Can you take your family member to their previous doctor after admission for scripts etc. or must you use nursing home doctor? - AgingCare.com

Can you take your family member to their previous doctor after admission for scripts etc. or must you use nursing home doctor?

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My mother in law has been on a tricyclic antidepressant for more than 25 years with NO ill effects and it works wonders for her. The nursing home doc took her off as it has black box warning. her depression is worsening agitation is increasing and she overall psychologically is doing very unstable. they have tried several others, keep increasing and adding more and increasing dosage. Just getting worse. she and we just want her back on her original anti0depressant. Now they are starting her on risperadone, which as a nurse I know is basically a chemical restraint in her case/ when we asked her to be taken off due to adverse side effects they suggested maybe she wasn't getting enough and wanted to increase dosage to 2x a day. she will be a zombie.
she asks for it, we ask for it and they will not honor our nor her wishes. do we have any recourse?

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I took my loved ones out to doctors too when they needed a specialist. If this nursing home has a problem with using this other doctor for he depression issues, then I'd ask the previous doctor to call or write a letter to the nursing home doctor explaining the issue. I think that the nursing home doctor is just trying to cover himself since the black box means that their could be significant reasons not to give this drug. But as MaggieMarshall said, it can still be prescribed because it does help some people. This is no time for them to fool with a medication that has worked for your mom for 25 years. If the NH doctor feels that he or she is off the hook for ill effects from the drug, then maybe this can move forward.

Please update us when you can!
Carol
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To my knowledge, you can take your nh patient any where you want. Make an appointment, pick her up or have her transported.

I'm hoping that when you speak of "doctors" here, you're talking about a geriatric psychiatrist in both cases. If your mom has been on a tricyclic for 25 years, she may need a dosage adjustment, or it may be causing side effects that are unrelated to the depression.

Changing antidepressants is tricky because they take a while to come out of the system as you taper them off and a new one takes 2 to 4 weeks to kick in. Have you had a face to face chat with the nh doc about why he's changing the old med? Even 25 years ago, tricyclic were "old medicine". Your mom's body has changed a great deal in that time.

As to the "fact" that nh docs are not "always" at the nursing home, that's why it's a nursing home and not a hospital. If your mom needs acute, inpatient care to switch meds (and she might) get her to a behavioral hospital unit that specializes in this sort of thing. The nursing home my mother resides at is staffed with nurse practitioners, RNs and LPNs. This is the proper level of care for someone who is chronic and stable.
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I chose to take my uncle out of the nursing home for doctors visits but he was in there for rehab purposes. After about 6 weeks he decided to stay there full time and that is when I switched to their doctors. Could you discuss on the phone with the old doctor and see what he suggests?
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If your mother has been on an antidepressant for 25 yrs. I am sure the doctor is considering a "medication break". However, anyone who has taken a drug this long for depression perhaps is not responding to the drug, but a placebo effect. If you have POA, you can demand her not be given any drug. If you do not like the nursing home doctor, she does not have to use him/her per Medicare payments so do not let them bully you. If they insist, I would find another nursing home. I've taken my husband out of one hospital three times because they want to keep doing tests on him when there is nothing wrong with his heart. He is still living and still alive - not like they told me he would be if he left the hospital. Be her advocate!
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Please trust your instincts. Maybe ask her regular physician to intervene with the NH doctor or find a facility where they will work with her doctor. My mother was in a Skilled Nursing facility for therapy after breaking her hip. While there, the NH doctor changed her meds. My elderly father trusted the doctor and watched as Mom declined rapidly over 2 months. When I came from 900 miles away, I asked why they had changed her meds and they said they "needed updating". She couldn't sleep at night, they put her on Haldol during the day. I told them to stop. They kept changing meds and one day in a hallucinatory state she fell and shattered her other hip. We took her off life support a week later.
It's never cut and dry. There were a lot of other factors with my mother's health. But I will always wonder if I had been more assertive or changed facilities if she would still be alive - or not have suffered as much as she did.
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I'm not sure what the effect of a black box warning is. I know the drug is still safe to use -- or it would be off the market. To answer your question, I think it would be difficult to keep mom's previous physician. AND that doctor is not going to prescribe unless she is his patient. This is very confusing and unnecessarily upsetting for mom.

Set up a face-to-face appt with the NH doc. If not face-to-face, then a phone consult. Tell him in no uncertain terms that you want her back on her previous medicine. PERIOD. If he hems and haws, ask him how you go about changing primary care physicians in the nursing home so that she can change to a doctor who will put her back on the medicine that worked.
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I would keep her with her regural doctor I saw at least my husband while he was in a nursing home go down to a zombie from a normal person who needed rehap and all his true physical dangers high blood pressure and clots not even addressed by a nursing home doctor and was told if he stroked out they would call me and ask me to arrange to get him to hospital for care I had to call 911 there doctor is only in one day a month and you wonder why people die in some of those homes with in two yr they aren't old or sick they are left under the care of the home some times it not the med didn't work or was dangerous it was it cost too much and it saves them money to use the zombie kind
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Can you call the ombusman for the NH Right away and they will do an investigation? I agree that her primary care physician should write a letter to the NH doctor with a cc to the executive director and director of nursing stating the facts about her positive response to using the prior medicine and urging the doctor to put her back on the medicine that worked, and explaining you will take action if your requests are not honored.
I have a similar situation with my mom in an ALZ facility. The dr wont prescribe my mom a small dose of anti anxiety nor daily pain medicine for my mom and because my dad has POA, he has final decision and authority and wont enforce it with the dr,for reasons beyond my comprehension.
Can you call an elder law attorney and find out what legal action you cantake against the dr and NH if they ignore your requests? Good luck and let us know what happens. Take care
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Evelyn123, You do not tell us why your MIL is in a nursing home or what its credentials are. We do not know her age or anything except that she has had mental health issues during her adult life. I feel for your concerns, but be careful accepting advice given with too little information. If you just want to vent, we are all here for you. We have all had problems dealing with others who disagree with us and when they use their authority over ours, we feel impotent and angry.
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Oh my goodness i am so sorry to hear about what happened to your mom. Thats terrible. I.m sorry you and your father had to watch her decline And make the decision you did.
We all do the best we can with the circumstances at the time, so although you may wonder, i try to have faith that things happen for a reason at the right time and right way. I have had a hard time watching my mom suffer with such pain and anxiety and the dr and MC staff not convincing my dad to give her meds to make her more comfortable. It makes me very upset. But i have prayed alot about it asking God for guidance because i cant get anywhere since i dont have poa. She has no other primary care doctor and my dad wont sign tbe authorization form to let me take her to a geriatric doctor outside of facility. I have written him letters and asked him verbally why he made those decisions and he wont answer me. When i ask the m.c. staff why tvese decisions are made, the director turns it back to me with questions. infuriating. Thank you for yr feedback
My mom was given haldol at the first facility after breaking her hip and she was catatonic for several days. I begged them to never ever give her that again. The next place gave her risperadol and even worse reaction.
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