My Dad's (88) meds are questionable, family member gave permission for deadly cocktail, Dilaudid?

isn't there a patient advocate at the facility?

I did a short google search and here is a list of elder abuse hotlines.
http://www.nccafv.org/state_elder_abuse_hotlines.htm

Call law enforcement or elder abuse hotline if you suspect abuse. They will check it out.

Narcotics are not without side effects including high risk for falling, chronic constipation and bowel obstruction. Is he dying of cancer? If you suspect abuse--you can report it to authorities (law enforcement) and have it investigated.

Just want to say thank you ALL for caring enough to respond...warmest hugs, tons of strength, I'll be thinking of you all too...until.

Hey Flyn, hang in there. It is really hard to worry about them and wonder if things are being done the best they can be. That Dilaudid is some no messing around stuff, my Sister was on it for Cancer, it made her pretty "high". Does look like there are some risk for someone who has had a stroke to be on it as well. Chronic pain like that is just such a balancing act, seems like everything they can give for pain like that has risks. You're right to question, observe, keep on it. You know him better than they do. Even though my late GMA had a medical POA she put my Sis and myself on a HIPPA form so her Doc could talk to us too. It was comforting for us and her. She knews what little pit bulls we would be if something looked funny concerning her treatment. :-) I'm having some trouble of my own getting straight answers about my Dad's health from a new stepmom, and they are 1/2 the country away. I go to sleep at night hoping he's OK, so I understand how you feel. I try and stay focused and clear headed about it, am taking baby steps and on the edge of making progress. Hang in there. Thinking of ya.

Oh dear, thank you both, I think I'm driving myself whacko!!!
Dad is living in AL. The staff, well, it's as though almost all of the medicals are on a gag order, except for a few lovely PRN's who've said it all re: his meds through a wide eyed look or a gasp of air or shaking of their heads...no one has come right out and said anything but a look is sometimes worth a thousand words.
The onsite doctor was removed (that's what was told to us) and a new onsite is the prescribing physician, who is absolutely unreachable~
Oh my goodness, I'm guessing that I should stop perseverating on his meds sheet, *yep you are right and thank you again* for clarifying the doseage, 6mg's it says and is BUT there is an extra pill in the bedtime slot, (I photocopy everything, is that weird? I'm sure it is along with multiple other things I mistakingly do, eh, I'm only human) though the prescribing information is 1 tab, by mouth, 3 times a day (1,2,3,4) ---that's what written by the pharmacy...along with 3mgs being long acting.
You know @cwillie, what I wouldn't give to talk like civilized humans beings with my sister, love her just don't like some decisions she's making for our dad...in all honesty, on my life, the staff are afraid of the poa, or another explanation cuz they hear me but it stays between us...nothing is ever forwarded onwards.
Don't know if it's terribly important or if it might help but I am on the POA should she be unable or just does not fulfill her duties for our dad...
I can't thank you both enough for your help, hugs of strength and understanding to you both (I know we're all going through or have gone thru personal nightmares or grievances, my heart aches for any and everyone in a caregivers position)

Use your POA. If it is for Healthcare also great. If not report to adult protective services. The narcotic load is to high. Not all POA include Healthcare, but if you'd does that doctor has to see you.

Talk to your dad about getting you a Healthcare POA on a day when he is not taking the narcotics. Pay a lawyer to come to you it is worth it and most likely to give discount cause hell see the overdose. That is what saved me.

I was on fentanyl lollipops x6/day 1mg dilauded for breakthrough pain 20 count/day and 125mcg Fentanyl patches. I was a zombie homebound and need a nurse to feed me. My POA &HEALTHCARE SURROGATE took all the meds to a single pharmacist asked the narcotic load and stroke potential. He was shocked I a130lb man was alive.

Get all your meds filled at one pharmacy. Go to a cancer pharmacy and get your meds pre packaged daily so you don't screw up. If you take more than 5 meds is very impt.

Best of luck

Is there any chance that the change of meds was necessitated by pain from an unreported injury (fall, drop, or back strain) or being left in bed too much? Maybe, with the POA's permission, a visit to his regular Dr. to check for recent injury? There is a tendency for facilities to be less-than-observant and just cover up symptoms with pills.

FLYNSOLO, I'm a little confused with your math, you said he was getting dilaudid 1 mg X 3 and controlled released hydomorphone 3 mg at bedtime, that makes 6 mg total, not 16???
Even so, you are seeing that he is having classic side effects to having too much for his system to handle. What are the staff at the assisted living telling you, are they seeing this as a problem as well? I think mentioning what you observed and presenting this as a concern that perhaps his medication dosage some tweaking would be the way to go, and if the staff at the assisted living express the same concerns to the doctor and poa it can only add reinforcement to your observations.

