Have you any advice about medications and assisted living?

My mother entered an assisted living facility right after Thanksgiving and this all sounds familiar. I am still working on having the correct meds given and prescriptions written as they need to be. Do not have anything prescribed "as needed" unless your loved one is able to actually request the meds. My mother became extremely constipated to the point of needing to take her for an abdominal CT scan and it took months to get this situation resolved. I ended up taking her home and giving her Miralax, stool softener and finally Milk of Magnesia until her BMs were regular enough that I felt she was safe and we were at least starting fresh. I took her home after a tooth extraction because I thought she might need a pain medication and wouldn't be given even a tylenol at the facility. I understand the rules/regulations but it seems that my mother's only option is to call me if she wants something simple like a Tums. I also took all of her meds to the facility when she moved in and they pretty much gave them all back to me and ordered new from a specialty pharmacy where she reportedly can't get coated or easy to swallow pills.
As for the shower situation, that's familiar too. Until last week she wasn't given even one shower without my asking and she went as long as 12 days without being bathed. I was even lied to and told that she had a shower but refused to have her hair washed etc. My mother might not be able to tell me she had a shower last Tuesday but can absolutely tell me if she had a shower today. I feel like the administrative/office staff avoid eye contact and scurry away when I go in the office.
I worry about the residents who might not have family nearby or someone to advocate and look out for them.

All medications need to be prescribed by her doctor. Staff can not give medication that has not been prescribed. Please give the facility a list of all her medications with the times she takes them. The doctor can prescribe the medications. She - and you - may have to get used to some medications not being on her usual schedule. Staff are extremely busy and do try hard to be accomodating.

Choppedliver,

All of my mom’s medications; prescription and otc were turned in when she entered the facility, which is their policy. They had previously gotten what they called an MAR (?) from her primary doctor, approving her meds and dosages etc. One of them, prescribed by her urologist, was not in his records for some reason. There were also otc meds and prednisone that were not on the paperwork he submitted to the facility, ( even though he was the one who renewed her prednisone last). So it took time to get those approved, The thing is, her doctor’s office is literally across the parking lot from the AL facility and the local hospital is across the street! Yet it takes days and days to get anything done. It just doesn’t make sense. My mother signed the papers and paid the deposit two weeks before she moved in. I offered to give them a list of her medications, but was told it wasn’t necessary, just bring them at move in. We also moved her things in before she moved in so we could have provided the meds beforehand, but that was not communicated. We thought a smaller facility would be easier to communicate with, but communication seems to be the biggest problem. Live and learn I guess. But my siblings and I are all feeling terrible about how this has played out. Hoping we don’t have to move her out. I don’t think she will want to go through this again.

Familyscapegoat: Imho, this should have been standard operating procedure at the AL since all of your mother's medications were handed in on day one.

UPDATE:
I appreciate all who responded. I think we have finally resolved the meds situation for my mom, but not without serious damage done to her transition to Assissted Living! Those first days should have been so positive and reassuring to my mom and to us, her family. It was her reluctant choice to go to AL, and they really blew it. They definitely got her off on the wrong foot. I hope they can repair it, but I’m not sure. They just affirmed all of her fears about AL: that she will have no freedom; that once they are paid she doesn’t matter; that no one will listen; that she is being “ warehoused” till she dies”. And, they undid all of our reasons for suggesting AL in the first place; her meds would be well attended so she wouldn’t forget(ha!); she will have trained personnel assisting her with bathing,
(she went 6 days without a shower after they told her at intake that she would have bath or shower twice a week!)
I finally got her bladder control medicine approved yesterday, but it still was not given till today! I do not understand why it took so long. We turned in the medicine that clearly showed her prescription and the prescribing doctor, but for some reason it was not on the primary doctor’s MAR . I called his office and he called me back directly, and texted to he that he had approved it and it still took another day!
I spoke to the AL director about all of these missteps and to the nurse in charge of meds. I told them that she has not left her room in 6 days because she has not had her bladder control medicine and she has not had a bath! She is self conscious about both of those things of course! Whenever we asked any of the CNAs and/ or other staff, nothing. No one knew anything, or they would “find out” and come back, or they passed the buck. One shift would blame the other shift. I asked why they did not communicate with each other at shift change?
We tried to remain patient over the weekend because there is not much anyone can do about that. But her first shower should have been on Friday, and no one knows why she was not bathed. And as I stated before, she did not get ANY of her meds on the first day! Just so many things went wrong that should have been in place seamlessly. My daughter used to work at a very large county health facility and she said that this small, local ALF where my mother is, is so lucky that we have not reported them. I told her we will if anything else happens. We were so hopeful that in our small town, this beautiful, small ALF was available. It’s minutes from my home, it’s relatively new, clean and has residents whom she knows, and has great reviews.
I just can’t understand why this first week was so poorly handled. I have documented everything so if we have to file a complaint or meet with the head director, we will be prepared. I think we have been patient long enough. NOT the experience we were expecting.

