Medication refusal, what to do?

We need more specifics to adequately answer this question intelligently. A person has a right to refuse meds, however, there are exceptions. Nurse Ferris

In my experience, most cares given to those in a facility will have a Dr. order before we do most anything with our residents. (This in response to questioning whether it is legal or not, to put medication in food.) The "rules" may be different state to state, however, the Federal standards usually supersede the state rules. In my facility, we must have a Dr. order for medication administration. In this case, crushing meds and putting in applesauce etc. I think everyone's comments are so important and look forward to more of them. Thank you for sharing.

I am a vegetarian and the worst thing that I can think of is being fed meat if I become incompetent. When my mil, whom I am guardian of, refuses her meds I put them in her tea or in anyway that I can because her view on end of life was extremely different from mine. What I am attempting to say is that everyone is different and ultimately it is about making the loved one happy.

Phewf. I just hope that by the time I'm too old and tired to read a patient information leaflet or check my food for interesting new flavours I'll also be past caring what meds I take. Now where did I leave that living will form..?

You need to do what you need to do.

I, personally, would want my wishes to be accepted. No meds. No meds.

Rough on your sister, Wisconsin, but as MPOA she should aim to do what she honestly believes your mother would want to do if she still had capacity. Very hard, especially in cases where there's a conflict between what you believe your mother would have wanted and what you feel is best for her now. You can only give her your best advice and support. Good luck x

Veronica I know! - I asked because I couldn't see it in Wisconsin's posts, hadn't spotted KarenRW's. Chase Farm cleverly infected my aunt with MRSA following her mastectomy, just to add to her overall enjoyment of cancer treatment. This was nine years ago, when it was still something they tried to hush up - when I asked (over the phone, btw - my aunt had decided before she went in that she would not see any visitors, nothing to do with infection, she was just a bit weird) why she had been moved to a side ward the chirpy Staff Nurse told me it was MRSA - this was then indignantly denied by the Ward Sister, and it took another month to winkle the truth out; not that it made any lasting difference to the outcome, sadly. They also gave her yoghurt with thickeners in it in spite of GLUTEN FREE painted in red capitals all over her notes - she had coeliac disease. Chase Farm was my mother's nearest A&E for many years, and on not one occasion did we attend without something nasty happening either to her or to another patient while we were there. Only hospital in the country that's worse than the fictional Holby City - I'm so glad they're closing it down.

Nowadays they swab everybody pre-admission - and touch wood so far we're all right Jack..! Good to give out the heads-up on infection control though, thank you.

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.

My mother who is 76 with depression also refuses to take meds.but me and my two nurses children tell her that please take your vitamins (her meds) to make you healthy and be more healthy because we need this to be heathy. We conditioned her that this is not a medicine but a vitamin...so she takes it. Meaning our password is vitamins not medicine. For if she hears medicine she won't ..but if we say vitamins ..she would.

We have also tried before to mix her meds in with her milk..but she noticed it because of the different taste (bitter)... So we refrained from doing that..that's why we decided to have "vitamins" as password of her meds. She believes in what we say because we also are showing her we are taking vitamins. We put her meds in the vitamin canister same as the canister of the vitamins we are taking.

My mom is 91 and has been in the nursing home a couple of times in the last two years to rehab a hospital stay and a knee fracture. She also refused her meds. They come at them with a cup of pills and want them to down them all at once. My mom is now very suspicious about any medication they try to shove down her. I wrote a large sign and hung it up in my moms room that if she refused her meds, they were to call me from her room on my call phone and I would talk to her. I would tell her that her regular doctor, that she really likes, wants her to take this medicine and is going to be very upset if she doesn't. That usually does the trick. She is also not allowed to refuse therapy and they call me from her room when she does and I get her to agree to doing it. It is not against the law to put meds in food. My mom sometimes has swallowing issues so it's the swallowing process that is giving her the problem. The pills that can be crushed up, they put in pudding or applesauce. There are no problems with that. The new doctor needs to make an exception and see your mom immediately. You should call the Director of Nursing for the facility and explain the circumstances to her and she can make that happen. Good luck.

My mother who is 76 with depression also refuses to take meds.but me and my two nurses children tell her that please take your vitamins (her meds) to make you healthy and be more healthy because we need this to be heathy. We conditioned her that this is not a medicine but a vitamin...so she takes it. Meaning our password is vitamins not medicine. For if she hears medicine she won't ..but if we say vitamins ..she would.

