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Also her mood and behavior have changed a lot in the past few weeks. The drug that concerns me the most is the simvastatin. At home I gave her very high dose omega 3 fish oil. And this kept her cholesterol down. My question is, can I tell the facility/doctor that I do not want her on the "statin" and substitute it with pharmaceutical grade fish oil? (Sometimes called esters Or omega 3, legally, as her daughter do I have the right to tell them to take her off that medication? I am mom's medical proxy. Her bill for medication for 4 weeks is $150.00. At home it was $50 for blood pressure meds. They also have her on high dose very strong anti-depressant (mirtazapine) if it works I don't have any issue with her taking it.

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And please stay on top of that med list you ask for! My MIL was prescribed a drug we agreed with,,, never received even though for 3 months of caremeetings we saw it on the list, and questioned if she was getting it. Always some excuse, even though Dr ordered it ( opps, not sent in, opps we missed that) At the last care meeting they said " well shes diabetic",,, nope! Well, she has ALZ".. nope! Family finally asked if they had the correct chart....
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You can advocate for your mother, but you should follow the doctor's protocol of care. The physician should be aware that you're giving your LO OTC meds.
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You can advocate for your mother, but you should follow the doctor's protocol of care.
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My LO gets an EOB from her supplemental prescription provider about once a month. I always review it to be informed of meds and any change. I would highly encourage it. I was shocked to see a med started that I had not even heard about. Anyway, a meeting with the doctor cleared it up, once he understood Palliative care is what we wanted. The statins and a few others meds were discontinued and others reduced.
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Why is she receiving a bill for her RX plan?
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I haven't heard anyone say you can get them to give patient the fish oil. Do I understand correctly that without that, the statin might be necessary? So the question is getting a facility to give a "vitamin" as if it were medicine, which in this story, it is. Good question.
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I agree with Igloo; medications are doctor orders and the doctor has the last word. I am thinking that it’s absolutely reasonable for CG or the patient to approach the doctor with your concerns. I don’t think he wouldn’t take your request in mind either. Some docs like patient/CG to take an more active role in their loved one’s care.
And we really don’t know what her lipid labs are- they could be sky high.
Speaking with the doctor would be my first step.
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So are you saying that she is currently on Medicare, of course, but does not have part D?
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JanetM is exactly right concerning discussions about meds. MD's ARE touchy about someone questioning prescribed meds. When I ask my parents' docs about meds, I approach with a questioning & curious demeanor. I find also that they ARE receptive when one mentions the increased cost of new meds & "I was wondering if there might be something more affordable..." Another approach is to speak to the MD's nurse, again with a deferential approach, & just mention that she did well on _____ med. & you are wondering if _____ med could be considered. Yes it is a game but you will "catch more flies" that way.
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Since you have the power of medical proxy, yes, you can request changes. Be sure, however, to couch your concerns in terms of wanting to discuss, vs. wanting to instruct. Doctors have brittle egos and do not always take kindly to family members pointing out medication problems.

For information on drugs and drug interactions, you can consult ehealthme.com, WebMD, Drugs.com and the NIH drug information library. To find out about medication either recommended for the elderly or not recommended, download a copy of the BEERS list from the American Geriatric Association. My mother's doctor did not appreciate my research, but staff at patient care meetings helped to broach my requests in nonthreatening terms.
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Too young - unless you are the attending MD for the NH resident, you on your own cannot tell the NH to start / stop / change meds. That is determined by their physician at the NH. As family - even if you yourself are a physician - you can ask for a review of thier medications and you have at the ready a list of new RX to be discussed at the next care plan meeting. Care plan meeting every 90 days or so but family can request one sooner and schedule it through the DON.

If you want it so that you are calling the situation on thier health care, they need to be in a small private pay custom care facility. It will be pricey. But if thier “duals” so it’s medicare & medicaid paying, the medication management will be whatever is the most cost effective & ok for M&M compliance.
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Yes, you can request anything you would like....doctor just has to write the order and it's done.
Check out your medical journals...statin-drugs do more harm than good.
Mood and behavior for the better? Is the anti-depressant necessary? What mg? Seniors don't require high doses of anything....especially if it's a new drug.
Start off with 5 or 10mg, and increase if necessary.
Just my 1/2 cent ;)
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If they are in a SNF - skilled nursing facility- aka a NH, it usually becomes the situation that the medical director of the nursing facility becomes thier primary MD. The SNF / NH MD is now in charge of thier overall medical care and put in RX orders. So if they change mom’s meds it’s going to be the new norm for mom. When mom applied for Medicaid, all her meds and health chart info was included in the medical aspect of her Medicaid application and meds can be changed to follow the medication management system of the NH. Medicaid allows and expects this to happen as there is cost savings with everything coming from a single outside vendor. 

