Can I have the nursing home inform me before they add medications to my father's daily regimen if I'm his Medical Power of Attorney?

Summer this is an old thread - you may want to start a new one.

You would think you can reliably get updates on all med changes by asking, but I found you actually need to get the updated lists every now and then. Sometimes you make the request to be notified, and they will call you if they add triple antibiotic for a scrape and not call you if they add Geodon or restart something they have reacted badly to in the recent past.

Seroiusly, thought it is not totally medically correct, if the facility uses only an "Allergy" list and not and ADR (adverse drug reaction) list it is not wrong to put the meds that have had bad reactions on the allergy list. Too often, otherwise, people add back a medication that does not agree with someone because their symptoms that occasioned using it in the first place are still there, most people do not get most side effects, and for some reason health care providers too often assume that no one already thought of the obvious and tried it already, without even asking the patient let alone a caregiver who may have been keeping track.

My dad had a cardiac areast and triple heat bypass now left confused by brain damage he was in a reabitation centre for a year now medical records sent and he is on to many tablets of hospital to control his behaviour our gp says waiting on reports to come back it's so upsetting seeing my dad like this we need to get him on the right meds any thing we can do apart from phone doctors

helpingdad,
Your comment and information is really helpful to me.
Do you know if there is a name for this type of "condition or problem" when a person has a reaction of this type to drugs?
Something I can call it when I talk to my dad's doctor next week?
What you said (in quotes below) is what is happening when they put him on allergy, cold medicine. Does this toxic reaction have a name?
-Thank you

""If you look at the list of medications that can SIMULATE age related conditions, antihistimines and anticholenergics are the worst. They can cause agitation, anxiety, cardiac arrythmias, confusion, constipation, depression, dizziness, disorientation, depression,fatigue, hypotension, and restlessness, urinary dysfunction and visual disturbances. I am a licensed nursing home administrator and for the past 30 years I have been a geriatric nurse. So yes I have seen this many times. In a long term care environment """

with that many medications he surely needs a pharmacist consultation.?

Helpingdad had a great comment, though there is one thing I disagree with - staff MUST take time to think about medication reactions. They are omitting a very important part of their job of coordinating and managing medical care, if they don't. I take care of rehab inpatients and that is a huge part of what I have to do, to try and determine if medications are contributing to any functional decline that we may observe (versus neurosurgical, psychological, or other complications for which medications may actually help, and/or more major intervnetions may be needed). Of course we are expecting all our patients to get better, so maybe that helps make sure alarms go off when something goes awry. We've seen everything from confusion on Motrin and hallucinations on Inderal, and at just ordinary or even low doses, which some people seem to believe can't possibly cause any problem. I've seen a Celexa reaction misdoagnosed as an MS exacerbation. I've seen insomnia caused by sleeping pills. You can NEVER stop thinking.

Cold and allergy medicine is designed to dry up mucus membranes in the head, This way you do not choke and cough, your nose does not run and so on. If you look at the list of medications that can SIMULATE age related conditions, antihistimines and anticholenergics are the worst. They can cause agitation, anxiety, cardiac arrythmias, confusion, constipation, depression, dizziness, disorientation, depression,fatigue, hypotension, and restlessness, urinary dysfunction and visual disturbances. I am a licensed nursing home administrator and for the past 30 years I have been a geriatric nurse. So yes I have seen this many times. In a long term care environment, staff usually do not have time to look for the underlying cause they just look for the next pill that will give them a quick fix. Your dad needs a medication vacation after about 2 weeks drug free re-assess what issues need to be treated.

Regarding my original post. The NH has said they will inform me of all my dads medication changes.

Thank you for all your comments.

Looking thru all this paperwork and seeing what I think I see -makes me feel like I must be crazy to believe I know what I am talking about. How could the doctor & nurses not see it other than they have too many patients?

Can medication side effects even from cold and allergy type medications really affect the elderlies health and mind this badly?

I decided to go to the nursing home and get all of my dads medication records, nurses notes, and doctor notes to see if they did anything different leading up to his decline and hospital stay in Feb 2009.

