My mom was in nursing home in another state and I moved her in a nursing home near me. She then had to be admitted to a hospital because she started screaming and yelling all the time. At the hospital they found she also had UTI. All of them have been give her psychotic drugs to try and control her yelling. She has been transferred to a psych inpatient facility to try and get the screaming under control. More new psychotic medication. Even one that was just on the news back in May regarding the manufacturer advising providers to use it for dementia patients, even though it was not labeled for that and kills more elderlys with dementia.
What is wrong with these facilities? What happened to treating Dementia? Why are they all jumping to psychotic medication?
No, they should not be medicated "into oblivion," but sometimes anti-psychotic or anti-anxiety medication is warranted during dementia. The issue is that many physicians are not familiar enough with dosing and the elderly to be able to titrate the medications based on the patient's symptoms. (I am a former Psych nurse.)
My late father had vascular dementia. He went through a phase at the nursing home where he was assaulting the female residents by intentionally pulling out their hair in clumps. They phoned me (the POA) and said they were going to have to put him on a low-dose anti-anxiety medication to control that agitation level, even though the med would make him less "with it" as a side effect. The safety of the residents took priority over my father's mood - so I told them to "go ahead."
R.I.P Mother......
Your loving daughter, scaredclueless
Lewy body dementia can give adverse reactions and can be very dangerous if the patient is given antiphyscychotic medications. I went through 3 months of no sleep struggles before I researched the affects of such drugs and found out this information. I hope others really check the mixes of medications and their reactions so that they prevent any unnecessary stress on the caregivers and especially their loved ones suffering with the disease. So sorry your Mom went through all of this before they discovered the underlying problem. I pray for comfort and peace for you both. God bless.
The first hospital put her on Haldol (I was out of town and my brother was dealing with the situation) because she did not want to go to the hospital and became very combative at the ER. I had to tell him not to allow them to give her Haldol again. This was my first time dealing with ANYTHING like this because my mother had never been seriously ill nor did she take any strong medications outside of her Blood Pressure, Potassium and Vitamins prescribed by her Primary Care Physician (Folic Acid, Vitamin D, Iron & Magnesium). And a RX for Acid Reflux. She was also on Zoloft at the time for depression (she had been on that for about 1 1/2 years 50mg). They admitted her and by the time I got there she had been give all kinds of other anti psychotic drugs.
They discharged after 3 or 4 days after being on an IV for antibiotics. They gave her with a RX for Respiratol (which at the time a nurse told me would make her rest) and an RX for 5 days of Cipro. The Rispiordone (we think) made her really "crazy" she was MORE confused than before and didn't recognize her home it was AWFUL. After calling her Primary Physician he told us to stop the Rispiordol immediately. We took her back to different hospital 2 days later because we knew something was wrong. Thank God we did.
From the ER up at the second hospital they took her off of ALL medications outside of her Blood Pressure, and Vitamin supplements and acid reflux and switched her from Zoloft to Lexapro (10mg). A neurologist wanted to get to the bottom of this and also wanted her body to get rid of all of the anti-pshchotic drugs that were in her system. Turns out that due to her being severely dehydrated, her kidney's went into renal stage making in even harder for body to get ride of those powerful drugs. Long story short. She was given 25 mg of Seroquel one day at 4pm that knocked her out so after that the Neurologist reduced it to 1/2 does to be taken as needed and was discharged.
She is now at home after a HARD 3 month. She is now taking Aricept after exhibiting increased short term memory loss. The Dr's feel she has early onset Dementia that was most likely underlying but kicked into gear after the UTI and renal failure. I have given her the Seroquel 1/2 does 1 times after she got home from the hospital the first night, as directed by the Dr's on 2 other separate occasions since October after she exhibited combative behavior. She does not take it daily and only took it at night or close to evening the other 2 times. It seemed to calm her down but not knock her out making her loopy. She woke up both times refreshed with no agitation. I guess everyone reacts different to medications.
I too had concerns when at the hospital the neurologist wanted to give her Seroquel (I had done research on all drugs before ok-ing any being given to her while in the hospital) and had concerns. The side effects seem to occur in some patines that take larger does daily. Her Primary Doctor also recently started giving her a B12 shot (she goes once per month for blood work).
