Can I demand the nursing home to give my Mom a supplement?

ANDREAAG
.
I believe that you, being her son, and possibly having "POA" can give you mom anything in the way of food and supplements that are "non" medicinal!

I gave my wife the attached supplement for 3 years including 3 months at her nursing home. It is a very high calorie, nutritional drink that cannot be bought in the store; however, you can purchase it via the internet from many sources. I bought it through Amazon and it shipped for free. It comes in vanilla and chocolate and has a nice flavor and texture. It has 530 calories per 8oz...This is more than double the amount found in "over the counter" boost drinks. It kept my wife from losing weight and gave her many vitamins that she needed. Check out the ingredients on "google".

Talk to the dietitian about this and "not" to a nurse or doctor! It isn't a medicine and you have a perfect right to give it to her

Lots of luck, Sonny

BOOST® VHC-Flavor Vanilla Calories 530/ 237 mL Packaging 8 fl oz carton - Each 1
by Nestle Nutritional

I agree with Angreaag, you have the right to see your mom gets vitamins. I f you need to, go to her Dr and get him involved. Some supplements like melatonin might interact with her other meds. I buy my mom vitamins and bring them to the home. They give them to her. And also she has a prescription for vit D, I pick it up at the pharmacy. Ask to talk to the med tech or head nurse where your mom is. You may need to go to her Dr, like I said.

What other supplements are you wondering about. I would think that they may contain ingredients that cause reactions with the meds she takes. Vitamin D is standard and taken my many, so not an issue. When you get to some of the other ones, seems there is a new one on the market daily, someone would have to carefully evaluate whether a specific supplement is safe to take. They are not all safe, there are drug interactions with some supplements. Has her doctor recommended the supplement? Does he know she is taking it? Do you know what all is in it?

My mom was in a NH for rehab a couple of years ago. They would only give her a multivitamin and vitamin D. I have several other vitamins I give her, some that her doctor recommended she be on but they did not give them to her. They messed up with her regular meds also because hers were not the norm, she takes Parkinsons meds five times a day. It was a constant battle, I did not pursue anything with them on the vitamins because she was there short term and I went to the facility daily. I hope you get satisfactory results and that they will work with you.

Although it can vary a bit from state to state, to the best of my knowledge, this is pretty much how it works:

If someone is in residential care or assisted living, which is a form of residential care, it is considered very much like your own home: your choices in almost all circumstances.

If, however, it's necessary that the patient be in a nursing home or a long term care facility which is structured like a nursing home, ie: with the doctor in charge and overseeing the patient (read that as: RESPONSIBLE for the patient), you will only be able to give what a doctor prescribes, and it will generally need to be available through their pharmacy on blister pack cards, which is the way most nursing homes are currently choosing to dispense their medications. The cards come already pre packaged each patient's medical requirements, the day count during the month is right on there, the nursing staff doesn't have to handle and count bottles and bottles of medication, it is supposed to be safer because it eliminates which of the chance of human error.

According to recent research. So many people are vitamin D deficient that you are finding doctors who will prescribe it. consequently, pharmacies make it available as a drug, not a vitamin. Rather then being a vitamin D3 from a source you might prefer, it's going to be a USP form of chemical vitamin D from the absolute least expensive source, while dispensing it at the highest possible cost, of course.

I am a nutritionist. At home, I had my dad on a slew of "industrial strength supplements" from 1985 till 1994. He was a big man, and my mom was small. When his behavior became uncontrollably violent, we could no longer keep him at home. The only type of place available to us was a nursing home, yes, with a doctor. So no more supplements.

Within a few days of admission, they did a cursory examination as required by law. They didn't get to a serious evaluation for 10 days. By that time, he was off his supplements and the doctor there had "adjusted" his medications. His mental and emotional condition deteriorated very rapidly. The comment they made to my mother and me was that they were surprised from his behavior that he was in as good a physical shape as he was. Well, of course IMO, that's what the supplement did, although you'll never convince any medical personnel that don't believe in supplements that that was the case.

He was in the final stages of Alzheimer's; his mind was already was already gone, his mental faculties did not work, we had kept his physical body healthy. Withdrawing the supplements took care of that. My dad was a strong, booming 6 foot 3 inches. He went in to the nursing home at 219 pounds. He crossed over 16 months later weighing 147. I don't know if you can even imagine a person of that height weighing so little.

