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Mnnfhfnnmm.

No replies possible. Not with teeth this tightly clenched. Oh Barb, are they trying to drum up business and have her entire family admitted with apoplexy?
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So to continue the saga (no replies necessary; this is for my own benefit)....

Social Worker called last week to apologize for the lack of communication. I wasn't having it. I told her that we just KEEP having this same conversation over and over. I want something to change.

Talked to the Ombudsman over the weekend. Yes, we have the right to be informed about med changes. This cut back on Lexapro is apparently about the increasing incidence of Serotonin Syndrome in the elderly who are often (and my mother is) on more than one antidepressant. The thing is, my mom is on palliative care. I would rather she not be agitated, even if the meds are going to put her at risk. REALLY; my brothers and I all agree about this.

I went to see mom yesterday; she's fine. When I went to fill her water pitcher, an OT appeared and was asking mom questions about her hand strength. I asked pleasantly what this was all about. The young woman said that nursing had asked for mom to be screened for OT. I asked why that was; she said she didn't know. Mom was a bit agitated about being asked questions (as she can't answer, being aphasic and all).

I emailed the powers that be last night and got a call from the head of rehab today.

My mother has stopped her "ambulation protocol". (They've been walking her up and down the hallways with a walker and gait belt since she stopped being able to walk, more than a year ago). When did mom stop walking? Rehab didn't know. She was evaluated for PT last week, and approved; nursing wanted her OT skills checked out as well.

As you can see, they are taking excellent care of my mom. My brothers and I just don't know anything about it.
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FOX News has nothing to do with it. Perhaps political commentary (or snipes) are better left on other message boards? Just say'in.
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Communication is identified as the single most important issue in big public reviews of service quality, ooo, I would say once every three to five years? And there's always a big hoo-ha about it, and everybody rushes round talking about multi-displinary teams and interagency co-operation, and Grand Plans are implemented, and this usually filters down to something as exciting and innovative as someone saying "I know! Each service user should have a journal, and everyone enters information in it ad hoc or daily, whichever is the more frequently occurring."

[thinks: no sh1t Sherlock]

So they do that, and it becomes one of the criteria on the service quality inspection list, and each service user is dutifully supplied with a journal. Which you initial on each visit, and which otherwise gathers dust and tumbleweeds.

And if, every so often, you get a little bit excited about it and jump up and down with steam coming out of your ears and demand to know why this isn't being *done*, the reaction you get from the front line staff tends to be best described as - well it's not even dumb insolence. It's just dumb. As in "uh?"

It makes you want to shake them. And I will put money on it, Barb, that the person who told you that your mother had been seen by the dentist, at the time of his or her speaking, was failing to distinguish between a dentist and a dental hygienist. Hey! - it was someone who looked in her mouth, yeah? Not deceitful, certainly not abashed or covering up, just unbelievably, breathtakingly *thick*.

You sometimes think that they must have an entire training module devoted to "Disengaging The Brain (Your Own)."
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The NH industry is very difficult to navigate - your mom is private pay and has her children watching out for her

The poor folks on Medicaid without loved ones involved in their care
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I so agree, Veronica. When I asked the DON and Director of the facility if the psych service checked on patients in the late sfternoon/evening to follow-up on adjustments, there was thundering silence at the other end of the phone line.

I said, folks, that is Geriatrics 101, right? I'm not even in that field, and I know that.

Cold comfort to be right.
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Barb I was not advocating the chemical restraint of the elderly. I was just commenting that needed medications are often with held as in your mother's case. There is nothing wrong with trying to lower the dose of something but it should be carefully monitored to be sure the patient does not still need the higher dose. Your Mom obviously needs the higher dose of Lexapro so it is good that you stepped in and caught the problem. The point is you should not have had to and many people would trustingly accept anything they are told. On my soapbox everyone needs an advocate these days.
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Veronica, in the State of Connecticut, and elsewhere, there are regs in place to make sure that elders are not being chemically restrained by meds. I get that. Most elders should not be over medicated.

My mom's dosage of Lexapro was increased, and did the trick, when she thought she had leprosy. We tried redirection, taking her to docs, etc. Nothing but meds helped.
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I don't know if it was this thread i commented on this subject. there is a growing trend in long term health care to reduce any and all medications as a cost saving measure. on top of that there is pressure on all drs to reduce the amount of narcotics and psych drugs prescribe. naturally there are two sides to these decisions. When I broke my elbow i was prescribed 6 whole tablets of oxycodone. Fortunately my PCG prescribed another 20 which I did not finish. patients have the right to have their pain properly controlled.
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I agree you need to know when her meds are changed and she deserves better than that. She is paying the bucks. Poor communication for that long is hardly excusable. It is their modus operandi.
It may be more than poor communication if they have no procedure in place to monitor the effect  of the dosage change on your mum and to take into account what you have tried to convey to them which is that your mum will people please and not show them how she is feeling. They need your input to properly assess her. This should be built in by now IMHO.
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Part of what is going on here is that most NH's these days outsource their behavioral health (geripsych) services. There aren't enough geriatric psychiatrists to go around and in most situations, having a team go out to manage these meds is a very efficient and cost effective solution.

As I've pointed out to the senior staff, adminstration, social worker and front line nursing staff over and over again, my mother hides her emotions from "strangers". She is not going to get weepy and agitated for them She saves it up for us. She has ALWAYS been like this--a real people pleaser. So the ONLY way they are going to know if she's upset about MRSA, Leprosy, etc, is if we tell them. And I think we deserve to know that they've changed her meds. I looked back at my records and found that the day after the reduction was started, mom told my SIL that "something terrible" had occurred. It hadn't, but mom interpreted something ordinary as catastrophic.