I am new to Dementia so I am not sure what will ultimately work for my mother to give her quality of life during these early stages. I can only imagine what will happen when the disease progresses, and everything is trial & error with medications from what I've read here.
Take care
It sounds like you are on the button in your assessment.
She is very likely manipulating with food and behaviors..
That the Guardian was appointed in that way, =should mean= family still gets to interact in her Care Plans.
Sometimes, it means family walks a fine line between being a nuisance, and being a good persistent advocate to get proper care.
Her refusing to eat mush or drink thickened water, is very common, as is a facility's recourse to use ground foods.
Their other recourse when patient refuses to eat, and there is measurable weight loss, is to supplement using something like hi-protein Ensure--though that usually lacks fiber, and can cause other problems, like constipation.
It IS sweet though, and many people like it---well, until they get it once too often...!
Of course, instead of thickening water, they could thicken juices instead--something with decent flavor!
[[Mom used to make a more liquified Jello--the kids loved it!--it provided water, flavor, and the gelatine is somewhat nutritive]]
It also sounds like the facility is NOT documenting your family reports that she eats solids and regular liquids with gusto when out with family or when you bring food to her in facility.
==SO....to get them to document that,
you could make sure the Nurse sees her eating with gusto, when you bring her food from home, and the CNA staff, too.
BTW--since she hates thickened water, refuses to drink it,
==that could =potentially= contribute to increased episodes of UTI's, related to dehydration, and what little urine she produces staying in the bladder too long.
==Giving nursing staff a set of ==basic statements== [entered into records so staff can refer to them when "stuck"] that Mom will respond to by behaving better, [[like: if you do not eat/drink this, you will get fed mush food]]
etc., that could be a help to them, to gain her compliance in daily routines.
==There is not much to be done for "stimulation" in Nursing homes
...or other facilities, for that matter.
It's complicated.
BUT...I tend to foist the fault squarely onto Insurance corporations.
Insurance Co's have grown into such overwhelming entities, they have absolutely bean-countered health care into the ground, over the last 60 years.
Staffing is kept =to. the. bone.= ,
There is just not enough staff to handle patient loads beyond basics.
It is very hard to handle fluctuations in patient loads, in some facilities, so like airlines, buses and trains, they tend to over-book, gambling that they will be able to discharge enough to make way for incoming, fast enough, and never have too many empty beds.
Because of the bean counters, odd logarithms and number-crunching, hospitals must operate on a 24/7 warm-bed policy [no bed goes empty for more than a few hours, tops], and no patient stays a minute longer than they can get away with foisting them out the door--any excuse will do--sometimes, no excuse is given
One patient, admitted to a local hosp. for pancreatitis of unk. etiology, was there barely 24 hrs, then told her spouse could take her home--never mind they had not informed him, had no reason to discharge her, had told both of them she'd be there a week getting IV fluids--they very nearly put her out on the porch in her hospital gown, to wait for a ride--she was thankful 2 friends stopped by. The facility told the friends to take the patient to the neighboring hospital. She went, in hospital gown, and reception asked "where are your records"? she didn't know; former facility had not sent anything via fax, no phone call to give them a heads-up, nothing--admitting simply sighed and said quietly "not again!" .
Some NH's have started accepting more complex cases that used to be only in Acute Hospitals--except those are being forced to discharge to cheaper care, or home, faster--facilities have gotten to the point of not caring where--just "away". Discharge planners can be extremely pushy towards family and fiends to get the patient OUT. .
Health care is pretty much governed, run, & controlled by Insurance companies.
Docs are afraid to lose their license, if they blink wrong, recommend anything different, or base a diagnosis on good old-fashioned patient assessments, instead of mechanized lab results [which come out wrong more often than any wish to admit].
Years ago, while working acute hosp's, the trend was to bump ICU pts onto the Med-Surg floors [without proper equipment], and to bump anyone off our med-surg floor that could be--even in a VA hospital where lengthy stays were the norm.
THAT kind of institutional garbage contributed to my Gma's premature death.
Happens a. LOT.
There is a book:
"Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix /It" by David Goldwill.
You got lucky. So many elders with mental issues were able to avoid mental health care entirely, related to our society, social stigma, ignorance and the nature of the illness. .