In reading the 4 months prior he is doing great (other than not wanting to live there) he is walking, using the bathroom fine, they have to keep getting after him for walking to lunch and dinner without his walker (because he didn't need it), he is transporting himself in and out of bed okay etc....

They started giving him Robutissin DM on Feb 7th. (for cigarette related coughing (stupid))

Then Feb 10-12 they start sending him to the hospital for breathing problems, hallucinations, fatique, lack of response, talking about stuff that isn't happening, the 11th he stumbles and falls, etc... he makes 3 trips to the hospital but they decline each time to admit him since he seems to not have anything wrong (the E.R. doesn't know him and doesn't know his behavior is not like him) No one from the nursing home goes with him....

I visit him and tell the nursing home they MUST be messing up his medications, or he has had a stroke of SOMETHING. No no no nothing has changed his meds are the same.

Then on the 12th the hospital admits him and it all goes down hill from there and continues to be going downhill now. Since that time they have added anti-psych, alzheimers, anti-depressants etc... etc... and keep changing his meds. (which I never knew they could do without telling me)

ANYWAY, weve always known dad had exaggerated response to any tpe of cold, anti-histamine, allergy type medications,, he just cannot take them. We always thought because of his diabetes but....

I am reading all this stuff and I can see what has happened with each incident and I can see it all started on February 7th with that Robu DM and then the trip to the hospital - where who knows what they gave him.

After 3 days there he went completely out of his head. completely
gone and really, really bad scary scenes. then to mumbling. First time in his life he is incontinent and this is a horror to him.

Then he miraculously recovered (mostly) after the said they could do nothing for him, could find no infection, no cold, no pneumonia, there was nothing wrong with him..... so they quit all antibiotics quit all treatments (except the fluid) and he recovered but was never quite the same.... and it scared him and he got mad at the NH and so within a month
the NH doctor started prescribing anti-depressants and anti-psych to make him a happy boy.... risperadal and venlafaxine. (and he is now also on two alzheimers meds for the side effects of the above OR now we don't really know)

I can sit here and read the nurses notes about something really weird happening or a decline and then go look at the medicine chart for a day or two or three before and see a big medication change (added or dropped) and it is like they never even tried to make these connections.

I just am sick that I am too selfish to have my dad live with me. He must really have terrible toxic reactions to all kinds of medications... I wonder how many other older people are going thru this in nursing homes. and this is REALLY the best nursing home in this state,,, everyone says so. They just are not used to dealing with toxic reactions to drugs. AND I didn't have a clue!

I go back to talk to the head nurse again tomorrow.

I really have to get them to never give my dad these cold and allergy medications. EVER. Sometimes I feel like I must be nuts because how can they be wrong in what they are doing and I be right? But it is right there in these papers. I wanted to see if the dates of traumatic events correlated to medication changes and they mostly do.

but how do you get all that backed off .... will doing that hurt him?

Your father is on 20 medications?!!! Oh My GOD! Is it possible that there is some drug interaction going on? If it were my dad, I'd get a list of medications, the dosage and schedule then take it to a pharmacist and ask their opinion. Allergy meds alone can cause all kinds of problems with the elderly, then when you combine blood sugar issues and other meds, it's impossible to know what can happen. I've read that allergy meds are also not tested for interactions with the "new" drugs for alzheimer's treatment - which I find rather scary... Anyway - you're not likely to get much help from the ombudsman at the VA either so go up the chain of command. See if there's someone with the state dept of health that overseas long term treatment facilities. I've heard good and bad things about VA facilities. I don't feel right about commenting too much since you have not asked for advice on that matter but it if were my dad - I'd look into moving him. As a veteran he might still qualify for some financial benefits to help with his rent in assisted living. There should be a VA rep in your county or state that can help you understand what's possible. Good luck!