So much in medicine is hidden behind the curtain.

The hospital's official charges are in no way what the insurance company pays. On generic medication, the main ingredient may be bioequivalent, but as FreqFlyer says, sometimes the differences are all too noticeable to some of us. I loved Effexor, but it was expensive. The first generic I tried gave me weird symptoms that were really nothing, but which led me to spend an expensive night in the ER. (Plus Effexor causes weight gain.) So generic prozac at $3.89 a month it is.

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.

Sherry, what I liked is the way you presented the facts to your mother. You let her know what will happen if she chooses not to take her medication. That is informed consent/

Now you know that she has the facts, so as hard as it is, you can accept that she knows what she's doing. God bless you.

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.

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

Good advice about getting meds down to the 'vital few'. The doctor can place a 'discontinue' order for those meds that are no longer necessary to take. Not sure why the NH is telling you it's illegal to put meds in her food unless the law is different in the state where your Mom lives. In California, it is legal to do this, but, only if the doctor OK's what's called a "crush order" and then this can only be done on some medications. Those that will upset the stomach are typically enteric coated so the dissolving process is delayed until the med gets into the intestine. These types of drugs cannot be crushed. Your pharmacist is the best person to advise you about which meds can/cannot be crushed, but, your Mom's doctor has to give the order to the NH.

Wisconsin - I have the same problem - ask the doctor to give the NH a crush order for the meds then everyone is covered. Granted you don't know how much they get - but if they can put it in a food she likes or pudding that May hide the taste - it could help.

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.

Where can I find a copy of the federal guidelines on medications?

As for guardianship, it really depends on whether someone is being properly cared for. If the meds are not a matter of life/death, perhaps it's not such a big deal if the person refuses to take them. On the other hand, if there is a pattern of refusing the care she absolutely needs, like eating enough AND the life expectancy is pretty good, the refusal to do what is good for her becomes an ethical one - she may be suffering from dementia and is basically relying on loved ones to make sure she is keeping herself as healthy as possible. When dementia becomes significant, guardianship is necessary.

Under the new federal guidelines one cannot be forced to take meds, unless they are deemed a danger to themselves or others. If the diabetes is mild and she is able maintain her blood sugars by diet alone, Dec. 3 is a long time to go without a diabetic crisis which would have put her probably in the hospital. So follow up with the new doctor and make sure the psychiatrist knows about the diabetes. There are M.D.'s as well, so they can make an adjustment. Has anyone asked her why she is refusing medications?

Why force her to take the meds if she doesn't want to take them. Why prolong a life that has no quality. I have to admit sometimes I want to stop giving my Mom her meds to hasten her demise. She is miserable in her current condition and has no quality in her life.

Sometimes their instincts are correct. Check it all out on the Internet to make sure she even needs each medication. Last night we finally got a list of our Mom's medications and learned she is taking 28 medications! Some are for issues she no longer has. Others are duplicates. We are very glad we listened to her complaints and refusals. Doctors seem to solve everything by writing yet another prescription. The family member with the POA didn't check and also placed her one hour and 15 minutes from us. Still, we found talking to her in person had a better chance of getting her to comply. We are changing the POA.

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.

My mom who is still in her own home called 911 and had the ambulance pick her up (yesterday) and take her to ER because as she puts it: she "was feeling a little under the weather." She checked out fine (physically) but doing this gave me and my husband more "evidence" that she indeed needs our guardianship...which we can get on on emergency basis in 72 hours if needed, according to the hospital social worker. If your mom is refusing meds, you probably should be her guardian. Look into the process. Someone in your area can tell you what you need to do. It's really not hard. Let us know how it goes!

Veronica, I missed the MRSA bit - where's that, please?

I crush my mom's pills and put them in applesauce and she takes them. Every time I do this , I tell her what a great sport she is. Somehow that seems to work. As she is taking them, I talk to her about something really good coming up after she takes the pills such as eating a muffin (her favorite thing).

Now, I went thru a time with her when she refused to eat, so I know how trying and upsetting it can be when a parent won't eat or take their medication. I tried everything to get her to eat and spent a fortune buying all kinds of food that ended up being wasted since she kept refusing. Finally, her doctor prescribed a pill called Mirtazapine which has not only helped her depression but has given her a huge appetite as well. You should talk to her doctor about what you can do for her. Maybe she is on the wrong medication for her moods and if you switch, she will do better. This all ties in to why she won't take her medication, I'm sure. Best of luck to you!!

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.