My experience was that ONLY IF they came in with say an time limited RX from a specialist MD - like for my mom it was a retinal specialist opthalmalogist who had mom on a specific med for post surgery issue - would the NH staff MD allow medication to be done and ditto it into mom’s at the NH health instruction chart so it would be administered. 

All medications come from whatever outside vendor pharmacy the NH uses. The RX for NH come packed usually different from a consumer pharmacy. They come in 30 - 60-90 day blister packs usually on hanging files with reportage tags. If family mpoa wants to use another pharmacy the NH can tack on a outside vendor fee. Like $100-$250 a mo. I’d bet a case of Processo that the only way around this is IF mom is on some kinda drug that HAS to be compounded as that’s specialty pharmacy stuff so there’s probably a Medicaid waiver to allow these RXs.

Please please don’t bring in an OTC medication and leave it hidden in mom’s chest of drawers thinking that you will on your own give it to mom. Doing this can be reason to have mom viewed as noncompliant for care and mom / you are send a 30 day notice (to find another facility).
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Tell the doctor to take her off the statin & tell them you want her to be on fish oil instead. Statins are bad news and, in my humble opinion, as a healthcare provider, good for nothing. At her age, she doesn't stand to gain anything from being on a statin for cholesterol.
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I've taken my husband off of all medications with hospice doctor approval. Honestly, it's much more expensive for me because hospice pays for prescription drugs, but he is so much better without all that junk in his system. Funny thing about blood pressure meds. Since I've taken him off, blood pressure great. Same thing with statins. I recommend discussing with her doctor and getting her off of everything you can.
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You can tell or request anything - getting them to follow your wishes is another story. Most likely you will need your physician to agree with you.

RE: $$: You are paying for the medications and a person to administer them. I asked about that in hospital where DH was charged more per day than we paid all month.

You are paying the pharmacy (inhouse) to fill the prescription, the person seeing they get to the floor and the person administering the medicines.

Good luck with that - I finally started refusing to allow them to medicate my DH and I carried my own. It's a terrible fight. If she is in a NH (not sure what SNF is) - unless you can be there to see to the administration of the medications, your hands are probably tied.
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I think part of the answer of why meds are more expensive is because institutional places are required by law to have every pill in a labeled package. Generally homeopathic or OTC meds do not have this kind of packaging. The omega may also not be in the facility formulary. You can ask the doctor about this as well as removing the statin. Plus if her diet is different in the institution the maybe a followup cholesterol level may already be lower
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Personal opinion here but...
I think that unless there is a real risk of heart attack or stroke a Statin could be eliminated strictly due to age. Any benefit from a statin to lower cholesterol at this point may be unnecessary.
And another point since you are her Health Care Power of Attorney you can make a decision like that.
At some point after my Husband was diagnosed with Alzheimer's his doctor wanted to put him on a statin. I had a discussion with a very good friend of his (a doctor as well) and he said there really was no point to taking the statin now. He called me a week or so later and said that he had thought about it and it might be better if he started the statin because if my Husband had a stroke it would be more difficult for me as a caregiver to care for someone with Dementia and Stroke symptoms. So he went on the statin but I took him off when he went on Hospice. (Also discontinued Aricept at the same time)
There is another "natural" that can be given Red Rice Yeast rice contains natural statins and that can be a lot less expensive than the prescriptions.
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How old is Mom. Because of a Thyroid medication Mom was on she was taken off her statin. Both effect the liver. At the time the doctor did this he said that at Moms age, 89, cholesterole was not really necessary. Are u aware that statins have been linked to Dementia? Some people on this forum have seen a change for the better in a LO when taken off.
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Are you saying her mood and behavior have changed for the better, or worse?

You should ask for a meeting with the doctor to discuss the medication changes that have been made. You have the standing, as Health Care Proxy to challenge the use of a particular med, like a Statin, but I don't think citing its cost is a particularly effective way to approach the issue.

Remeron is actually a very" gentle on the brain " antidepressant which also has good antianxiety properties. It is also used to increase appetite.

Once Medicaid kicks in, her meds will be paid for by them, isn't that correct?

Going forward, when you attend care meetings for you mom in the future, always asked them to run a list of her current meds for you. It's the only way to keep track of changes. It also helps if your loved one ends up in the hospital.  The NH will send the current list with the patient, but they sometimes go astray. It helps to have a backup copy in the hands of family.
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