I've had that happen more than once - it suddenly dawns on me that a symptom is really a side effect - I wonder why it takes so long? I've never had anything permanent, I hope yours clears up eventually! My other great hope is that someday we will have ways to predict more of these in advance - right now they only have it for a couple of cancer drugs. If they could tell you with a little more certainty you'd be OK on the muscle relaxer it might be worth trying it, but if it is a benzo in the same class as Ambien I don't blame you for steering clear.

Ed,

I really enjoy your posts. Thank you.

I took Ambien for a few months about 10+ years ago and I believe my brain NEVER recovered.

It was the first time in my life I was not just the sharpest knife in the drawer. Hey, I was used to being "always right" LOL :) and all the sudden I was having serious memory problems.

All the sudden, I forgot meetings, i forgot conversations, people started saying "don't you remember that?"
When I started seeing things at night and answering the phone with no memory of it later, my husband got concerned.

It dawned on me the Ambien was doing this to me.
It is extremely dangerous for some people.

I truly believe it messed me up good and I think it did some permanent damage...... live and learn....

I warned everyone I knew about this and several people told me wild stories about Ambien later. Now you hear it in the news.
No one in my family can take it without doing bizarre things like cooking at night, sleep walking, making phone calls.

It also made me forget hours during my days. Not just nighttime stuff. I wish I had figured out sooner what it was doing to me so I would not have taken it for nearly 2 months.

Taking Ambien is one of the biggest regrets of my life. AND it was my only prescription medication ever. The doctor also gave me a muscle relaxer but I didn't get it filled.

I can sure relate to this - my mom's neuro brought up possible Lewy Body disease because of her hallucinations, but those vanished off Cymbalta. She has that problem of mixing up dreams with reality big time - it was extrememly disturbing to me at first, but its not that awful as far as her day to day quality of life, and at this point, what else matters? She almost certainly has vascular dementia also, related to 25+ years of moderately to poorly controlled type II diabetes, and she got worse on an Alzheimer's med also. Both types may do badly with antipsychotics unless kept to a VERY low dose, with Cogentin at the first hint of motor side effect (usually Parkinsonism) which they may have anyways - my mom's repsonded really pretty well to a little Sinemet as we never went that route. Funny story there - the geriatrician was more worried about side effects on Sinemet than I was, go figure. I guess he had someone hallucinate on it, but we got lucky and I'm glad we tried it.) Trying to subsitute for good healthy brain function by messing with the balance of neurotransmitters is a dicey business - great when it works, but defintiely has its limitations. For my mom, "really pretty well" meant she stopped spilling stuff all over herself when eating, and maybe a little less retropulsion that was throwing her off in trasnferring and working with PT - not a cure by any means. Ideally they should be working with you and any therapists invovled as a team to determine what is really helpful and what is making things worse, overall - you may have to decide what functions are most important to try to improve if possible, what will not be possible, and what will just have to be accepted and compensated for.

GUYS/GALS:

Took a 5mg Ambien last night, and am still having "senior moments." My eyes are open, but the brain's still napping and I feel run down. I'm going back to bed to "detox." Good night family.

-- ED

N1:

Amen to that!.

SO ALONE:

I meant to say "slapping the taste out of someone's MOUTH out ..." Sorry for the typo.

SO ALONE:

This smells like malpractice to me. As his MPOA, they should consult with you about any medications and their side-effects before administering them. Make sure they know that.

Although you already have a listing of the medications added, ask them for the monographs you can "better understand how to cope with possible side effects" [how they're turning him into a vegetable to make things easier for them]. Heck, ask them for a copy of his chart in its entirety. Paper trail baby, paper trail. In our highly litigious society what you say and claim isn't nearly as important as what you can prove. If you don't have it down in black and white, it never happened and push comes to shove it's going to be your word against theirs.

Like Gilly said, contact the ombudsman and calmly raise your concerns. If you feel he/she isn't helping, take other calculated measures so you don't let your emotions cloud your judgment and do something stupid like slapping the taste out of someone's out just because you're overstressed. After you've exhausted every option, your last resort is the court system.

All of us here want you to be balanced and happy, so keep us posted on your progress. We're glad to help.