I sure wish my Mom would have allowed herself to be diagnosed and treated for her mental issues....she made life altogether 'too interesting' for us kids, and programmed my younger siblings, from birth, to favor her behaviors in a number of ways--they do not even realize it..
Which has meant they have also started blocking her Docs from learning of her mental, drug-seeking, suicidal tendencies, etc.
--even though Mom's behaviors are usually used to manipulate others, it must still be monitored, because she HAS actually tried to suicide in the past, and continues to threaten.
Mom's seen too many horror stories about psych meds/treatments, and is terrified to be found out and treated with any of the horribles she's seen---but is perfectly willing to use other drugs and alcohol!
Closest to any sort of help she got, was signing up for Medical MJ...
which actually helped calm her, helped her get better sleep, stopped intestinal bleeding [dunno how, but it sure did], helped her feel better, reduced pain....but now she's out of state, and cannot get it, nor do those family members wish to help her get it. .
It is so important for families -who can-, to keep actively involved in their elder's care.
Families know their elders best, and can [but not always] be the best advocates for them.
In today's health care settings, it becomes necessary, too often, to really be persistent --being the appropriately squeaky wheel to get the proper care provided.
As for studies?
There are far more now, than ever.
Raging , tantrums and manipulative behaviors, is common to Schizo, bipolar, and a number of other mental health diagnoses.
It is also pretty common to dementias, until they get so far into it, they cannot maintain those behaviors.
You might try starting with these sites listed below, I Googled "geriatric mental health, rages, tantrums" :
http://www.mayoclinic.com/health/intermittent-explosive-disorder/DS00730
"intermittent explosive behavior--Mayo Clinic
This is what I originally posted on Saturday:
"I am brand new to this site and don't know if this topic may have been explored or not. My 87 yo dad is home with my son caretaking 24/7 and my 85 yo mother is in long term care.
My mother has always had mental/behavioral issues. She was finally prescribed an antipsychotic about a year and a half ago. Now her mood is typically quite pleasant. With dementia, she requires nursing home care. At the home she continues to exhibit certain behaviors and languishes in bed 95+% of the time. They get her up for breakfast which she eats robustly as she is famished. She goes back to bed. They will get her up for lunch (unless she refuses) but she eats that inconsistently. Actually when she refused to eat the prepared meals, they were feeding her peanut butter and jelly sandwiches daily. She is up for 30 minutes after "lunch" to sit in the hallway near the nurses' station. My mother has a history of paranoia, dependency and isolation. Apparently, she will scream in the hallway or in group settings and demand to go to bed claiming fatigue and/or pain. (We learned this just yesterday). She is back in bed all afternoon. Bed at 6:00. Staff are supposed to get her up for dinner but often she "refuses" (their word). She seldom eats any significant portion of dinner. Although my mother underwent a complete swallowing evaluation at the nearby hospital, the speech therapist at the facility insists she requires ground food and thickened liquids. My mother can and will cough on command for attention. The speech therapist claims she will "aspirate". She never has. She did contract pneumonia over a year ago from a bronchial infection that was going through the place and during one meeting the speech therapist tried to link that bout of viral pneumonia to aspiration. The result was to have my mother undergo the evaluation at the hospital. The hospital evaluation says she does not need a special diet other than suggesting she might take a thickened liquid if she is fatigued. The ground food is completely unappealing. I believe I would probably refuse to eat it also. Thickened water is well...disgusting and she takes in a very limited amount of fluids as a result. In just the last 30 days she is down 5 lbs and has not been ill. Since her admission 15 months ago, she is down 12 lbs. My sister and I each bring her in a well balanced meal weekly. My son brings her out of there once a week for most of the day and she eats exceptionally well...no thickened liquids and no ground foods. If we were not feeding her, we believe her weight would be even less but of more concern is the lack of nutrients she is consuming. We have observed her coughing/gagging episodes to be behavioral. Not only can she stop but when told she may not be able to have "real" food she will readily stop. We understand it is easier for the facility to give her ground food. It can be more or less shoveled into her more quickly. (My mother is capable of feeding herself but likes to be infantalized with spoon feeding.) Granted having my mother feed herself takes longer and her hand/eye coordination is certainly not like it used to be so there is more spillage. The primary issue appears to be liability on the part of the facility. My mother's quality of life is diminished, her health is at risk but the nursing home is admittedly covered legally.