My mother took her own medications for the first couple of years she lived in Assisted Living. I organized her pillbox for her, she took the meds independently. The OTC stuff had to be kept under lock & key in the kitchen drawer; only she (and the ALF nurse) had the key. When I put her on their medication administration program, then THEY took over the administration of her medications, but not before all the meds were approved and orders written by her prescribing doctors. I had her signed up with a PCP who came into the ALF at least once a week, so that facilitated smooth operations and communications between the ALF, the pharmacy, the doctor, the nurse and the QMAPs who dole out the meds.

IF your mother has been signed up for the medication administration program at this ALF, then they should have had this matter all straightened out before she moved in. I'm sorry you're going thru such a thing, and can only imagine the aggravated calls you're getting from mom. My mother also felt she was The Only Resident living at the ALF, not one of 100 people, and that as soon as she needed or wanted something, the CGs had to stop what they were doing to see to her every need. That's not to diminish this matter about your mother's meds; just to empathize with you about your mother's Me First attitude. It's hard (nearly impossible) for them to learn how to wait their turn in life, I know.

I hope this matter resolves entirely in short order. I would also highly recommend you sign your mom up for the docs who come into the ALF to treat the residents. That was the smartest move I'd ever made with my folks and facilitated a much easier run of things in general. Give mom a while to adjust to things too, and see if you can get her OUT of her apt and socializing with the other residents so she's not hyper-focused on what's 'wrong' and complaining 24/7

Good luck!

I was caregiving my Mom with Parkinson’s before she entered AL. I had the same issue with the facility my Mom entered even though I did the following before she arrived:
1) Pulled and provided her entire med list from her MyChart medical records. It included Doctor, dosage, timing, etc.
2) Provided a typed list of all of Mom’s docs, phone numbers, address, specialty, and meds they are responsible for.
3) Took all remaining meds in labeled bottles to facility and reviewed timing, etc with head nurse.
4) Note: I was a forensic drug chemist for years and understand the state and federal rules related to dispensing medication. I have never blamed the poor med techs as they have to follow protocol. I went to the nursing manager - she was responsible for ensuring this was worked out.
Even after all of that it took days for them to get her meds initially correct. I was insane.
All I can recommend is listen to her/ your instincts and check daily to ensure her meds are being dispensed appropriately. If necessary have them pull a med chart which should list meds given along with times. This has been invaluable especially when I suspected her Parkinson’s meds were not initially being given 1 hour before meals - otherwise they don’t work as well. They assured me they were but Mom was barely able to walk. When the med chart was reviewed - sure enough - they had been giving her the meds all at once at breakfast. I was furious.
I have to say, after less than a week or so of me “being a pain” to both the AL and Mom’s docs, it was worked out. And with minor exceptions for over a year they have her meds down correctly. At this point - especially with my Mom on Hospice care, the med techs are her/our “angels.”