It's a sad reality for all of us, but Alzheimer's and other dementias are death sentences diseases. There is absolutely nothing you can do you totally prevent the progression. It's admirable that you have given supplements. You have no doubt extended not only the length of time but the quality of life. But once you reach the nursing home stage, you are on the slippery slope.

Frankly, I was trying to help my mother, because she wasn't ready to let go. But the caretaking was killing her. Because my dad had become violent, we could have continued with him at home longer by giving him antipsychotics such as Haldol, but we would have been dealing with a pendulum swinging between violence and zombification.

If it had been up to me, alone, I would have withdrawn the supplements and allowed his physical self to deteriorate in line with his mental health and emotional self. When they are in a residential situation, you have control over this. When things have digressed to a nursing home situation, the control is removed from your choice he was very large degree, something you will have to adjust to.

To be sure, there are facilities that are licensed for memory care which are residential and not skilled nursing or long term care with doctors in attendance. We had one of those in our area, but it was private pay. We needed to place my dad nearly an hour away from home, and it was a nursing home.

I don't mean to be depressing or bleak but everyone responsible for taking care of dementia patients needs to be realistic about the progress of the disease. I will mention this, just for the irony of it all: after we placed my dad, my mom started serious, deep cleaning for the first time in 10 years. Behind couches, lamp tables and my mom's electric organ, as well as under the beds of all three bedrooms, we found little piles of supplements. Certainly not everything we had given him, by a long shot, but enough to realize that the very taking of them irritated him. Hahahaha...

Get support from her GP. Then they will not be able to argue with you.

Well... the assisted living my mom lived in would give everything the doctor ordered, however the AL had a triple tier pay scale for medicines given, the more medicines my mom took, the more we paid. Money talks! We had the doctor take my mom off everything that wasn't paramount to her health. We paid roughly $12 instead of $25 a day to administer medicines after the adjustments were made under the care of a new doctor. How important is that supplement? Is it worth possibly $10 extra a day? Careful what you ask for... hope this helps!!!

My mother is in a nursing home. She has been there for almost 6 months. It's very pleasant for a dementia unit. My best friend's mother is in a nursing home and has been for 8 years. What we have learned is that nursing home staff loves to throw their weight around. They lie. They love this "ultimate authority" power trip and to put it mildly, you may have a difficult time reasoning with them or making any progress changing their mind, even when you are 100% right and within your rights. You need to get an outside person involved. NH is a closed circuit. I would call the ombudsperson and have them schedule a care meeting to discuss this. That way the NH will know that they're being watched. Sometimes an outside person is the only way. Sad. When my mother entered the NH, they stopped her aricept and nameda without saying a word to me. When I told them that as her health care proxy I did not consent to stopping treatment, they closed ranks and everyone, even the social worker parroted the same line "those meds don't help." And they were FDA approved and had recently been shown to be benefcial to patients, through the late stage of Alzeimer's. I've had other people tell me the meds "stop working" or "don't help," but that's simply not supported by the science. The medication is, however, specialized, so I concede that it may only help people who truly have Alzeimer's, as opposed to other dementias. But I digress, the point is, I was within my legal right and they still violated it. I had to get a lawyer and threaten to sue. After I did that, they gave the meds back so fast it literally made my head swim! I was so stunned by the suddeness of it that I was unable to focus at work for the rest of the day. Nevermind the fact that a patient needs to be stepped up to my mother's dose. Another lesson I've learned is that there's this prevaling attitute that these people are on their way out anyway, so really great medical care is out of the question. Pretty disgustig, huh? Yesterday I took my mother to the NH dentist. He told me the only thing they do is cleanings, extractions and dentures. "Palliative care," he called it. Who concented to that? there's so much you don't know until you're actually in a nursing home. I should write a book. In short, the caregiving journey will break you down. The nursing home experience destroys you by beating you down and tiring you out until you don't have the strength to fight anymore. In my opinion, you won't get anywhere with these people until you get someone more powerful than them involved. Then you'll be surprised at how they are suddenly "able" to do something they were previously "unable" to do. Hypocrites! My wish is that for all the anguish they cause people's families, they get exactly, precisely what they deserve!