Always at your service,

-- ED

Thanks for your help, support and comments.
I have gone to the VA office and talked to the person dealing with nursing homes. He took very prompt action in checking into my concerns. He isn't a doctor so any explanation to him was sufficient but I believe just his questioning them and his attention will key the doctor to think before prescribing so many medications at once.

I tried switching his primary care doctor to a VA doctor here in our town but apparently this is not allowed in the VA system.

I am going Monday to review my dad's medical records and get copies of anything I may need to help me get help and second opinions (using medicare since VA only allows the NH doc to be dads doctor) apparently you have no right to your choice of providers.

Also -Once I get the information and backup needed, I am going to talk to someone at the nursing home to ensure they inform me BEFORE prescribing new meds so I can be on the alert to watch for bad reactions.

Because CMS mandates it, most states require that the POA be informed of any change in condition. This being said a facility is hard pressed to say we are starting a new med but there was no change. There had to be a change, even a minor change or they would not have started a new med. When you are speaking with a facility do not hesitate to remind the facility DON and/or administrator that if they do not wish to cooperate, you should be able to get the information you need from your state public health department. Facilities can try to stonewall you but they will not stonewall the state agency that grants them a license.

My heart goes out to you. From the info you have provided, I would definitely start looking for a new doctor & nursing facility.
God Bless

Hello Thank you for your comments and help.
I just stayed with my dad several hours each day over the past 3 days. I just stayed in a hotel in the area.
The nursing home did stop the anti-histimines and the allergy medications. I requested they stop the vicodin but they have not.
The doctor comes in who is affiliated with the nursing home and he prescribes the meds.
My dad is a possible vascular dementia but who knows with all these medications. His main problem is diabetes.

From all I know of my dad and from staying with him for 3 months following what we thought was a stroke I am getting pretty convinced myself that dad may have Lewy Bodies Dementia and these drugs for alzheimers, mental dementia, and anti-psychotic the nursing home has added are making mild confusion and paranoia into true dementia.

I feel that I am complaining and that they are defensive. They take good care of dad but who cares if they keep him alive for 15 years but bring his quality of life down to nothing?

Really, how bad is a doctor when they newly prescribe Vicodin for pain, Namenda for dementia, Actifed, and Zyrtec all in the same day to a person with "vascular dementia"?

3 weeks ago my dad went to Wal-Mart with me and walked around using only a shopping cart. A week later he could
not even get out of my car and could not feel his feet.
Now he has blisters on his feet because they put his shoes on
him with the back folder in against his heel and he is a complete mess.

Dad is on 2 Alzheimers meds, an anti-depressive, and an anti-psychotic all new since he went to the nursing home over a year ago.

Things I would ignore like his believing his dreams for 10 minutes after he woke up, I would just talk to him until he realized it, and he'd say "what in the world am I talking about"

Well that sort of thing freaks the nursing home out and they started prescribing stuff. I tell them to stop the medications
but they have to check with the doctor. I say my dad and I discussed and he doesn't want it but they leave the say up to the doctor (the va doctor who visits the home)

I have to find my dad a doctor but I don't know how to get a good one and I am afraid to make things worse.

My dad was NEVER incontinent in his life and now he is probably because of these new medications?? If it were not for that I would take him out of the nursing home for a week and wean him off some of the stuff to see if he improved.

It is a nightmare. But the more I look into it the more I am believing he may have Lewy Bodies.

When I was there with him this past Sunday afternoon he was really good and I was so relieved that taking him off the allergy and anti-histimines had mad such a good improvement. He was no longer blank faced. But today I went earlier in the day which would have been closer to his morning pills and he was hallucinating about seeing people and things. He was still better as far as being alert but he was seeing things that were not there.

I am in Central Mo I would love to find a good geratric doctor or psych MD who could become my dad's regular doctor.
How do I find one?

I am a LPN and I know it's state regulation that in Ky and IN nursing staff MUST contact POA, closest of kine or who ever on file before admin of 1ST dose. Check out the state reg for your state. Facilities can actually be fined for failure of this in KY and IN if it's a presistant issue. A copy of the state regs should be found in the lobby at your dad's facility. You can make any request you want for your father's care as POA.

