What options do I have for a mother who refuses to give up control of her medicine?

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What options do I have for a mother who refuses to give up control of her medicine?

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We have caregivers with my 93 year old mom 80% of the day and during the time she is to take her meds. She refuses to allow the caregivers to fill her weekly pill box insisting they do not know what they are doing. Any mention of the meds and she goes ballistic. I have offered to fill it for her once a week and she told me I am not to touch her "D...medicine." She does have moments of confusion, but overall is still fairly sharp but unreasonable. She will suddenly wake from a nap and move meds around in the box and get her days all out of order. We have recorded this to show her and she insists we are staging that. I am at a loss as to what to do.

Medication Management Medications

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Sit with her whilst she does it. - She wants the control, you just want to make sure it is right so have a coffee and get her to do them then so you can keep an eye on it.

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Wow, does this sound familiar. My dad is 93 and refuses to give up control of his medications. This is a big sticking point between me and his care service. They want to take over his med management and he absolutely refuses. He refuses to let me fill a pill keeper and insists on working out of the pill bottles. He takes about 8 different medications a day, most of them twice per day. A few years ago, I created a sheet for each medication - one per page. It looks a bit like a calendar with the name of the drug at the top in big bold letters with the dosage information. There is a square for each day with the day and date and one or two checkboxes underneath depending on how many times a day he takes each drug. It is printed in 'landscape' format so I can fit 7 days across the page. As he takes each drug, he checks the box that he's taken it. I created it in Excel and before the beginning of each month, I update the days/dates for the next month. When there has been a change to medications, I can easily pull a page out of the stack or add a new one. They are stapled together for the month in the order that he takes the drugs. It has worked well. He still feels like he has control.

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What would happen if you left her in charge? You say she is competent so what’s the issue about her controlling her own medicines?

I expect once she wins the battle there will be no cause to fight anymore.

Further, if mistakes are made, how serious are the repercussions? Do you know why she doesn’t want to take them?

You may be better off saying, “okay, you’re the one who’ll be sick (or unwell or whatever) if you don’t accept our help.”

I think it’s a good thing that she’s cognizant of her medications. My mother doesn’t even notice if she’s dropped some of her pills that I’ve counted out to her. Nor does she know which pill does what.

She also is mostly competent. She just doesn’t care to know about her medication. When her doctor and I discuss them, she lets it go right over her head and it’s like pulling teeth to get her to respond to questions about how they are affecting her.

Good luck.

Charlotte

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P.S. I should mention that my mom’s doctor has pared down her list of medications a lot. She only has 4 prescribed medications and 3 over the counter. When I first came on board she was taking 14 prescribed medications.

The only pills she takes that are critical are 2 diabetes meds that I notice he plays with randomly so I’m not sure “critical” is the right word for them.

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My mom was the same way, she simply did not want to give up the responsibility for her meds. We started the process of trying to take it over with the assistance of her Primary, it helped that she had some hospital visits and added heart medications as a result as well as aphasia post stroke, who ordered visiting nurse care to asses her ability to take care of her own meds and live alone. She had been setting up a week at a time in those long pill boxes that hold a week at a time, one for morning and one for evening but it had become very confusing with all the meds, we had set up sheets with the name and picture of each pill as well as a numbering system for the pill bottles that helped and of course when the VN saw that they were so impressed they thought she was perfectly capable. She had several times when she neglected to take pills or took morning in the evening or vise versa, the wrong day that sort of thing and I got one of those round auto dispensers on Ebay to try. You can set it up to dispense 1,2,3 or even 4 (I think) times a day, fill it for a week or two depending on how many slots a day you use (we use 2 slots a day and can fill for 2 weeks at a time) and then you lock it so there is no going in to get more meds if they are confused or mess around with the meds. At the time you set (for mom it's 7:50 am & 7:50 pm) the tray turns and makes the appropriate slot of meds available, it has an alarm (not too loud but annoying constant beep) and a red light that blinks until the unit is turned upside down so the current dose of meds drops out, no more no less available and if they miss that dose, say her morning pills they are covered back up when the next dose (Mom's eve) are due and available so she can't double up. The reminders stop in 1 hr I think it is but... Anyway my mom dug her heels in too about letting go of managing her meds until we got this which we figured there was a 50/50 shot of her going along with, she loved it! She absolutely bought in 100% after using it the first day and never balked at either my brother or I being the ones to fill it, she never even asked never mind insisted again that she be the one filling the weeks pills. We never had her do it in the new machine, saying at first we were trying to figure it out and wanted to get used to it, test it out and we locked it and hid the key at first but never made it well known that the thing was locked and she never questioned it. She let go easily, I don't know if that was because she had been nervous knowing she was having a harder time and this gave her back total control of taking her pills each day, they are just dispensed for her or what. She did know how many pills she should have each night and each morning and knows when the appearance has changed, like when the pharmacy changes manufacturer of a generic so maybe that gives her enough of a feeling of control, I'm not sure I just know it has been a God send!