Well, Christine, I did write a book about the nursing home tragedy to make people aware of what goes on within those walls. Before-Door-Closes-Daughters-Alcoholic

For every state there is an oversite agency that surveys and licenses facilities, in Maryland it is office of health care quality, in west Virginia it is department of health and human resources. Look for the oversite agency for your state, they should be able to give you an answer. The facility should have the number posted someplace visible in the hall, you can also contact the long term care ombudsman, who should be able to assist. Good luck.

A LTC facility cannot refuse to give ANYTHING if there is a doctor's order for it. They're yanking your chain. They don't have the unilateral and/or independent decision-making powers to say yes or no to what a doctor orders. But it would be helpful if you said what supplements you want your mother to have & what compounded medication they won't get for her.

Usually, the state Department of Health is the regulatory body for LTC facilities. There is a federal law that governs state laws for LTC facilities, which is CFR 483, "Requirements for states and long term care facilities". It outlines the requirements that each state must enforce. Section 483.60 covers Pharmacy Services.

I worked in a LTC facility many years ago as a nursing administrator, and from what I remember about billing & medications & things, insurance/Medicaid pays for prescription medications & the LTC pays for anything else that is prescribed that is not covered by insurance/Medicaid. I don't know if that still applies. If it does, what they're telling you is just a cost-saving measure for them because they don't want to spend the money. Sometimes certain meds are not on their formulary, but they will find an appropriate substitute & request the physician's approval to substitute the medication for the one that was ordered. It's usually the cheapest option available. I don't know what the deal is with "supplements", though. I don't know what "supplements" you're talking about.

Why were you giving your mother the supplements? Did she have verified low levels of vitamins and/or minerals that she required them? Or were you giving them because you wanted to for no special reason? What result do you expect from the supplements? I'm not sure that at your mother's age & with Alzheimer's/dementia, all the supplements are necessary. The Alzheimer's/dementia likely won't improve, so why have her take all these extra supplements? Concentrate on having her live her life with the highest quality possible.

If one of the meds your mother is on is compounded at a specialty pharmacy & her doctor determines that it is necessary for her to take it, it is the responsibility of the LTC facility to get it. LTC facilities are usually contracted with a local pharmacy that services LTC facilities & other places, & they want to operate as cheaply as possible. If the pharmacy that the LTC facility your mother is in won't/can't compound the medication, then give the LTC facility the name of the pharmacy that compounds the medication & have the specialty pharmacy send it to the facility once a month or on a regular schedule. Or, you can fill/re-fill the prescription, pick it up & bring it to the LTC facility.

It angers me that LTC facilities spend so much money marketing themselves as these utopian places, with wonderful care & offering everything a person could ever want or need, and then when they get their hooks into you, it's all about doing it as cheaply as possible, despite how much they are getting from each person every month. The majority of LTC facilities are for-profit enterprises, and the owners/administrators take home a very tidy salary every year.

Please do not write my reply in stone, for I stand to be corrected of course, but if the supplements are or can be considered just food type stuff, I think we as family members are allowed to take Example: fruit, vegetables, other goodies,etc. into the room and if individual is able to eat them without injury to their diet and health, they are able to consume those items as food. However I personally had an experience when in a care center , due to cracking my arm and waiting for it to heal enough to go home and care for myself. Vitamins. They did not recommend my taking vitamins in their establishment. So, I said, I am able to walk, do I just take them outside to my car and take them in your parking lot, or must I drive the car off your parking lot to public road, then take the vitamins? Finally they consented to let me have them in a special containment box, so I got a tool box with latches on it, and hid it under my things, so that roaming patients from other areas (something they like to bring up to prevent you from having things like that in your room) could not get a hold of them. Rules and regulations of nursing homes nearly wore me out over the years. My mother was in one for nearly 7 years, my husband off and on for month here and there, myself when breaking leg and arm at same time a few years ago, then the cracked arm, when my husband was at that time presently in care center again. Believe it or not we were located in same room while my arm was healing. So it goes. There may be a way to work around things, if you personally were able to dispense the vitamins to your loved one. But that causes limitations for your schedule as we all know. Gas, time, travel and whatever. Rules and regulations should not be so difficult for people to survive according to their personal desires, but it seems many are just up against it. Hoping something good will work out for you. joylee

Everything has to have a doctors order for it. You might have to discuss this problem with her doctor, and write down what's ok for her to take----she still has to have an order for it. Some supplements might not mix well with her medications.

