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Mom has both narcotic and non-narcotic prescription medication and I fill her weekly pill dispenser and stop by almost every day. The Director is convinced she falls because of the pain meds. Mom has some memory problems and bad balance and uses a walker. When I was out of town for a week, Mom fell again and the Director searched Mom's room and locked up all of her meds, forcing her to quit cold turkey, without medical supervision. She didn't tell the AL nurse, me, or Mom's doctor. I didn't find out until Mom called me in pain. I have tried turning over Mom's meds to the AL to distribute so there is no question of over-medicating on pain pills, but don't trust them now. The Director would find some fault with the Rx (e.g. doctor said "1-2 pills every X hours as needed" and AL can't have an option; Rx has to say "1 pill ever X hours", etc.), so the Director would pull the pills off the cart and lock them in her office so Mom couldn't get any pills. Again the Director didn't call me and say "there is a problem with the Rx, it needs to be written differently." Instead I find out from Mom when she is in pain that the pain pills have been locked up again. What can I do to improve communication with the Director (who won't return my calls) and make sure Mom gets her medication as prescribed?

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Contact the long term care ombudsman's office. Contact the managing company for the assisted living and let them know what their administrator is doing. You have trusted your mother to their care and they broke that trust. A nurse should be the only employee to remove meds from your mom's room. If she won't return your call, the ombudsman will get her attention, or her superior. Also, make sure the Doctor knows about this happening twice. Assisted livings are all about the referrals from medical people in the community. I would NEVER refer a person to a place like that.
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I had exactly this problem with my mom in AL; we needed to move her. You need to have a sit down with the DON with the doc on the phone, conferenced in. It IS true that the scripts need to be written in a very precise way, but not returning you phone calls is inexcusable.
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My MIL's doctor discourages narcotic pain medication for that very reason. She already falls due to her feet tangling up, so he says we need to try to use OTC as much as possible. There are also other side effects that narcotics have (constipation was one I believe, another problem we have anyway) that he tries to avoid.

That being said, it was small, petty and probably illegal for the director to refuse your mother her medicine. It sounds like you are saying this isn't even the first time she's done this? I do believe I'd report this facility to the proper authorities. There's no excuse good enough. I'd look for another facility for my mom.
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Joint commision on accreditation. They can pull their license.
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PS, the proper way for the doctor to write an optional additional pill is PRN. We also had a problem when mom was in AL because her outside doctor wouldn't write prescriptions in a manner that was consistent with STATE LAW? He knew better (sigh). When we moved mom, we got a new doctor who specialized in geriatrics and non-pomposity. It's a winning combination.
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Just an update for all of you who have been so helpful: I had a meeting on a Friday with the AL Director, her boss, the new nurse practitioner on staff, and a few other staff members to discuss the problems. I very clearly stated to the AL Director that I did not trust her and communication needed to be better. I finally got a very grudging apology from her and we all agreed to communicate better going forward.

On the following Monday, I had a meeting with the staff regarding her care plan, and they said they were increasing her from 1 care point to 11 care points a month ($1100) because they were going to take over dispensing all her drugs (with my blessing) for 4 care points, 2 points because Mom was "verbally abusive," 1 point because she used a walker (which they knew when she first moved in), and more. I felt it was in retaliation for my complaining and gave notice I would be moving Mom as soon as possible.

On top of that, I found out from the med techs that sometime after the Friday meeting, the AL Director added 19 narcotic pains pills to the med cart that she apparently had locked in her office since the Thanksgiving debacle. (I don't know how many pills were taken from Mom's room at Thanksgiving and don't understand why any were not locked in to the med cart.) I stormed over and asked the Director why, and she said "I was monitoring how many your mother was using and restocked the cart when I thought it needed." I told her I thought that was inappropriate and was going to file a complaint with the State Department of Health. I wonder if she took any of Mom's pain meds?

I found a new AL facility that seems to be a much happier place, and moved Mom the day after Christmas. Wishing you all the best in 2015. Thank you for listening and caring.
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SoFrustrated, I'm so glad you've moved your mom. Trust is a hard thing to get back. It sounds as though the former AL did a very poor job of assessing mom's needs when she moved in. Retaliation? Hard to judge. But moving her was the best solution. Happy 2015!
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Did it occur to you that the Director may have an addiction to opiates and is stealing your mom's meds?
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Glad you moved your mom out.
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I agree that the director is probably an addict. Now that your Mom is safely out of there, I'd complain to absolutely everybody, especially whoever handled Medicare accreditation. Call whatever insurance she was using, the elder abuse folks, the long term care ombudsman, etc and tell them what happened. The reason is, if you don't put a stop to this person, she will continue to abuse her next patient. If this ALF is owned by a corporate headquarters (like Brookdale or other), I'd be sure to complain to them as well. Good job on getting her out of there. I'm betting the huge increase in points was retaliatory.
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