I'm glad you clarified that you're not banned from seeing your dad and didn't realize he's actually in a facility, assuming like AL? so what do they think about his change in behavior? Does the facility have its own doctor? is that the one who's prescribing these meds or does he still have his own private one?

I am truly grateful for your posts, thank you.
I posted my question because I FEAR FOR MY FATHERS WELL-BEING and I feel exhausted in my resources and my emotional being, reaching out for help, an ear...
I'm in my 50's, knowing a thing or two about severe pain having undergone knee surgery, hip replacement, coupled with three degenerative disks, I'd go on but this isn't about me, or my relationship with my sibling.
My aged father is presently taking:
3000mg of Tylenol per day
16 mg of Morphine per day,
THE LATTER IS NOT TYPICAL DOSING FOR THESE MEDICATIONS.
The differences that we saw, my husband and friends who've known my dad for decades were delirium, absolute confusion, falling asleep sitting at the dinner table with a fork in his elevated hand, significant sweating, shaking/tremor like, random acts that I've never witnessed my dad doing and because the medications are new, he didn't act this way 3 wks ago,5 wks ago, 8 wks ago leaving me questioning why, what's new in his life, the meds are new.
My father has pain, he's lived with me, I know he hurts but the dosing of the new meds are ridiculous and are doing more harm than good. (My dad was never constipated from Tylenol 3's, we discuss everything, we speak daily, we've been close as father daughter since I can remember.
I'm terrified...
(My post in by no means was meant to undermine other POA's and the copious, unending things they do for their loved one, my sister doesn't see my dad, there's a book to login upon visiting her name is never there,and the staff have told me I'm the only family member who comes to visit. To clarify, I'm not banned from seeing my dad, impossible HE WANTS TO SEE ME SO HE DOES, I can't take him out without the POA's ok, no one could if he still had his friends but that is another story for another forum.

the POA does have the right to ok the meds. But if you can express your views to the doctor, and if the doctor feels that it would be negative publicity for him or the facility if he is not responsive to your inquiries, then the doc may re-think the meds. While talking to him, say off-hand, "I'm on a caregiver's forum...when I posted about this, they told me..." or "I would've given this facility a positive YELP (or Angie's List) review before this...but now...I just don't know...I mean, if you aren't RESPONSIVE to family member's CONCERN here..." And Oh yes...put it in writing. Write a letter to the doctor and a copy to the head nurse and one to the director/owner of the facility. Get a friend or librarian to help you edit it if you are unsure of your writing ability. Sound calm and logical in the letter. don't threaten...but suggest -- that you know a lot of local people who have asked you whether this was a good place, "and frankly, at this point, I wouldn't know what to tell them..."

As a family member, you don't have to be a POA, You have a right to talk to the doctor, express your views, and get answers. Follow the steps to that end. 1. patient advocate/community liason 2. social worker 3. director 4. secretary of state department of health, home health hotline or whatever your state names it -- that is what oversees all healthcare facilities and homecare companies. 5. ombudsman, either in your city or Council on Aging ombudsman) 6. Community mediation center. 7. call the local library reference librarian, they can help you get these names and numbers. Good luck.

Can you pick up a hippa form from the MD, have Dad add your name to it, then make an appointment with MD to discuss your concerns/observations regarding new meds?

So since you said before this change in meds he slept all day. So is he now "wired? "

I know it must be difficult. But, I too am being questioned all the time by his niece. She has NO idea the way he suffers from back pain. I can tell her over and over but it just does not matter. She is consumed with the fact that he chose me as POA. She lives 4 states away and if she saw her uncle today, she would not recognize him. The disease has changed him considerably.

Sometimes my Partner seems to be so drugged and other times, he is alert. I think it is also the disease that causes the deep sleep he gets off and on. Personally, I would be a bit upset with someone calling the authorities on me and having an investigation started. Until they have walked in the Care Givers shoes, they will never understand how just "one more thing", will make their job even harder. That is not to say if you TRULY believe this is happening and this person is "killing" your dad, of course, you should do something. But, be careful. Love your DAD, his time may be short. You need to be able to see him. The POA will come around and you will be able to see your dad.

Maybe your POA would do you a favor and add your name to the list of people the doctor can speak to. There are so many things going on here and I hope that you can find your answers. I doubt the doctor is doing anything illegal. But, again, if you TRULY believe this, then report it. But, get ready for a battle as it will not be easy on your dad or the POA. Good luck and let us know how this turned out.

The previous script for tylenol 3's was already a narcotic pain reliever, being tylenol, codeine and caffeine, and although directed "as needed" you say he was taking them 4 times a day. It would seem he was not getting adequate relief from that anymore so he was switched to regular tylenol plus hydromorphone in a daytime and extended release nighttime prescription. What makes you think this is a "deadly cocktail"? You say he slept all day prior to the change in medications, so what difference are you seeing in his behavior that alarms you?