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Thank you! I am going to check this out now!

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As well as the pill pouches mentioned above, a pharmacy can put the medications into blister packs. We did this for my late fil.

Although I am in Canada, so this may not apply in the US, it was not at all an issue to have his prescription renewal dates matched. We have more recently done this for my former mil and the pharmacy delivers.

I understand about the higher authority attitude, but perhaps the pharmacist could have a chat with her about the importance of taking the medications as prescribed? Perhaps even threatening to take some away if she is not taking them as ordered? I know a pharmacist does not have this authority, but a threat to talk to her doctor about it may help.

When did she last have an RX review with her doctor and pharmacist?

And even though this has been her personality for a long time, it maybe time for a neurological assessment. It does not make sense to pay for Rx and not take them properly.

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She was seen by her doctor in June, and we reviewed all meds. I also had a long talk with him about my concerns. You made me laugh suggesting the hint of a threat from a pharmacist....she would eat the poor pharmacist alive! Thank you for responding...I appreciate the suggestions and advise from all!

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Those pre-filled pouches sounds like a great idea, coupled with the theraputic lie that this is the way they do it now.

Before reading about this solution, I was thinking that you could let your mom do her thing with her meds BUT when she is going to take them, you or a caregiver needs to go over them with her. Have an up-to-date list of what she takes, how much, what it looks like, etc. to make sure everything is correct.

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Guiltridden...Just tell her that this is the way the medications now come from the pharmacy. It would be worth checking with the Doctor(s) and the pharmacy to see if they can get all the prescriptions within the same refill time.

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Sounds like she has become paranoid and defensive, and unfortunately that won't change. It also appears she is trying to exercise control, which is common as people age and feel like little is in their control anymore.

Does she know and understand what each med is for? Some elders worry that meds may have bad side effects or will hurt them somehow. My grandmother was similar, and we had to explain to her what each med was for and how much per day. Otherwise she was nervous about how they would affect her.

Maybe each morning she can sit down with the caregiver and they can set out that day's, and that day's ONLY, meds (assuming the caregiver is legally allowed to do so). Repeat every morning. That way she feels she's controlling it and the caregiver is just the extra set of eyes to make sure it's correct.

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Yes, she knows each med by name and milligram, and the purpose. I do believe it is more of a control issue. I try to stay on top of it as I am there for at least a pop in visit 5 to 6 days a week. I am definitely willing to give the daily method a try if she will cooperate.

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What are the meds?

Is your mother considered competent or not?

If this is becoming an emergency, it should be possible to "divert" her meds into safe hands following their collection from the pharmacy (I assume your mother doesn't pick them up herself?). But it's not straightforward, because if your mother has mental capacity then handling and taking medications isn't something you can just stop her doing.

You could perhaps ask her doctor to read her the Riot Act about it; you could download official Best Practice Guidelines on the Safe Storage and Handling of Medications; and perhaps she'll take advice better from a "higher authority."

If your mother were more confused I'd suggest filling her pill box with placebos, but it doesn't sound as if you'll get away with that.

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Never in her life has my mother thought there was any "higher authority" on earth aside from her. She is considered competent. I have POA, medical/healthcare POA, etc. but she is still "large and in charge." The daily battles are draining me, and I can assure you she would have never tolerated the behaviors she exhibits from anyone. Just getting her to take the meds is an issue. She acts like a toddler making faces and saying she will take it later. The caregivers have tried everything and so have I. The doctor has not offered any real help. He just tells her I have her best interests at heart and she should listen and cooperate. Fat chance of that happening.

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There are companies the do prefilled "pill pouches" I wonder if this might be an option, they are all sealed so that unless she cut them open she could not switch them. And if you told her this is the way the medicine comes now would she accept that?
I just checked and there are several companies that do this CVS is one of them.

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We approached this and she pitched a fit. Unfortunately, all her meds come due at different times. I will call the pharmacy today and see what options we have. If they will do it, I am not above telling her it is how the pharmacy is doing it now and we do not have a choice. ;)

What options do I have for a mother who refuses to give up control of her medicine?

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