believe he also has cognitive impairment. I think I might finally be at the stage of accepting what 'is', letting it go and surrendering it to God and just treasuring each day I have left with my mom. The less communication I have with my dad is the better. I am so grateful for this website, forum and for all of you who have been so compassionate, thoughtful, empathetic and caring--something I have so desperately needed for a long time. my gratefulness to all of you.

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score 2 · Answer 9

Carol, one reason your Dad isn't doing much to help your Mom is his generation where the women took care of everyone's illnesses in the household.... majority of men [not all] would just sit on the sofa reading the newspaper while Mom was Florence Nightingale.

Now it is Mom's turn to get some care, and Dad is now clueless about what to do. He's is baffled because his job probably was to go to work and fix things around the house.... he cannot *fix* Alzheimer's. The poor fellow is so overwhelmed.

When my Dad [93] was in the hospital for a recent fall, I told him that Mom [97]should be here with us because she is his POA for medical.... but Mom wouldn't come to the hospital because she is almost blind and very hard of hearing so she wouldn't understand what the doctors were saying. Therefore, I told Dad that he might want to consider someone else to be the POA or co-POA with Mom. I shouldn't be making his medical decisions for him.

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score 2 · Answer 10

Carol, just remind yourself that it's not that they WON'T communicate, it's that they CAN'T communicate, due to HIPAA regs. You can give them loads of information, they can accept it happily, but they can't tell you anything. Appreciate the situation that they are in. Believe me, they don't want an agitated patient any more than you want your mom to be agitated.

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score 1 · Answer 11

Dear give a hug:
I appreciate and respect your points. In fact, if the Doctor or Director of Nursing or Executive Director or my dad explained to me and my sister that "the reason why a certain drug isn't being prescribed is because it would react badly with other medicines" then I would let this all go and accept it.
but no one has said that, which is what leads me to believe that my dad just won't request it with the doctor. I asked my dad last week, 'has the doctor finally prescribed something for mom's depression'? He answered in his usual angry and defensive manner, so I hung up.

Your question: Has the facility checked the patient for an urinary tract infection which can cause the patient to act out, be angry and disruptive?" is a great one and yes they did. she did not at the time, nor does she now.
Your question about the health insurance--it is not the one your Dad had when he retired from work. He chose Freedom because it was the cheapest but none of us understand why Medicare is not their Primary. I pray he will change to Medicare as their primary during this enrollment period.

I am trying to accept that the best solution right now is to 'let go and let God' and to honor the Serenity Prayer that says: God, grant me the serenity to accept the things I cannot change,
Courage to change the things that I can,
and Wisdom to know the difference.
I am trying to trust the doctor's decisions and all of the staff involved.
it's just hard when they won't communicate.
thank you again.

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score 1 · Answer 12

But I agree that it might be time to step back from this insoluble problem. First iff, you need to take care of your health. Get to your doctor and have those cardiac symptoms taken care of tomorrow. Mom is in a facility. Let them figure out her meds. Yes, Respite done is an antipsychotics and it may be what mom needs if it's not, facility will find that out. In my experience, antidepressants, which don't kick in for a month, don't do much for sundowning. You've done everything you can do, short of calling APS and I don't think that would much good at this point. Mom is safe. She may be miserable, but she's safe. She made the choice of making dad poa. My aunt and uncle went through this. He had dementia, she had mobility problems. He fired aides, did report her broken hip (he pulled her around on a throw rug for three days). And after rehab? She went back to the house to live with him. She was competent. She refused to give her daughter POA. She predeceased my Uncle by three years. She made her choice.

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score 0 · Answer 13

My MIL refused to have Medicare as her primary because she thought they took too long to pay. My BIL finally got poa and changed this.

Agree that you need a united family front and perhaps pursue guardianship. I can only imagine how frustrated you must be.

Agree with

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score 1 · Answer 14

thank you so much for your suggestions. My supportive sister and I just recently tried to proceed with this direction, then my sister who supports my father flew in to town, had a meeting with my dad and the facility's Executive Director, which only firmly confirmed that he is p.o.a. and mom's advocate and will be the only person allowed to speak with the nurses and staff about mom's meds and decisions for her care. Neither me nor my other (supportive) sister could attend due to commitments.
He has neglected my mother and her Alzheimer's condition for several years, would not buy healthy nutritious food, not allowed my mom to go to an adult day care facility for social activities, did nothing to improve my mom's lack of showering for many months and her hygiene, and chased away four home health care agencies that I had researched and who were helping my mom. The list of my dad's incompetency's are lengthy.
Unfortunately my sister in Washington D.C. supports my dad, for reasons I and her twin sister do not understand.