With this same cycle is the nearly total lack of stimulation being provided to her. We have repeatedly asked for the TV to be put on for some background noise and perhaps to spark some interest. It is not. They ask her. She says no to everything like a 2 yr old and the staff then fall back on having to "respect" her wishes. My mother has been deemed incompetent. She has a court appointed guardian. The facility feeds her PBJs, have her in diapers (she was not incontinent when this began) and bed bound but continue to ask her open ended questions which result in refusals consistent with an oppositional defiant disorder. My mother has an extremely dependent personality. She never drove a car, socialized, worked perhaps 10 yrs of her life and relied on my dad until June 2011 when he was seriously injured in a car crash (he was driving).
My sister and I attend the care meetings with the most recent, yesterday ergo my inquiry today. My mother has medication reviews by the mental health people but no therapy which she would refuse anyway. She needs someone to work with her on these behavioral and personality traits. She is capable of so much more and it is distressing to see her literally waste away. When she is out weekly; she is engaging and interacts well with us, eats very well, shows no fatigue and does not complain of pain. My mother sits up in her wheelchair (she refuses to walk) for sometimes up to 8 hours at a time. This has all been communicated to staff and her guardian. What can be done? Are there geriatric behavioral specialists who could develop an action plan? Ideas?"
I am certainly seeing the similarities voiced by many people on this site. Today I requested a meeting with the mental health worker assigned to my mother. I do not know her current med list. I do not know her treatment plan. My sister and I do attend her care meetings and email our concerns. We do not always receive answers though. I do know Risperdal has been effective in reducing my mother's paranoia (life long issue) and in turn making her so much more compliant. At the same time we just learned about her screaming so she gets to go back to her bed. I understand the facility cannot allow that to go on but her self imposed time outs could perhaps be limited or maybe she could be redirected with a little 1:1 attention or change of environment; a quiet room.
I am curious about any studies conducted on aging and certain behavioral patterns like raging and tantrums. My mother was at the house all day into the evening both Thanksgiving and on Christmas without any issue. My son goes and gets her from the facility once a week to spend time with my father. He takes them out to restaurants, to feed ducks, for a ride to the beach. There have been no issues. It is difficult to reconcile her behavior outside of the facility with what is happening within it.
During the last approx. 15 years, I have noticed a distinct up-tic in Nurses Aides deliberately passing themselves off as licensed Nursing staff....that is, they say "I'm a Nurse" or, "I'm a Licensed Nurse", etc.
Nurses Aides, properly trained and experienced, are worth their weight in gold for the services /supports they give.
BUT...they are NOT "Nurses".
Their level of training and certification does not allow them to make Licensed Nursing decisions, and they are also prevented from discussing patient cases with family or anyone else, generally speaking, especially according to HIPPA laws these days.
They generally do not know who has permission to discuss a case.
Any N.A's or CNA's who promote themselves as Licensed Nurses, or who discuss cases with visitors, risk losing their jobs and their certifications.
There is still a chain of command, that needs maintained.
From the top, down, it generally goes like this:
1. =Doctor/ M.D., O.D., or sometimes, an N.D.
2. =RN//often with additional letters after that, or in front of that, in charge of the floor or section of facility, who can form Nursing Care Plans, give ordered treatments, do IV's, pill meds, hands-on care, etc.; they can do what all the staff below them can, under their license;
3. =LVN[s] can pass pill-meds, give some treatments, do hands-on care, etc. but not IV's, unless they have special training and permits for it;
4. =Nurses' Aides ["N.A." or "CNA"], mostly do hands-on bedside supportive care, feed patients, etc. [unless at VA hospitals, where NA's can also do some pretty incredibly complex dressing changes, etc.--some I worked with, did nearly what LVN's did, except pass meds]
When speaking with a worker caring for someone you have permission to discuss the case about, make sure their name tag tells at least their first name and level if license/certification.
IF you cannot tell by their nametag, ASK.
IF the person says anything not very specific, go find staff that does have a license/title after their name on their tag, that IS specific, or keep asking.
It is -NOT generally- appropriate to discuss particulars of a patient's case or care plan, with NA/CNA's
[though in certain circumstances, they can be a blessing for their blabbing...though consider source, and take in context...].
