Medication refusal, what to do?

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Mom has been refusing meds off n on for awhile now. Nursing home called to inform, that she refused over 6 days during the holidays. My father could not get her to take them either. At recent family meeting w/NH, we are informed that she has refused blood sugar tests since Dec. 9, 2013.Disappointed that we were not informed of this sooner. She is between M.D. 's currently, but have one onboard now, but won't see her until rounds early February. We are told NH cannot force any meds/procedures against her will. That we need a court order to do so w/guardianship. Isn't POA, MPOA the same as guardianship? I know she can be coerced into taking meds etc.. but I live an hour away. No one wants to move her to another NH, as Dad is closest now, but less than helpful. Wrote the new M.D, a letter to inform of situation. Current temp M.D. and Psyc. doc. says wait n see, but not sure if they are of aware of the history here. She takes pills for diabetes, and is not a severe case, but non the less, needs her meds. & blood tests. Psyc has her on anti-depressants for moodiness. Concerned with effects for on/off this medication as well. What to do?

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A technique that I see staff use regularly with my Dad and others in his memory care unit....when they say they don't need or don't want their meds....try just 'forgetting' about meds then, and go away, and come back in a couple minutes and start a conversation about something your Mom CAN discuss....life as a little girl in her house...or a trip she remembers enjoying...almost anything that will get her remembering and talking about something. THEN, while she is sharing and talking, just hand her the pills and a drink without much commenting to interrupt her...and see if she doesn't just go along with taking them, because her mind is focused on something else. If it seems as though she is going to focus on the pills, just ask her another question about what she was remembering and discussing...and don't comment any longer than to say, " It's time to take these pills" or something similar. Sometimes, you have to walk away and come back a couple times even. It's called diversion and with dementia, it works really well to calm agitation, disperse anger....all sorts of things because by the time you come back again, or get them focused on something else, they have totally forgotten what had them upset.
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My wife has been bedridden for almost 4 years with dementia. There are moments when she refuses to be cooperative. At those times I simply change the subject. Two minutes later she has forgotten the problem and then I try again, repeating the procedure as necessary. So far that technique has worked. If necessary I would prioritize the medicines. Some are much more important than others.
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My Mom has been in hospice since last Monday. She had stopped eating and was hiding her meds most of the time. It was gut wrenching and soul destroying to watch this behavior or to try and not change it. Since she has been in hospice it has been so much better. They make her comfortable, but she makes the decisions about what she wants, and they have helped me to understand that she should have the right to make decisions for herself. I've read a lot about it and talked to a really nice Rabbi at the hospice and he said that sometimes this is a person's body's way of saying it has had enough. That she is probably tired and ready to go, that she just needs me to be. Don't get me wrong, I will never be ready, but I do understand now it is not about refusal or giving up, it is about making a choice to move on. Mom is now taking her meds with ice cream or applesauce or pudding most of the time, I think mostly for me. She is still not really eating because she is not hungry and doesn't want it, and that's ok. It should be her choice. The hospice cannot and will not make her take her meds or eat. It is against the law to do so. I could go the route of getting guardianship, but these things are not what she wants. I asked her if she understood that she would not get better and that it was a matter of time given the current status, and she said that she did. I asked her if she knew she would never get to come home like this, and she said she did. I asked her if she was right with God and ready to go and she said she was. I believe this is true and she has a good life and is ready to leave this one. This is not easy and never will be, but I want to honor her in death as I have honored her in life. It is her choice. Maybe it would help to talk to your Mom about these things to find out if she understands them. I know it helped me. Maybe it would also help to find hospice care for your Mom. They are experts and their job is to make the person and their family as comfortable as possible and to help everyone understand what is going on. They have been such a blessing for my family and I. I hope these thoughts will help you, I do truly know how hard all of this is. I have never given up hope for my Mom I want her to get better if she is meant to and wants to, but I have been able to get some understanding and acceptance.
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There is a fine line between crushing meds and putting them in food to make it easier for some one to swallow them and hiding them in food so the patient is fooled. When some one refuses to eat, drink, take meds and have been considered appropriate for hospice there is little point in worrying about routine medication if the patient refuses. Meds for pain and anxiety should of course be continued.
A word about MRSA. The advice you received about this was far too casual. everybody entering that room should be doing so using infection control measures. This means wearing a gown, gloves and booties over your shoes. This is a very serious condition to be exposed to and make no mistake you are exposed as everything in that room is contaminated. your future health could be jeapodized if you become a carrier of MRSA. When you come to visit bring with you some form of protective clothing like a lab coat which does not have to be white, rubber gloves and either covers for your shoes or a pair of washable sneakers and some hand sanitizer. Leave your purse in the car and put any valuables in your pocket. Put this stuff on before you enter the room maybe in a restroom or the car. Do not touch anything in the facility without using hand sanitizer and do not remove anything from the room. When you are ready to leave remove your lab coat gloves and booties and place in a sealed plastic bag. If you plan to dispose of this gear place it in the trash in the patient's room. Use your hand sanitizer liberally. do not touch your face on your way out. use the hand sanitizer again before taking anything out of your pocket or touching your car keys. have a plastic bag ready in the car to drop the bottle in and seal it. If you are taking your protective gear home immediately wash it on the hottest setting with bleach. You can also request that you be provided with the necessary equipment by the facility and dispose of it before leaving the room.
I realize this sounds very paranoid but it is essential for your own protection. I would also not use a restroom or eat or drink anything in that facility. MRSA is probably everywhere and proper guidelines are not being followed. All the staff could be carrying it.
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((((((hugs)))))) Wisconsin POA, MPOA is not the same as guardianship. If the person is not capable of making decisions for themselves the court can appoint a guardian to make those decisions. The POA is appointed by the person when they are competent to assist that person in the stated ways. I think it is fair to say that guardianship gives more power. It is a distressing situation. My mother who is pretty well physically but mentally ill will not take the antipsychotic meds that help her. You cannot force them to take meds. I have read on here that in some cases meds are put into food but not sure how legal that is. Is you mother competent? If you think you could get guardianship it may be the right route, She certainly is not doing herself any good by refusing treatment. How ill is she? I she getting ready to go? Hope the new doctor has some ideas. Let us know how it unfolds, (((((((hugs)))))