We placed my MIL last Monday in a lovely-looking Board & Care. All female residents and staff, which made her happy. But, we have run into communication issues, and I too was/am uncomfortable with the medication procedures. We had her med routine down to a science and sent the list to the administrator to give to the med nurse. I feel like they really disregarded it, and did it as was convenient for them. MIL has increasing memory issues, so we take her reports that she doesn't get all her meds with a grain of salt. However, she was admitted to ICU yesterday with Sepsis and extremely low blood pressure. I had taken her to her podiatrist and as we were waiting for the doctor to come in, she just went blank stare on me and was unresponsive. I called for help and they got the in-house response team right away. Ended up calling 911 and transported her to the hospital. So, don't really know the exact cause (other than UTI), but it tells me my feelings about communication and meds were not totally unfounded. I don't know what the discharge plan will be, if in fact she does get discharged, but I actually kind of hope they will say she needs skilled nursing for a while at least. I don't think I'll be comfortable sending her back to the B & C, unless some changes are made.

Don't mean to scare you, but do pay attention to to your gut feelings. We placed MIL because we simply could not keep increasing her care at home, and budget constraints don't allow for a wide selection of facilities. This one seemed so promising...

Snarky? I'd be in the lobby having a pink fit and biting people's ankles.

I'm all for protocol. I think protocols are great, and nothing makes me happier than a checklist and an entire manual of Standard Operating Procedures.

But a protocol that does not follow the process complete from one end to the other is not a protocol, it's a tripwire. And this ALF's protocol did not start where it ought to have done, at pre-admission. A four to five day hiatus in your mother's medication routine because THEY didn't either get her ducks in a row themselves or advise you on the requirements for doing it for her is flipping outrageous.

Make a formal complaint with a view to the ALF's treating this as a learning experience and improving their admissions procedure. I don't care how common it might be, this is *poor*; and worse, as Alva points out, gets her off on the wrong foot. Not Fair.

She did get the diuretic this morning, thank goodness. Not sure why she didn’t get it yesterday. Like I said, miscommunication. Her primary doctor did fill out her paperwork/ report beforehand. But considering how this has gone, I wish we had taken in a list with current doses / times, so ALL of her meds could have been approved. Again, not sure why they weren’t anyway. Her pulmonologist has been very non communicative, so we need to find a new one. Anyway, hoping all will be resolved tomorrow. Thank you.

The medication nurse is correct. Their medication RNs cannot give medications that they have no order for. They have to clear medications with each physician, sadly.
Is your Mom capable of taking her own medications? My brother was on Level I and was able to administer his own meds.
If your Mom is not able to administer her own meds safely this will sadly take some time. I am a bit surprised that the number of meds and number of MD orders and how this would all work wasn't completely discussed with the MPOA and Mom prior to going in.
I hope they will get this together quickly. It has a bad effect on Mom's overall trust going in, and isn't a good thing.

Has the diuretic been dispensed?

If mom is symptomatic from lack of this med, I would call 911 and have her taken to the ER.

My situation...They told me they could not take Moms meds. They would need to get prescriptions from her Dr. That was even OTC and orders on how they were to be taken. I said the pharmacy will not refill her prescriptions if it shows that she still has pills left. I was told I was wrong. I wasn't. I got a call later telling me their pharmacy would not fill the prescriptions because she still had pills. So I had to take her pill bottles back to the AL. They locked them in a drawer in her room and the Medtech had to get them from there until a refill could be done.

Your mother should be getting her meds on the times prescribed. Her water pill, IMO, is important. I will be surprised if the pharmacy does not tell them the same thing I said.

She doesn’t have dementia, but she is very impatient. I am hopeful they will give her the diuretic this morning as it was approved. I’m afraid she is already pegged as “difficult”, although when I talked to the staff member involved, she said “ they are all like that”. She is going to be miserable. But she was when living with me too.

The AL should have told you beforehand that they needed to obtain MD approval for meds; yes, her PCP should have a complete list of her meds, but may not have signed off as s/he was not the prescribing doc.

Is this an emergency with any of her meds? If it is, get hold of the DON and her physician to straighten out.

If not, let your mother be snarky. She will reap what she sows; people will find her annoying. Not your problem.

My loved one kept OTC meds hidden in her room due to the very situation you described. We also had several days worth of prescription meds in the pill separator for her for this very situation. I only knew to prepare for this due to what we went through with another family member.

this won’t work with a dementia patient tho.