IF the persons on duty is an LVN, they -should- be able to help you some; better the RN;
IF that fails, then the D.O.N.--Director of Nursing for the facility....and up to the Doc.
How old is your Mom?
The Public Guardian handles lots of cases.
While each patient has uniqueness, there are so many similarities, related to aging, mental issues, illnesses common with aging, which a person in that position may SEEM to treat a bit cavalierly.
It may be related to handling so many, and not having much --umm--compassionate language? ...to provide "softer" answers to family--it can come across as a bit harsh or cold sometimes.
AND, it can be frustrating to -not- have control over one's parent's case, having it allotted to a guardian.
==OTH, there are usually circumstances that determined having a public guardian would be best.
The public guardian is not likely to take initiative to ask for things for Mom, unless it is pretty glaring.
The guardian will let the Doc, the staff at facility, determine best course of treatment/care, and would only intervene if something out-of-line were noticed.
It is my understanding, that family members who are -not- guardians, and lack a POA, ==BUT have NOT been barred== from visiting or speaking with the staff about Mom's care, ==can speak with staff [the nurse in charge, not the Aids], about concerns, ==best framed as questions to learn more how the situations are usually handled. .
IF further intervention is needed, can ask the Doc on the case.
IF that fails to get adequate results, and it is still a matter of something being handled badly, it may be time to seek help from Ombudsman.
Kinda like military chain of command...you start at the bottom and work up the chain, all the time learning more data that can help figure it out. .
Your question is a good one:
Actually, the RN in charge of her case, could be one to ask your question about a Care Plan to address Mom's limited ability to choose for herself.
Often, Nurses can formulate that kind of plan, called "Nursing Care Plans", add it to Mom's file and to various care-plan notebooks staff use as references, to instruct the rest of the staff on it.
==Like: "...this person has shown she cannot adequately answer open-ended questions. The new nursing plan is to have all staff give her only 2 choices to pick from, when asking questions like: food choices, what to watch on TV, etc..."
THEN, staff report how well or if that got better results,
and if it works, they continue doing it; if not, they stop it and try another approach.
This is also reported to the Doc.
It gets reported at shift changes to instruct and remind staff of it, and what, if any, progress has come of it.
The nurses in charge, are responsible for making sure that Nursing Care Plans are carried out by other staff, and if successful, to keep it going, OR, modify it. There can be "Nursing Care Plans" for all kinds of things needing done, and, these are pretty quickly implemented.
It is -not- what we -like- to hear, and we work like anything to make it all better even a little, to hear words spoken that remind or tell us our Mom is going through a certain amount of 'fading away" --it still feels painful.
==When a person is elderly, and/or has dementias, they reach a point when they just slow down, shut down, and prepare themselves for their time to leave this mortal coil.
==When people have no dementia, and reach their late 80's or 90's, it can be pretty clearly the process of gradually leaving this earth.
==When a person is younger, and/or, has dementias, it is harder to determine.
==It can be a difficult fine line to determine if this is what is happening, or something else that can be adjusted or treated.
While giving antidepressants to younger persons who are depressed, may be appropriate, it is -not- always appropriate for those who are gradually slowing and approaching their time.
Observing elderly people approach death, can be kind of like watching a prolonged birth, in reverse.
[[not everyone understands that analogy--I mean no disrespect nor hurt]]
It is eventually expected, and, it is something that I am not at all sure it is appropriate to fight against--depending on quality of life and other circumstances.
When someone is frail and elderly, it might be good to ask ourselves, who are we fighting to prolong life for--ourselves, or our elder? OR are their other circumstances it is being done for?
How much of what is being done is going artificially beyond "comfort" and "taking proper care of things that are proper to care for, such as sores, hunger, breathing, etc.?
Would what is going on, be agreeable to the person in the bed, if they still had their faculties intact?
And sometimes, it is just really hard to tell.
[[One of my G'mas firmly believed certain things during her entire life.
When she was approaching death, she suddenly had lots of doubts. She still had most of her faculties, tho some were flimsy.
All we could do, was reassure her as to her authentic beliefs of a lifetime, lots of hugs, hand-holding, etc. ]]
==When a person has lost most of their faculties, and may be pretty confused, all we can do is reassure them, in a way that they would have appreciated when they were more in control of their normal lives--only short statements-- and, responding to the elder's comments in that moment.