I'm also a doctor and a lot of my colleagues just seem like they don't believe anyone ever has side effects. I think I have learned diferently from 1. being a rehab doc and needing patients to function plus 2. needing to take a few pills myself!!
The only other excuse I see for making it into a hassle is its just easy and fast for them to Rx whatever they think should work and not worry about the consequences, and they are pretty well swamped and depend on overworked physician extenders to boot. A thoughtful discussion of effects and side effects takes a little time, as does an intelligent medications review. Both NEED to be done though, and we need to insist sometimes, our loved ones may do a whole lot better once it is straightened out and notes made of what does not agree with them. I think everyone should keep an ADR (adverse drug reaction) list as well as an allergies list. Sure, there are people who make mistakes about what really gave them problems and end up saying they are allergic to 30 different things, so this is not foolproof, but most people are pretty realistic.

It took me months to get them to give my mom a med I knew would give my own patient in a heartbeat for a specific condition she clearly had, and it finally worked when they did...the one doctor would not do it at all, another agreed but started a differnt med. There were somewhat good reasons at first to do that - needed a little antidepressant effect as well as pain relief - but in the long run, my pick was the better one for her adn would have avoided some hallucinations that she got as side effects. And I never did get my dad's headaches treated, though the doc was otherwise very good and took him off everything he did not really need. We should try very hard not to underestimate side efects - they may not be behind everything that is going wrong, but may be behind some very severe problems at times. I watched my mom end up with an ER trip when trying an Alzhemier med (she has vascular dementia, it was a long shot and I did not mind them giving it a try, since the increased irritability and resulting combative behavior was a very unusual turn of events, and they stopped it pronto after that. My dad got serotonergic syndrome when given the SSRI they usually use in this one ICU he was in, not adjusting the dose lower for geriatrics which they should have done. The nurse seemed to feel I was intruding to complain about his being beet red and miserable (no he wasn't on vanc) even though I have medical POA too. Maybe it was because my license was from out of state...but they did fix that one too after I insisted this could be serious and I wasn't leaving til I talked with someone. Just getting a list of meds can be a hassle - I had to literally get my POA papers out and point to the exact line that said I could get it from a nurse with a bad case of HIPAAphobia once!! That was at the same place they refused to treat her neuropathic pain - not suprisngly she did not do well in therapy there and we had to move her out shortly therafter.

As POA you have the right to insist on approval on any medications. Speak to the Director of Nursing and insist on notificaation PRIOR to starting on any new meds, anti-histamines are notorious for causing lethargy and confusion in the elderly if his nose is running, give him a box of tissues. If he is on 20 meds that exceeds the CMS standard of 9 meds raising a red flag for polypharmacy, and his medication regime needs to be reviewed. Nursing home physicians visit the facility sporadically, they are required to assess a skilled resident every 30 days and a custodial resident every 60 days so trying to catch them on roundes is difficult. Ask the DON for the physicians office number and schedule an appointment either at his/her office or at the facility, but make it a scheduled appointment so they know you are going to meet. Also ask when your dad's care plan conference is they need to be quarterly and GO. Ask questions let them know you are concerned and want to be involved in his care. God Bless

I didn't know Nursing Homes have the power to prescribe meds. Can they do this even if the person has their own doctor, seperate from the facility? You mean they can just give your parent something without even giving you the option of yea or nea?

Yes, as tyour dad's POA, you definitely have the right to know what meds/care your father is receiving. Refer to 'Patient's Bill of Rights' to learn what you & your dad are intitled to be informed of. I do not know what state you are in but from my experience in caring for my mom, the doctor's in one state were very willing & cooperative to keep me in formed, however, the doctors in the state she now resides are less willing to tell me things or answer quesions. It's like they are intimidated if I ask about test results, meds or etc but i know that she & I are both entitled to know. And, I make it a point to be 'in the know' because that is my mom - & I only have one mom & dad. If you can not obtain info from the nurses or doctors, speak with the supervisor, director of nursing or owner of the facility. Sometimes, because we truly love & care about our parents, we have to make ourselves be seen & heard. Best of luck.

