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

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

Here is a really good article on the subject:

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

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

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

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

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

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

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

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

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

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

Good luck!

Hap

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

Contact the ombudsman at the facility

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

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

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

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

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

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