If someone has a history of mental /emotional ills, helping them find a bit more calm is a really good thing
--it is improving quality of life AND, the risk: benefit ratio is good, even with some minor side effects.
However, since frail elders can have more difficulty with adverse effects, avoiding giving too many prescriptions daily, is erring on side of caution.
It is common for psych meds to have adverse effects--including antidepressants.
Choosing Risperdal over an antidepressant, may be the better choice for your Mom....The Doc is best to evaluate that.
If you have concerns about possible adverse effects of that med [or others] please read the med information here [on Resperdol]:
http://www.drugs.com/risperdal.html
then if you still have concerns, ask the Nurse in charge, or the Doc, just to see if her current behaviors may be part of side effects to be concerned about. .
There are numerous online sources to read about medications--just Google the one you are looking for.
Those open-ended questions can also be part of her on-going daily assessments, checking on her alertness, state of mind, etc.
Nurses Aids report to the RN/LVN staff in charge, and stuff like that inability to answer open-ended questions should be charted.
OR, it could just be the Nurses Aids do not think to ask better questions....if a patient cannot answer that kind of questions, the Aid may just make an "executive decision" to fill in the answer for the elder, instead of asking a question containing only 2 choice options
--for some caregivers, it seems easier to do that, though, CAN result in the person refusing to eat...and thus, related behaviors that look like shutting down!
Some elders "regress" or "shut down" when in a circumstance they hugely dislike, or cannot "process" mentally and/or emotionally. They stop talking, stay in bed, refuse food, etc.
It can also be that she has low energy, and saves it up for her outings.
When you take her out, she is looking forward to it, enjoys it, is with those she loves, and "comes out".
Folks should also know, it is common for facilities to NOT document what they don't witness.
Sometimes, they do not even document things they DO witness, if it is counter to what is expected, or what's been being done.
POA's and patients who are able to do so, can sit with a nurse and read their chart.
IF there is something out of line, it needs corrected while the patient is still in the facility.
IF staff tries to prevent accessing the chart/staff notes, there is something wrong that needs addressed to Ombudsman.
all those can also apply to Acute hospitals, as well!
Seems like it's pretty pervasive....and for this, the costs keep jacking up annually or more often!?!
This stuff, alone, is crazy-making!
""The five most frequent nursing facility complaints in 2011 were:
Improper eviction or inadequate discharge planning;
Lack of respect for residents, poor staff attitudes;
Medications – administration, organization; and
Resident conflict, including roommate to roommate.
The five most frequent board and care and similar facilities complaints were:
Quality, quantity, variation and choice of food;
Medications – administration, organization;
Inadequate or no discharge/eviction notice or planning;
Equipment or building hazards; and
Lack of respect for residents, poor staff attitudes.""
thank you for listing the Ombudsman information!
There are Ombudsman offices in each County I think.
They can and do help to resolve issues for clients in facilities.
IF you cannot get adequate results asking the Doc to revise the elder's meds, or at least evaluate them in her circumstances
---maybe put her on a "medication vacation" for a week or few, to help sort out what she really still needs---
Contacting the nearest Ombudsman office, and getting one of them to help you with resolving the issue, might be a great idea.
On the screen , they will see a white area on one side of the brain. Treatment is availalbe.
Instead of trying to identify the causes of her behavior, it's a lot easier to shut her up with medication. ... Chances are this NH has already contacted the previous one to find out what kind of "Rx treatment" she was receiving and, as a path of least resistance, has followed suit.
Still, you must understand that all the screaming and yelling is detrimental to others struggling to make the best of what's left of their lives. Speak with the Director of the NH about current medication(s), side effects, and the dangers associated with them. Insist on being consulted -- preferrably in person -- during the development or revisions of her Treatment Plans.
Out of options, the NH might ask you to take her home.
many of those I cared for, asked for these, and I supported them doing it properly.
d-mannose is the elemenet in cranberry that helps fight bladder infections.
It does usually need a fair amount.
It can often be used instead of antibiotics.
IF antibiotics are used, it is really important from an overall health perspective, to replace a broad spectrum of good probiotics, to restore gut function--a person's entire health is founded onhow well the gut functions!
