She was given gabapentin, without me knowing. I do not have POA, but I talk to her every day and see her on the weekends as she is 60 miles from where I work. She used to take tramadol for pain with no side effects, the doctor (who I have never even seen) ordered gabapentin for pain. It caused her to become extremely drunk, cannot stay awake, then she began seeing things that were not there. At her cardiologist she saw pumpkins growing in the parking lot, in her room she saw people who were not there, someone reaching for something, etc. She fell once 2/18 then again on 2/20. The last time she got a black eye, a huge hematoma on her head and cuts to both of her arms. She has a huge bruise on her right breast from the first fall. I was told the gabapentin was dc'd on Tuesday, but I found out yesterday it was not. I am waiting on the Nursing Director to call me as well as Quality Assurance. She is there for therapy only, she does NOT have dementia. She suffered cardiac arrest on 1/22 after her potassium crashed to 2.1 and after I had requested she be tested for a UTI as she had not been feeling well all week. I am afraid they are not watching her properly! I don't know what to do, her 100 days will be up 2/28 and now after the fall I am afraid she has had a set back. She was GREAT last week when she saw her cardiologist!
First, I think the focus now is twofold:
1. Getting her out of there and into a reputable place ASAP, and
2. Figuring out a way to get a Medicare extension.
1. Make a checklist of things to look for in a rehab facility; contact the local or state ombudsperson and find out which rehab facilities to avoid. Then interview them; I realize this is time consuming, but it'll be worth it. There will be different staffing levels and activities on the weekend, but try to go before and/or after mealtime as well as during mealtime because that's often when the patients get less attention, especially if meals are served in a common area as opposed to in the rooms.
2. In the meantime, document everything negative: incidents, dates, personnel involved, your own cardio's and other doctor's position, refusal of the rehab staff to accept the orders, etc. Ask the ombudsperson about these and if they're grounds legal action. But don't tell the rehab staff about any of your background investigations.
My thoughts are that there might be some vitiation of the Medicare time limit if care was improper, if not plainly against medical standards of proper care.
3. Ask the cardio, or other regular treating doctors, if they have any recommendations not only on placement elsewhere but on extending Medicare care, in a competently managed facility. Perhaps they'll script for an extended stay, at another facility.
4. Alternately, and depending on whether she experienced orthopedic injuries or setbacks from the falls, your treating ortho may recommend thereapy.
I recall reading sometime ago in one of the Medicare and You booklets that PT can be extended if another injury, of a different physical location, occurs. I don't recall though whether that's for in-facility PT or through home health care.
5. CAVEAT: I am not current on Medicare regulations on extended therapy for in-rehab injuries. You might even contact Medicare, recognizing that they won't give you specific information on your mother's particular situation, so present your questions as situational and hypothetical, as opposed to specific.
6. This is a lesser option, but ask your doctors about Palliative Care. It's not hospice; there's not a need for a terminal diagnosis; it's care for chronic conditions. You might be able to get it for home care, along with home therapy, and bring your mother back to better health.
PC is still somewhat of a new construct, as I've been told with companies which I've contacted. Some don't really do anything except make a monthly phone call or send a nurse out at specified times, and I found it really hard to find one that did more than that. But it might be different in different areas. And it's worth a try b/c (so I've been told) is paid for by Medicare.
7. Contact an elder law attorney whose website indicates she or he handles rehab issues. Some of these attorneys specialize in medical neglect at rehab facilities, as opposed to focusing on estate planning documents. It might cost a few hundred dollars for a short conference, but these attorneys should know their way around Medicare as well as the bad rehab facilities.
A conference might be a good idea, but I can pretty well guarantee that the staff will close ranks, plan to outnumber you and outflank you, and you'll feel defensive. Plan to bring an elder law attorney as described above, but DON'T tell the staff beforehand. You want to catch them offguard. Even if the attorney does not much more than take notes, scrutinize the staff with firm and concerned countenances, and raise a few eyebrows, it will likely prevent the staff from ganging up on you.
If you do have a meeting, demand specific action, by department and staff level, and with an outside deadline. If you have an attorney and the staff waffle on response, look at the attorney with a concerned look. Sometimes these "looks" can scare the staff into worrying about liability issues.
And don't tell them that you're planning to find another facility.
I hope this helps. I've been through 2 situations in which care was unsatisfactory; the first time a meeting with staff resolved the issue, but three of us in the family made a practice of spot visits (during which time I caught a psychiatrist saying "hello, how are you", and then charged Medicare for an actual visit. After I reported him to Medicare, eventually I was notified that they were actually taking action.)
Good luck; you have a rough road ahead of you, but once you find a good rehab facility, it'll be much better for both of you.
I am so sorry that you are going through this, it is hard enough with an ailing parent, I pray that you find some place where mom can get back on her feet and back to her life. Please file a complaint with the powers that be in your state, these places will never change until they are forced to.
Regarding the meds, you didn’t say your mom’s dosage, but Mom had been on low dose tramadol (100mg) and gabapentin for nerve pain (400mg) for years without side effects. Gabapentin is used for more than just seizures. However as she aged and lost weight, we thought the combo might be contributing to her extreme sleepiness, so we’ve cut back the gabapentin down to 200. We may go lower as long as her arthritis pain doesn’t increase. She also started on a low dose Zoloft and started to "see things" like your mom did. After ruling out UTI, I ordered the Zoloft stopped and the hallucinations stopped too. It’s so hard to figure out the side effects of medicines/combos as they can effect everyone so differently. It’s imperitive you stay on top of her meds and their administration.
They had her on 400mg of gabapentin, which I agree, everyone reacts differently. If everyone had hallucinations as my mom did, I am sure that med would be used differently or not at all. She didn't react well, but no one seemed to pay attention. They literally blamed her for her falling!
She is already set up for nursing home care and therapy as she is being discharged tomorrow. Her insurance will not pay past Wednesday. Her primary doc will set her up with more home care for showers and such.
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