She deserves better than that. If I'd know they'd reduced her meds, we all would have known that it was having a bad effect on her in one day.

This is all about lack of communication. And they don't seem to be getting any better at it than they were 3 1/2 years ago.
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One star vs five a big difference. Failure to handle meds properly is a big issue.

"while mom sees the dental hygienist every three months, she has not seen the dentist is over a year. I specifically requested this in early december, and was told she had been seen. "

This dishonesty/cover up really sticks in my craw. What else is being covered up?

Let us know how the pow wow goes.
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I know, CM. The current place has dropped to one Medicare Star; proposed place (no availability right now, of course) has five.

In part, in large part in fact, is that the way we've set this care plan up is that my SIL spots the issues and because I am mom's HCP, I run around and try to get the issue fixed.

SOME of this stuff I would let slide (dental, for example). Psych meds, no, I am like a mama bear on my mother having some peace of mind. But part of me just wants people to do their jobs!

If I had let the ball drop on issues like these, even at a large public agency like the one I work for (where everyone thinks we just sit around eating bonbons all day), my head would have been handed to me by my boss.
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Ideally you wouldn't have to move her anyway; but then there is also the thorny issue of whether an alternative place wouldn't just present its own new set of problems.

Reminds me of when Daughter 2 was doing her best to get herself expelled from school, sigh. It wasn't until I howled "you'll find every other school just as bad! I've looked! I *promise* you!" that she seemed to accept the point that she was probably better off with the devils she knew. I'm not sure the Vice Principal found my argument very flattering, mind.
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Correction, medication management. Yes mom still hasat least two years of private pay monies left.

It also transpires rhat, while mom sees the dental hygienist every three months, she has not seen the dentist is over a year. I specificallyrequested this in early december, and was told she had been seen. Stay tuned.

I don't want to move mom. She is content where she is. Need to have a pow wow with brother and sil.
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Barb, I'm tearing my hair for you. Who *doesn't* agree that psychoactive drug doses should be kept to a minimum? Obviously! But, so, they merrily go ahead and reduce the dose; but where's the follow up? Where's the baseline assessment, the monitoring plan, the review dates? And, too right, where's the consultation and advocates' agreement to this, eh?

Half-baked implementation will screw up any strategy. Wretched fatheads is what they are!

Unfortunately there are wretched fatheads in the woodwork wherever you look. But I agree it's nice to have an escape plan.
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Barb
Your mama has been through so much - hope if you decide to move her that it is an improvement

If you don't mind my asking, is mom still private pay at her NH?
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I had a longish conference call with director, Don, sw, Unit manager, etc., today. The bottom line is that the behavioral health group that does medicaid management reduced my mom6lexapro because by state law, they need to try to cut back on psych meds. I get that. I work in an educational organization where we are charged with keeping children in the " least restrictive environment".

The problem is the lack of notification. I've had this conversation with these folks at least 10 times in the past three years. It works for a bit, and then it doesn't.

Got an application for another, nearby, family owned NH. Just doing that made me feel better. I'm quite done with these folks.
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Poor mum. Hope they get the dose sorted out.
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Is thinking you've got MRSA better than thinking you've got a melanoma? Poor mother, for her it's a real fear whichever way you slice it.

Someone has Some Explaining to do, hm? Hope she's feeling calmer again very soon. Hugs.
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So, got a report from SIL last week that mom is weepy and upset, thinks she has MRSA. Long story short, asked for ßome blood and urine tests, turns out Someone decreased her lexapro. Not yet sure who. Stay tuned....
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Peter and the Wolf was fabulous. Went to see mom today, 6 inches of snow in Connecticut ( my brother says 3 to 5). Mom seemed about the same, maybe a tad more lethargic. No big change that I saw.

Thanks so much to all of you for your support and feedback. I re-read the whole thread the other night. It's like molasses with occasional Mercury. It makes me so glad that mom is somewhere where folks with training are caring for her.
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Whoo! Wish your son "break a leg"! That *is* exciting, hope your grandson loves it as much as I did :)
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Barb
I know you're an early bird but I hope you got some rest last night and that the winter storms don't impede your travels this weekend

Prayers and hugs to you
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My son ( the actor) is narrating Peter and the Wolf tomorrow with the NJ Symphony. More importantly, my 4 year old grandson will be in the audience. Hoping this all goes well, and that this is just a blip with mom. Love you all!
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Comfortable is good. SIL is a blessing. Try to get a good night's sleep - WHY do these things always pick the weekends to happen? Hugs to you, look after yourself.
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Oh, Barb! ((((((((hugs)))))) What a relief to be on the same page and have in laws that can be there for her. Keep us updated, please. My heart goes out to you and your family.
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SIL just emailed me; mom is slumping over heavily in her wheelchair. SIL got aide to come in and re-position her. SIL thinks perhaps a small stroke or TIA. Mom is comfortable, responsive to SIL's prayers. I'll call tomorrow and go up on Sunday, but we are so NOT transporting or seeking intervention. SO very glad that we seem to be on the same page. God bless wonderful in-laws, who can love unconditionally the way some of us damaged kids can't. B
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Barb
Hope your mom is better

Mom's private caregiver brought us both the dang bug two weeks ago and I still can't shake it off
Mom still has congestion and a cough and didn't want to get out of her wheelchair last night so the dang staff at the hotel California left her in it with her head hanging low - I was just too tired myself to go put her to bed but I will tonight - we have a little rain today and I hope the afternoon caregiver can get her into bed for a cozy nap
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Church
You must be thinking of a fish called Wanda
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