BUt when an elder gets to the point of being in a faclity, options for doing alternative care greatly diminishes, because of logistics [NOT because alternatives don't work].
It often has to get specially prescribed by the Doc, and family then needs to advocate for it...and educate staff on use of it. Alternatives cost most, out-of-pocket.
For instance:
Family told Doc: please script for Acidophilus for their Mom, because she frequently had diarrhea [luckily, that one was covered by her insurance].
Most staff kept forgetting, and messes increased; the stuff sat, being wasted as expiration dates came and went.
Taking stock of the med cart one day, I noticed the stuff in the bottom drawer.
It was segregated from her usual meds, easy to forget.
So, I gave it.
Voila', problem normalized.
Then, I had to keep reporting it at shift changes, and document it in chart.
It took a bit, but other staff finaly started using it, too, as needed--it was even asked for for a couple other patients.
While "acidophilus" all by itself, is not the best choice, it worked for that lady.
And, it was cheap, available via pharmacy, was covered by her insurance, and did not require refrigeration.
But there were more cases where Doc ordered "token doses" of an herb or a vital nutrient, based on poor information, or, figuring it was useless for the family to buy it.
[like dosing 10 mg CoQ10 per day, in a person also taking anticholesterol meds, which actively strip CoQ10 out of the heart muscle..]] CoQ10 is a bit spendy, but, it takes sometimes many hundreds of mg./day, to help a cardiac patient [[based on much research in Japan, and other countries]].
That Doc made a judgement call, which was not necessarliy in the patient's best interests....unless he was helping the person die faster--in some cases, that is a blessed mercy--emotional, but a mercy.
Educate yourselves, and ask lots of questions!
Be prepared to have to make executive decisions.
Consider: HALF of all professionals [name a profession], graduated in the BOTTOM half of their class...you guess.
AND...It is too common that "Docs"[used the term loosely in this instance..] , in it for income, and lack expertise/education/experience, will gravitate to work only in ER's, only in nursing homes, etc., ==where it might be easier to "coast", yet earning great income.
We had one of these charmers con his way into our old office; he also worked ERs all over the Bay Area. The other gig he started mining, was taking on "immigraton physicals". We were still getting calls for these, 2 years after we got him to leave. But, he was soooooo charming, so nice, so good looking, and fun company...but totally out of his element, even in our office; and pretty useless decoration in one ER when I was caring for patient in there [same hospital wrote him letter stating he'd failed to comply with presenting required patient write-ups to his proctor, and if he failed to turn them in immediately, he was fired].
About hallucinations:
One of my patients kept seeing a monkey on the wall in his room.
It kept being documented in records as hallucinations [seeinng something not there, and NOT based on/ related to anything existing around the person].
But none did anything about it.
The guy was pretty freaked.
One shift, I was at his bedside, doing vitals, and looked up at the TV on the wall, and suddenly, I saw that monkey, too!
It was the black metal bracket that attached the TV to the wall! DUH!
I spoke with him about it, and he was greatly relieved.
Shortly later, the meds causing the odd perceptions were DC'd.
The patient was very relieved to know he was not exactly "seeing things", but was seeing something real, tempered by medicated excitation of his imagination.
OTH, there were some really special episodes while working hospice, though those might stretch some people's beliefs--suffice to say, not all so-called hallucinations, are.
The take-aways include:
==Someone really needs to be the person's best advocate.
==Chat up docs about where they work, their practices, their education and interests; get freindly with staff,
==Get educated about the meds being used, not only from staff, but look them up online: google : "adverse effects of__[isert drug name]___";
==Keep asking questions;
==If you have a gut feeling something is haywire, it may be...
==Those most familiar with the "person in the bed", might be able to shed light on what is going on, that the professionals may be missing.
==It takes a village to raise kids up in the ways they should go; it takes a village to support those doing anything worthwhile!
==We sure get in trouble, if we try to do it "all alone"--so go after all the help you need, and be persistent in seeking those who can, and will.
Because there is so much debate about drugs there needs to be a continual healthy debate concerning our elders - giving them dignity, honoring them as whole persons and the like
There are times I am a witness to irresponsible experimental science that invlolves drugs as a mask to other issues