I think it would be irresponsible to inadequately control his pain because of some misguided fear of the dangers of narcotics, especially considering his age. The biggest downside to this class of pain relievers is the constipation issue, and that is the one that has kept me from using them for my mother, but since he has already been using tylenol 3 I think that ship had already sailed.

Not enough time, I'd like to ask about your father's drowning in his fluid - was he on hospice or between? let me explain; my dad was in icu in the hospital on a ventilator/respirator, not trach and being suctioned - still haven't figured out the difference there - when he was discharged supposedly to inpatient hospice, taken off the ventilator, and transferred to a regular room on a regular floor; however, when he got there we were told there was no inpatient hospice in the facility; apparently the icu doctor wasn't aware of that and possibly even if there were it would have been contracted out to an outside facility, where they would have to have somebody come in from to assess him for admission, which they would have to anyway, so they did but then the issue was when he going to be discharged to home for in-home admission or be transferred to the inpatient hospice at the outside facility, part of that depending on whether they had space for him there, so while we were waiting to see whether they were going to be able to take him there while he had been officially discharged from the hospital and admitted to hospice, with him being discharged they could no longer suction him but with still being in the hospital hospice, who had sent a nurse that was to take care of him if he were going home, was not allowed, either by the hospital or hospice - not sure which - to do her job in giving him the medication to dry up the secretions which were the reason for him being suctioned, so while all that was being done, and while we were trying to get in touch with somebody to grant authority for that to be able to be done, thankfully, the hospital CNA went into his room to do her job -which, technically, suppose she wasn't supposed to be doing either, since he'd been discharged but apparently she didn't get the word - and found him drowning like your dad, and also, thankfully, she got the hospital nurse who'd been taking care of him, who, also (and not really sure which came first at that point) called the doctor who'd been his and told him what was going on, who readmitted him, and got him suctioned and taken care of, but I certainly understand, horrible the look in his eyes as, yes, I do believe he realized what was going on; I cannot believe they allowed that to happen to your dad

@wintersun - the doctor won't, or at least legally shouldn't, discuss that kind of information with anyone who is not the POA. They may do it, as I have found that the medical community often talks to family more readily than financial institutions do, and doesn't always ask for the POA. HIPPA in most medical offices when you check in for an appointment, but I have found that it isn't a guarantee that the will adhere to it. They usually do, but there a very small percentage of the time the forget to ask the right questions of a family member who inquires.

Ask the prescribing Doctor, see what they say.

I think the most important thing here is to find out why the Tylenol was suddenly not enough, when it had been working well for your Dad. This is what the Drs. did to my Dad, slowly adding dulaudin, even though he told me he wasn't in pain. In his situation (92) they basically starved and drugged him to death, and once they start the dulaudin at a low dose, it's easy for them to keep increasing it bit by bit, and even to give additional "breakthrough" doses if they decide your Dad's in pain. If I were you I'd do whatever it takes to find out why they're giving this to your Dad. My Dad was drugged to unconsciousness and only came semi-awake the last few hours,to experience fear and suffering as his lungs filled with fluid and he basically drowned staring into my eyes. Please do anything you can to see what's going on because it does sound like a deadly cocktail to me. Maybe you could ask a lawyer or a Patient Advocate to help you. I think it's terrible how our trusting elderly are being over medicated to death. Just do whatever it takes, but do it fast.Maybe if you can calmly speak to the POA it may work. If not, talk to a Patient Advocate. Or talk to a social worker, or talk to a lawyer and see if they can help you. I really hope you can get your Dad back to just Tylenol 3, if it still is enough to control his pain. In between the strength of Tylenol 3 and dulaudin, there's percocet and oxycodone, maybe you could ask why they didn't try those first, instead of the major jump from Tylenol 3 to Dulaudin/Morphine. The stronger you go with painkillers, the worse the side effects. I hope you can get to the reasons they changed his medications so radically. Fight for your father.

It sounds like end-of-life care--maybe he has cancer? There are a few possibilities: He has cancer. OR they may be using stronger pain meds to control his behavior? It's impossible to say but maybe possibility the caregiver is taking them??? I'm just saying these are possibilities--and there is NO WAY of knowing. If he lives in Florida the State is notorious for being full of pill-mill doctors. All those narcotics are not without side effects including higher risk for falling, chronic constipation, bowel obstruction, increased confusion...etc etc etc.

Looking at your profile, I'm a little confused about how old your dad is. I guess that isn't really critical to your question ... just wondering.

