Should I not be notified when changes in meds for my mom are made in a skilled nursing facility? - AgingCare.com

Should I not be notified when changes in meds for my mom are made in a skilled nursing facility?

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I will apologize upfront for this being long, but I am new here. I am an only child who has been caring for my 77 year old mother, in my home for over a decade. In the last four years, she has declined from a walker to a wheelchair. I am fortunate to be able to stay home with her. We have had a few stints in and out of skilled nursing facilities but she has mainly been cared for by me alone at home.

She fell quite a few times recently and ended up with pneumonia and in the hospital two weeks ago. Thankfully, it was caught early, and as of last week, is back in skilled nursing. Unfortunately, she is not in the same facility she has been in before, because they no longer take her insurance. We were very comfortable there and it was very close to my home. Also, it was next door to her primary physician and he made rounds at the nursing facility as well, but where she is now, is a different county and he does not go there. So we are dealing with a new doctor.

I had been pleased, so far, with her care at the new facility, but tonight I found out from talking to the nurse that the doctor took her off many of her medications. Some she had been taking for years. On 3/16 she had blood-work done at the hospital and it was fine. My mother is severely anemic, and MUST take two iron pills a day, along with folic acid. Both of these were discontinued by the new doctor. She has been anemic all my life and, her count has gotten so low that she needed transfusions, but she has never been removed from iron pills since we found out how serious her anemia was back in 2009. I find it confusing that she was removed from the medications because “her blood work was all off” (those were the words the nurse used. Her blood-work has been fine for over a year, and on 3/16 when done at the hospital, then one week later they are all the sudden off?

Also my mother has severe osteoarthritis and osteoporosis, for many years she has been on hydrocodone every six hours and it does a great job of easing her pain. Both her hips and shoulders are bone on bone, because she is not a candidate for surgery. After being told in confidence by the nurse about her medicine changes, she gave me a copy of her list of medications. I had gotten a copy the first day she was admitted on 3/20, because I keep on top of things like this and the orders from the hospital were the same meds she had been on, at home. Now I see that not only have they discontinued seven of her prescriptions but they have her pain meds listed as PRN and she has not been given one since 3/27 (two days ago.) With her dementia she is not able to tell them she needs pain meds. This means she is getting nothing for pain. How is she supposed to function in skilled nursing on no pain medications?

I plan on talking to the Administrator on Monday but I wondered, is the facility not supposed to advise me when changes are made in her medications? Also, do I have a right to ask for copies of her blood work? The nurse tonight told me they were not supposed to give our things like that but gave me the prescription list in confidence, saying that things like that had to go through the front office. At the prior facility she was in, and the only one I have ever dealt with, I was called every time a change was made or something was going on with her blood-work, and I just had to ask the nurse on duty for a copy of things such as this, and got it on the spot.

Obviously, this all makes me very concerned, because now I am afraid that I won’t be told if other changes are made. We live in a very rural area of TN and there are not many options of places I can place her, and I have heard the skilled nursing section is excellent and from what I have seen, and the people I have met it is. It is just learning this new info that really has me very troubled. Thanks so much if you have read so far and any advice you have.

These are the medications that the new doctor removed. All had been prescribed by her primary doctor

Elavil/Amitriptyline 50 MG 1 at Bedtime
Calcium Carbonate 600 MG 1 in the AM
Vitamin C 500 IU 1 in the AM and PM
Vitamin D 2000 IU 1 in the AM
Magnesium Oxide 400mg 1 in the AM and PM
Iron Ferrous Sulfate 325 1 in the AM and PM
Folic Acid 1000MG 1 in the AM
Hydrocodone Lortab 5-325mg 1 every 4 hours NOW PRN

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Update: I talked to the Director of Nursing and to the Administrator today. Both were apologetic and understood why I was so bothered by this. We went over all of her blood work and it had been an error regarding her pain med being PRN. I was nice but firm, since this is the first encounter I have had like this. They both assured me that I will be notified regarding any changes like this in the future. I did let them know that I had to be able to have faith in them and that I would have no problem pulling her out of there, if need be.

Thank you each and everyone for your input. Like I said, I am new here, so I will probably be back with more questions.
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Thank you all so much for your replies. This was/is just so different from what my experience has been before. She is there for skilled nursing and I know she will need pain meds especially. I also still just can't believe in one week her blood work became that off. I plan on discussing this tomorrow. Again thank you all for your input.
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Fire the new doctor for failure to comply with the proxy. You don't have to use their MD, use the one she had previously. When we moved mom to ALF, I refused to use their MD, because he was not actually on site, he had a NP there who saw the residents. I also met with the director of Nursing and informed him I would be dancing on his desk if there were any changes that put the patient at risk.
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As I'm sure you have learned, when a loved one is in a NH there are battles we fight and battles we give up. We have to pick and choose. Any changes to your mom's medications is definitely a battle you should pick. I was my dad's POA and I had his healthcare directive and I received his blood test results when I asked. The blood was drawn at his private Dr.'s office then the results sent to the NH. I asked for them and received them. One time when I couldn't get over there I even asked for the results over the phone and the nurse gave them to me over the phone.

Time to throw a little weight around.
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I agree with what jeanne said. I would emphasize to the dir of nursing that your mom can no longer request pain meds. One thought is that, with such rampant abuse of prescription pain meds going on all over the U S, this might be the doctor's attempt to see if your mom actually needs that level of pain relief, or if some extra strength tylenol might not be enough, now that she's no longer walking.
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Take your healthcare POA document in to the nursing home and explain, politely and firmly, that you expect to be informed when medical decisions are made for your mom. Be sure you are included at all care conferences.

There may be good reasons for taking mom off some of these medications. I think that you are entitled to an explanation.

I share your concern about pain medications PRN. That is one topic that comes up frequently in my local caregivers group. PRN for someone who cannot articulate her needs can be pretty iffy. And pain makes every symptom worse.

Good luck to you! Keep us informed of your progress.
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Also, I am the one that signed all of her paperwork at the admission. I feel it that is why I am not being informed I should have been told then.
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I am her healthcare POA as well as financial. Is that the same as a medical proxy? I have never been asked to show these documentations to anyone either at the new facility or the old one.
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Are you officially her medical proxy ... that is, are you listed in her advance care directive as the person to make decisions on her behalf? Does the NH have a copy of that document?
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