Karen - (((((((((((((hugs))))))))))))) to you too Have you talked to hospice and/or her doctor to get an idea of what to expect. It is too bad she is refusing the thrush meds as they would make her more comfortable. Sounds like you are in a difficult situation.
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When elderly people living in NH refuse meds and food it might be because they prefer to check out. Why force them to hang on to a life devoid of joy? They should decide when enough is enough. My 101 year old mom continues to take her 5 meds every day, in the mean time her two caregivers and I are slowly expiring.
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Sherry that was a wonderful post. So hard for you but so honest and caring. the only thing I would ask is if you have told her it is OK to go and although the family will miss her they will take car of each other.
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CM MRSA is Methicillin resistant Staphylococcus Aureus. it is resistant to certain antibiotics and may cause skin and other infections. it is spread by contact with the infected person, things they have touched or used. It is most common in institutions and other crowded conditions. many people carry the infection and are unaware so it is very important to follow good hygiene practices such as frequent hand washing with soap which does not have to be antibacterial and if not possible in a public place use hand sanitizer and avoid touching the face. Be particularly careful around people with compromised immune systems, the elderly and young children. keep all open skin wound clean and covered and consult a Dr is it shows signs of infection or there is a fever. Take the full course of any antibiotics that are prescribed. It is becoming more common in the community and may be found on such things as magazines in waiting rooms or the library and shared sports equipment.
No one needs to be paranoid about this just be aware and assume it is on everything you may touch and wash your hands
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Has anyone considered the fact that when someone doesn't want to take a certain medication is because they hate the side-effects from that medication?

All medications have fillers, and depending on the fillers being used one could be hypersensitive to just one filler in the pill, which could cause a variety of different side-effects.

I know first hand how that can be with one pill that I need to take daily, and finding a manufacturer who uses fillers I can tolerate. I refuse to take the pill if it is made by two other manufactures, I rather take the health risk.
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Thank you emgo. Mom has minimal diabetes that only requires a pill a day. She used to take insulin but reduced her weight which changed her diabetic needs. She has Alzheimer and is also incapacitated by a doctors authority, signed by family members as well in 2011. She is 81 and is relatively healthy otherwise. Myself, I have no power of health, my sister is MPOA. We have discussed this guardianship, as it was brought up in the NH family meeting. NH said it IS ILLEGAL for them to put Meds in her food, therefore guardianship would be necessary. My sister has reread her MPOA papers which states that Mom does not want to be placed in any institution or use artificial forms to keep her alive. Not sure if this includes wellness medication. I don't think she is checking out, but anything is possible, as she is a very strong willed person and will do what she wants. Really I think most of the problem is w/the NH not taking the time to coerce her into taking her meds, as I was able to do so. Just wish she was closer, so I could provide more assistance. Thank you for your input everyone.
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