You say elsewhere that you are not a "drug pusher" and I can understand why this issue is "all-consuming" for you. There are people who believe in and rely heavily on the power of medication. There are others who are suspicious of drugs and try to avoid them at almost any costs. Among my three sister and me, there are both points of view. We discuss medications for our 95-yo mother calmly and respectfully and, in spite of our different outlooks, we agree on what to try.

In your situation, you and POA (your sister?) have different outlooks on medicine. That is not unusual. There is no particular reason people in the same family would have the same point of view on this topic. Someone has to make decisions. The POA has that responsibility (if she is also medical POA), and you don't. Your father selected her for this role. Perhaps (?) because he knew her point of view on medications.

If you think your father is deliberately being drugged to death, take the suggestions in vstefans post. Have authorities investigate. But it may very well turn out that the medications are reasonable under the circumstances and nothing will be done.

I think the most productive thing you could do is try to make peace with the POA. Accept that she (he?) has the authority to make decisions and that her point of view is simply different than yours. Agree not to make fusses at the care center and not to question your father about his medications. Talk calmly and privately with her about your concerns. No accusations, please. Say that you'd like some input when decisions are being made, but acknowledge that she gets to make decisions.

I think getting back visiting rights to see your father often is the best thing you can do for him now. Try to make peace with the POA. If you sincerely think she is a murderer even after reading these posts about the medications, then report her and the doctor.

Wow, I can sure understand the level of concern. Maybe something happened that he is now having a lot more pain? A gram of Tylenol three times a day for a 70 kg man is not out of bounds. If it helps any the usual adult dose of Dilaudid is 2.5 mg up to every 3 hours, and Dilaudid is a trade name for hydromorphone so his total daily dosage is not sky high or anything.

But, if you still think your father is being deliberately drugged to death at the request of his current POA, your options include contacting the office of long term care and the ombudsman, and possibly the state medical board. Ultimately, the doctor doing the prescribing is more responsible than the POA because they can refuse unreasonable requests. The doctor is not legally able to call you in all likelihood because the POA controls communications. You state he was sleeping all day even before though, and he had pain even before; and I can tell you the amount of Tylenol #3 he was getting would knock me out unless I could drink a pot of coffee or two with it - it really may not be a bad adjustment to his medication plan after all. Sorry this is happening and you can't visit - I hope you can work something out!!

If you don't mind, could I ask what the interval was between your last seeing your father's px and this recent occasion when you found out about the changes to it?

Tylenol - which is paracetamol, yes? - is at its most effective when it is given as a continuous background pain suppressant. 1000mg three times per day sounds an awful lot until you remember that that is 2 tablets, three times a day. It's not a big deal. The standard over-the-counter dose for any adult with a normal liver function can be up to four times per day without ill-effect, although everyone must be careful not to exceed that.

The two morphine formulations appear to be adapted for day and night-time use, which makes sense. Morphine is used to control severe pain. Perhaps your father's back problem deteriorated to the point where without adequate pain relief he would have become immobile - as a risk factor for TIA's, by the way, immobility beats morphine into a cocked hat.

I'm not impressed that the POA is refusing to answer sensible questions coming from someone (you) who has been entrusted with administering the medication - he or she can hardly claim that information is confidential, and at the same time hand over responsibility to you for acting on it. But there are ways and ways of going about querying a prescription, and you need to tread carefully.

Personally, I'd have started with my friendly neighbourhood pharmacist. They don't just hand out pills without knowing anything about them, you know. A quick chat with your nearest one could have told you whether there was anything to worry about or not.

You did give the medication as prescribed in spite of your reservations, did you? I hope you did. How long was your father staying at your house?

Your father's doctor can't answer your questions, not just won't. He really is bound by rules of confidentiality. Doesn't explain why he can't return your call and tell you that, though - bad manners, but sadly common practice.

Reference the ban on your seeing your father, the refusal to discuss his condition with you, and so on… Ok, who is the POA and what are the issues between you?

These dosages aren't unusual for severe pain. However, the tylenol will be potentially hard on the liver. This type dosage is normally given 2-3 times a day (every 8 hours) for pain and inflammation.

It sounds like your father is going through a lot of pain in his back. My mother also has a lot of pain and sometimes the Tylenol III isn't as effective as needed. If her pain were more severe, we would have to add on some things. That may be what happened with your father. Severe back pain is terrible to live with.

Since you aren't living with dad, you don't know how his condition may have changed to require new and stronger meds. It's really easy to armchair quarterback from a distance.

Call Adult Protective Services on dad and perhaps they'll open an investigation.

I would ask you to remember, though, that your dad selected this person as his POA which most certainly indicates a certain level of trust. Reading between the lines indicates that you and the POA have a terrible relationship. That does nothing to promote dialogue. Perhaps working on THAT relationship would help you to understand your dad's care a bit better.

Call a pharmacist and ask about these medications.

If you think this POA is over-medicating your dad call the police.