I advocate for an old friend who lives nearby in Assisted Living. She's physically healthy but has s short-term memory loss. She was un-diagnosed when she entered AL, but suffers anxiety which can on rare occasion boil over to threatening behavior ("get out of my room or I'll hurt you" or pushing them away (which falls under the category of hitting), both offenses which they say they are obligated to record/report. In order to treat (medicate) the anxiety, the visiting PA diagnosed her with Dementia - without letting me or her Trustee know. We had just referred to the problem as "memory loss," so the diagnosis of Dementia was devastating and contributed to even higher anxiety. I was able to get a Limited Health Care Proxy, took her to an outside physician, confirmed the diagnosis (ie, Dementia = memory loss and changes in behavior), and agreed to help reinforce to her that a low-level anxiety med would help her feel better. She doesn't remember that she has "memory loss" but she seems to remember the word "Dementia" with vengeance. That was the start of the fee-based extra service of dispensing medication, which over 4 months increased her monthly charges by $1200 (dispensing of 2 meds, morning and evening and for dealing with her reluctance/refusal to accept the medication. Long story short, the poor behavior began to appear more often - resulting in the AL requiring that she be re-evaluated medically with the intent of increasing the dosage with the objective of finding a level that kept her (and their job) calm. Not having another solution, I went along with all they asked; took her for re-evaluation today with her PCP agreeing that increasing dosage was a trial and error process. When I returned her (and her meds which I had taken to the appointment), I noticed that both one-month supplies had more than 15 pills left - which led me to question why since they were being paid to dispense 2x daily with the combative upcharge. THEN...I was told that patients have the legal right to refuse medication (a good thing) and that their records show she had refused medication 10x in January. The problem is, without this knowledge before I took her for re-evaluation, I helped lead her PCP to the opinion that the current dosage wasn't effective; and, on that basis, he doubled the dosage. I know caring for those with memory loss is difficult and I try to work with the AL. I just feel betrayed by their failure to be reciprocal with information. They didn't let us know that she had been diagnosed, at the AL facility, by a visiting PA; and now they led me to believe the meds weren't working without letting me know that she was refusing to take them. I understand that the AL industry is regulated - and why - they can't tolerate someone who threatens staff or other residents' safety and they are required to abide by patient's rights laws (right to refuse meds, not be locked in their rooms, etc.). I'm building a healthy dislike for administrative procedure in institutional living, yet I have no alternatives to recommend to her Trustee. Soooo frustrating!