It's so unfortunate that everything has to have a doctor's order. What did people do in their own homes, before they moved to the facility? Unless it is harmful then they should be able to continue, at the facility. Smoking cigarettes (or other "herbs" lol) would be about the only thing a facility could disagree with. If you want your mom to take "Move Free" for Joint pain instead of Tylenol then the facility should carry out that PATIENT REQUEST. Why are "doctor's orders" automatically placed above "Patient (or Medical POA) Request"?
Whoever is paying the BILL should be the one who says what supplements are given.

The reason why facilities don't allow patients have Tylenol and other supplements laying around is because they could take it ten times a day, or another patient could decide to help themselves too. It really is understandable!

mallory, the other issue is drug interaction with normal food or over the counter items that the patient or family may be unaware of. If the patient is allergic to shellfish, then Move Free with chondriotin could be a problem. If the patient is on an immuno-suppressant, then echinacea will be out. If the patient is on MAOI inhibitors, there can be a significant interaction with items like cough medicine and Sudaphed.

When people lived in their own homes, they assumed full responsibility for what meds and supplements they took. Once the NH assumes legal responsibility, they are going to expect full knowledge of everything that patient ingests.

I am not suggesting the patient have the bottle of pills in their room (unless in one of those locked cabnets). What I am saying is, if the resident already took a supplement, like Move Free, successfully at home without any issues, then the ALF which is receiving a fee to dispense medication,.should not be refusing to give something like Move Free, simply because their preferred (read: financially connected) pharmacy doesn't have it in a blister-pak. That's really ridiculous. Residents should get their medicine AND supplements that both doctor and Patient prescribed. It's all about human rights --they have a right to refuse medication and they have a right TO take something. As long as they ate competent tthey are wwithin their rights. If they are no longer competent, their Medical POA takes over,.doing what the person would have wanted. The Facility has no right to overrule the resident, or the resident's Medical POA..

In my experience with two nursing homes for my father (Pennsylvania and Texas), every "higher-up" I dealt with was a disappointment, including social workers, administrators, and ombudsman. Please read the book, Before the Door Closes by Judith Hall Simon and see for yourself the tangled web of travesty the elderly--and their caregivers--are caught in.

I am getting "nauseated" from hearing from so many caregivers that a personal caregiver such as a son, daughter or spouse should ask the doctor, nurse or an aid if a supplement is ok after a cognitent patient has been taking a nourishing and non medicinal supplement for some time with beneficial results and then told...no by a "professional" that he/she can't have one. That is ridiculous.

I believe that it would be best if at all possible, is to take your loved one home and have the nurse and therapist come to your home rather than have the person locked up in an institution. I believe my wife died unnecessarily because of the neglect and all of the pills that were given to her under "doctors" orders. Her personal doctor was not allowed to interfere with the "institutions" doctor!

I think my father died prematurely for the same reasons.

Judyjourneys:

You seem to be "my type of girl"

Sonny

No, it is not a payment issue. It has to do with the FDA NOT being able to regulate supplements which are mostly expensive pee, and the nursing home you are considering does not have to do anything they do not want to do based on their guidelines. It sounds to me like they want to keep all the money in house with meds only in their pharmacy. It is their right to do that. Try contacting other nursing homes to fit your needs and don't be surprised if the others want only FDA-approved drugs. Their are covering their as------ just in case of a lawsuit. Take them to her if you can if you want her to have them so much. Discuss the importance of taking the doctor prescribed meds, and if they will not make a difference (Nothing will help a person with dementia), then choose the nursing home based on your desires.