I have been told by doctors, home health care directors and my mom's out of town sisters who are hearing about the rapidly declining condition of my mom and my dad's poor choices, that my dad is inhumane, crazy, unreasonable, neglectful, and mean for doing this to my mom. I should have called social services when mom was still at home, but my dad has an interesting way of acting very different around professionals and would have covered up the reality of his neglect. I firmly believe that my mom wouldn't have fallen at home and broken her hip if there was a home health care aide in the home. but maybe this needed to happen to get my mom out of the neglectful environment and into a facility with better care.

It would be me and my nearby sister against my other sister in D.C. if we tried to get guardianship. this is what tears apart families and it is heartbreaking.
maybe I should set up a meeting with my supportive sister and an elder mediator??? do you know how I can find one? thank you again

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score 1 · Answer 15

There are times where we really need to step back and let the doctors, hospitals, and facilities do their job. We aren't doctors, nurses or pharmacists nor are our siblings. You can suggest and give ideas.

Has anyone said that the reason why a certain drug isn't being prescribed is because it would react badly with other medicines the patient is taking? Has the facility checked the patient for an urinary tract infection which can cause the patient to act out, be angry and disruptive?

Is the health insurance the one your Dad had when he retired from work? If he is like my Dad, he will refuse to change insurance companies because if said insurance is good enough for the company he worked for, it's good enough for retirement. My parents think their secondary insurance is pure gold.

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score 2 · Answer 16

You mentioned something about thinking your dad might be cognitively impaired. You might want to explore this as you could be right.This could get nasty and require getting an elder lawyer involved because your dad may not be able to make good decisions because of possible early dementia.You may be right about your dad because family will notice the first signs of dementia before strangers will, you know him better than others and will notice things first.You might have to start proceedings in getting your father declared incompetent and get guardianship over him and your mother. I do not envy your position but you and your siblings need to start talking and get a game plan before things get really bad. You and your siblings are your moms advocate now and also your dads because it sounds like he may have previous mental issues with possible encroaching dementia on top of them.

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score 1 · Answer 17

I'm so grateful for your fast response. I cried as I read your response because I feel so lost and like there is no one that will help. The bad insurance is Freedom, their primary insurance and Medicare is their secondary. Since I moved here two years ago from Colorado to be closer to my mom, I have been asking why Medicare is not their primary. My dad has always been a very angry, hostile, nasty person and he would always start an argument when I or my supportive sister asks a question, so it came as no surprise that he couldn't have a discussion about the reason for his decision not to have medicare as his primary. Finally though, the facility has convinced him to change his insurance to medicare since it is open enrollment. when I offer assistance to my dad about Humana, Florida Blue, United healthcare, he gets angry and says he's handling it and going to their seminars. My experience with Freedom's doctors is that they are incompetent and just need the clients, proven by my most recent experience with my mom's appt.
I asked about a geriatric psych and there is not one assigned. I cant admit my mom to a behavioral hospital because my dad has poa. I tried to do that already.
I feel so guilty when I hope that she falls again and has to go to a hospital so that a psychiatrist can see her.
Someone suggested palliative care, would that override the facility's doctor's decision?
is there a facility licensing or a regulatory company that I can call for advice?
my sister and I believe that ignoring my mom's need for this medicine borders on neglect and elder abuse. would you agree?
this is truly gut wrenching and I have chest pains and fluttering every day.
If there are other associations or patient/family advocate organizations that I can contact, can you please let me know? thank you again for answering. i'm so grateful.

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score 3 · Answer 18

Does your mother have Medicare or Medicaid? (Wondering what you mean by bad insurance). Unfortunately if your Dad has POA, you would have to get guardianship in order to be able to call the shots. Is there a Geriatric Psychiastrist who visits the facility? Can your mom be admitted to . The behavioral unit of a hospital in order to get her meds stabilized? If she falls again and goes to the hospital, get a psychiatrist consult right away
I'm so sorry you and your family are going through this.

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What can I do if the doctor at my Mom's memory care facility will not prescribe an anti-depressant and my Dad will not enforce it?

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