Contact the ombudsman at the facility

Only a physician and some nurse practioners can "add" medications to your Dad's chart. If you have medical POA, then that physician should inform YOU. The staff at the nursing home is merely the caregiver. Many patients are over-medicated. You have the legal right to refuse any medication that you deem unnecessary or incorrect.

If you feel your Dad is being over-medicated, or acting strange...I would imagine you can speak with the doctor on staff-to see what he/she might suggest. Since you have power of attorney for his health, you have that right....if for some reason, the nursing home is un-cooperative, you then will have to go to administration or the director of nursing. If your town has an agency that oversees nursing home care-you may want to discuss this matter with them, and in-turn they will check things out in your behalf.

Good luck!

Hap

Hello. Thank you for your feedback.
My dad cannot live alone because he is blind from his diabetes. He takes insulin and cannot give it to himself. Many of his medications are preventative, or to keep blood vessels open, some meds are to counteract reactions of other meds. I have entered all of his drugs into a mednotes program and that has helped me a lot.

My dad would not do a diabetic diet and this continued to ruin his health and eyesight and that is how he ended up in a VA home. He was clear minded when he went in. But could be loopy when napping during the day upon wakening. After about 5 minutes - he would say " what in the world am I talking about" like he was just waking up.
Then he'd be fine but with joint pain and loss of vision.

If I could visit him everyday I could keep him alert and watch what the VA is doing but I live 80 miles away. The VA doctor is not available, my dad has no doctor other than the doctor at the VA Home who "visits the home" and is never available to me.
I talk to the head nurse on his hallway but she acts like " this is just the progression of things" but my dad is 77 NOT 90. He just couldn't live alone.

Do they get MORE money if he they can say he has alzheimers?

One thing my dad has consistently had for years and years is some paranoia (which could be from his drugs). Not bad just things like people taking things from his yard. Of course he could not see very well back then either.
The more he worries the more distracted he is. The worst is the frustration when he can't think of the word he wants... but some days I am the same way and I am not on 20 drugs. Some are eye drops, some are for neuropathy, etc... a few are pills for keeping sugar levels okay and making insulin work better,,,, etc Most he has been on for years.

But he started getting really bad pain in back and legs after having flu like symptoms and the pain never went away. Then along with the blindness and inability to manage his own pills anymore... he made the decision to go into the home.

I always felt he was having re-curring symptoms VERY SIMILAR to what I have read of LYME disease. If you read about advanced lyme disease problems ... that is what happens to my dad over and over. and he is and was in the woods all the time his whole life so this is a strong possiblity but nothing I can do about it.

I wish I knew how to get a good doctor for him.

I have always felt that doctors tend to overmedicate seniors. They don't have the time to listen to their ailments, so out comes the prescription pad. Also, inexperienced doctors are throwing around the terms "dementia" and "alzheimers" too liberally. Most are not even trained in these areas.
Taking 20 medications a day seems just wrong. How can the body synthesize that much chemical?
Get your father a good gerontologist who will take the time to review his meds with you. I am sure you will find several redundancies. Also, I have a great pharmacist who will go over my Mom's meds and tell me what interactions, side effects, and allergies there are. My philosophy is: less is more. My Mom is on 2 medications. For the minor things I use naturopathic remedies and make changes in her diet. (btw, when Mom takes diuretics, her doc prescribes potassium. Depleted potassium can cause odd behaviors, too)
You should always be informed about changes in your father's meds. However, I do not know if a medical PoA would force them to do so. Since you have already talked with the staff, perhaps you could sit down with the administrator and let them that you MUST be informed whenever there is a change in medications.
Sounds like they are just trying to keep your father "quiet." Is it possible to move him to another VA facility? another care facility? 77 is fairly young. Would he be able to live in a senior apartment?

Here is a really good article on the subject:

http://www.informedmedicaldecisions.org/what_is.html