The nurses who administer meds in a nursing home can only give what the Dr has ordered. Those medications are dispensed sperately for each patient and placed in the drug cart by the pharmacy.
Most nursing homes have their own Dr on staff who oversees all patient treatment unless they need to go outside for specialized treatment for such things as dialysis.
I do not know how dental treatment is provided but in my opinion a filling would be more palliative than an extraction.
Nursing homes vary in quality as many have observed so once again due diligence will get the best care for your loved ones. Visit at many different times of the day so you can see how your loved one is truly treated.
the whole subject of suppliments is a very thorny

To continue as it posted by itself. Suppliments vary in their quality and may even not contain any of the ingredient they claim to have. if you actually call the company you will recieve a very evasive answer such as "It is a therapeutic amount" so you may well be buying sugar pills.

Here in NY, any adult home, ALF or NH must have written MD orders for any meds, including over-the-counter items like vitamins and topical creams and even cough medicines. No one can demand the staff give anything or hold anything back. Doctor's orders only, that's the law.

Just making sure u know, you won't be able to use your parent's prescription plan. They have their own parmacies and parent will pay out of pocket. Don't know how it works between PC and the doctor associated with the facility.

There is an OMBUDSMAN for long term care - check with them about the rules in your state. Get PCP involved...who will the PCP be in the NH? That may make a difference.

Nursing homes and other care homes, have regulations that govern what is given to patients, how they are given, etc..
They are not just safeguarding your elder, they are safeguarding other inmates--because many of those roam about, and pilfer things from other rooms, for instance. So nothing edible or meds can be left in the rooms.

If it's a supplement that's a pill/capsule, etc., Doc should be able to order it, and it would be dosed off the med.cart by the nurses, with regular med rounds.
IF the facility is telling you they aren't allowed, even if the Doc orders it?!
QUESTION THAT.
Look into how the rules actually are written--you may have to dig deep, and or, contact multiple agencies governing this, at the State level---because as others mentioned:
Corporations often lie, or, word things in ways to cover up what the situation really is....like: some store employees tell customers an item is not available anymore--can't be got....what they are really covering is: the chain store no longer carries that item, so wouldn't you be happy buying this other thing they do have?...
If it's a food supplement, such as "Boost" or another meal replacement shake or something, it might be that you could give her that when you are visiting, but not leave it there for the facility to give her.....
It's common for facilities--particularly chain operations, to Contract with corporations to provide certain Brands of things--like Ensure, for instance [just using that as an example only]. In those kinds of contracts, clauses can forbid the facility personnel from giving patients competing brands of similar products--so they just tell people they "can't give those, even if those are prescribed".

BUT...having worked in nursing homes, I can tell you there are Docs who DO prescribe supplements [even if they don't do it well, they are trying to help], like vitamins, minerals, even probiotics, CoQ10, etc., which ARE kept on the med cart, get dosed as ordered, at med rounds, or as-needed [PRN]....those have also included some meal replacement shakes in single-serving cartons or cans.
As long as stuff is not at the bedside/in rooms for anyone else to pilfer, as long as it is dosed properly as Doc orders it, by staff, from the med cart or med room, it should be do-able.
Unless that facility is under contract by some corporation that limits what they can do.
Can't imagine any State forbidding supplements. Just facilities or their personnel if they don't want to deal with extra stuff. I've met some of those, too.
As well as met some staff who pilfer the "extras".
One facility told me they discouraged supplements, because they knew those were expensive, and they didn't want families to get their hopes up unrealistically. They felt they were doing the families a good service, by limiting the dosing of nutritional supplements [costly], and preventing families building up hopes that those could cure or fix their elders conditions.
So many people are mal-nourished!
IF properly diagnosed for nutrients, they might get some serious relief of symptoms, just by getting proper nutrition. When there's, obesity, diseases....underneath that, is long-term poor nutrition, slowly compromising the body's ability to function, until it becomes a disease-state. We know so much most Docs don't use or deny, and need to know so much more!

The nursing staff must give the supplement if the MD prescribes it. They are not permitted to "ignore" a physician order just because it does not "suit them."

However, as pointed out above, the supplements must be available in single-dose form - such as blister pack. They cannot be taken out of an open bottle. It's a health and safety issue. (BTW - I am a registered nurse.)

Reading through these posts and living through nursing home hell myself, it's obvious to me that its all a fight. I regret that my mother's condition precludes her living with me. Now I have to put up with--or fight--all kinds of abuse, but either way, I lose.