I am caregiver and PoA for elderly mother who is in SNF following hospitalization; there are decisions made by some nurses w/o notifying me.

Medication dosage and changes are going to be assigned by a doctor, so you need to take your concerns to him/her and agree to a care plan. If your mom is new to SNF then you should be getting a care plan meeting soon.
Giving up control and leaving your mom's care in the hands of strangers is going to be hard, of course even the most qualified and best intentioned will never be able to give the one on one personalized care that you have been giving her. My advice is to go with the flow for the first few weeks and months unless you see something flagrantly harmful, it will take that much time for everyone to know each other and settle in.

I read your Profile and I see that you have a background in holistic nutrition and Psychology. So you should already know that the nurses have to follow doctors' orders. You apparently are upset that the nurses are giving your Mom some medications without telling you. They DO NOT have to call and tell you every time they give a PRN medication. And if the doctor writes a prescription that states "Narco 1 or 2 tablets every 4-6 hours PRN for back pain", then that is what the nurses will do.

When your Mom was admitted to the facility, did you tell the Doctor or the Nursing Manager that you did not want your Mom to receive any PRN pain medications? Did you tell the Doctor or Nursing Manager that your Mom's back pain is largely due to anxiety and IBS and not due to back spasms? Did you talk to the Doctor or the Nursing Manager and tell them that you wanted your Mom treated "Holistically"--using NO Narcotic pain medications and using certain OTC "Holistic" medications?

You mention that "She doesn't necessarily think through cause/effect thus I keep track of those things to ensure positive results with foods, meds, etc."--so I assume that you are talking about your Mom. Maybe your Mom doesn't agree with your Holistic Way of Life.

Your Profile sounds more like a commercial than an explanation of your Mom's situation. It also sounds like YOU THINK THAT YOU KNOW EVERYTHING and everyone else know nothing. Sorry, but you are going to have to take responsibility for your own lack of communication with the doctor and the nurses for NOT telling them exactly how YOU WANT them to treat your Mom.

Is your mom there for rehab or is this a permanent placement? If this is just a short term stay then you may want to just let things slide a little. And remember rehab is hard work, your mom may be in more pain than you would have normally been accustomed to seeing before her hospitalization.

See, I disagree. I feel that my PCP knows my parent. That a rehab doctor is just temporary and should at least consult with the PCP. My Mom was in rehab for 10 days before I had a care meeting and was not given her Thyroid medicine the whole time. She suffered from Graves desease. I was told her nos. were normal so they chose to stop her med. Really! the med was why her nos. were normal. I agree that you need to talk to the doctor since the nurses are just following orders. Even the head nurse maybe able to help.  

JoAnn29

What state are you in? Where I am, Cleveland Oh, anda Cleveland Clinic branch hospital used for my mom, the PCP doc does not "bother" the NH doc. PCP only gets involved if the patient is at the hospital.

Hi Wildflower,
Does your Mom have some type of cognitive decline? Is she able to answer questions for you? Have you asked her about the increased meds.? Did she ask for more? Was she examined? Had tests?

Shad, what I was saying, really, was the PCP is not consulted and I think he should be. Moms PCP has no privileges at our local hospital so he has a doctor who sees his patients. I was told one time when I asked a hospital doctor to call Moms PCP that while Mom was in her hospital they would do what they felt was needed. I could consult with her PCP after discharge. See, this is why I think mistakes are made. They make decisions at the moment and don't look at the patients previous record. My Uncle was almost given a medication in rehab that put him in the hospital because he had a reaction to it. TG my Aunt was there and asked what he was being given. He could have died if she hadn't told the Nurse thats what he was in rehab for.

I was told by a doctor our health system is broke. You have to be diligent when it comes to a loved one. TG I have an RN in the family. She wears her scrubs in the hospital or rehab and the staff jumps.

I was called every time my mother’s meds were changed. Not for my permission, but just to keep me informed. I was also notified of any of her behaviors and there were quite a few. I had a very congenial relationship with the nurses and aides and was there quite frequently. Because of my attitude with her caregivers, they knew I trusted them. It was difficult, at first, to give up control, but  after a while I realized they knew much more about caregiving than I did.

I also think it's important Mom's PCP is kept up to speed about any changes to Mom's meds.

Thank you Pepsee. I even give them a paper with Moms history, Meds and doctors. I went to visit in the hospital and was told they had called in a doctor for a neurological consult. I asked who, was told, and ask why they didn't call "her" Dr. who had privileges at that hospital. Out of maybe six of her doctors, 3 had privileges there. Why would you not call me and ask if she already had a Dr. for such and such? Isn't it better to have a doctor who knows her see her, if he has privledges, then one that is flying by the seat of his pants. And if he doesn't have privledges the doctor seeing her consults with your doctor. I think a lot of mistakes and added tests could be averted. My Mom had one kidney. They wanted to run a dye test but her kidneys would have to be checked. Really, my Mom had the surgery at your hospital that removed her one kidney. The one she has works half capacity. Oh, guess we can't do the dye test. TG I was there or she would have had an unwarranted test. Oh, I also had that surgery listed on the papers I gave them. Nope, never looked at the papers. It also told them what foods she didn't like or couldn't eat. They gave her a soft diet and commented she ate no breakfast. What did u serve her, scrambled eggs. If they had read my paper they would have found she doesn't care for scrambled eggs. It was a constant battle and all they had to do was read the paper.

One can almost see why the 92 year old lady did not want to be in a NH.

I appreciate all the info provided, above. It turns out that the SNF is transitioning to a 'health & wellness' program in conjunction with the one good local hospital (not corporate) and though there are bumps in the process, their program is taking root. I am glad that 'the powers that be' led us there. I am also glad that Integrative Medicine is taking root locally (see NY Presbyterian Hospital) and nationwide, that treating the person rather than the condition is becoming the mindset (as it was decades ago), and that wise medicine from around the world is being heard.

How is Mom Wildflower?