POA and power to decline drugs, where do my rights as POA stop? - AgingCare.com

POA and power to decline drugs, where do my rights as POA stop?


I have POA for a friend who has advanced Alzheimer’s and has no living relatives. He asked me to help him long before he was gone mentally. I’ve witnessed memory care facilities use drugs on him to make him compliant and wonder if I have the right to say NO to specific drugs for him. I understand the facility’s concerns and liability issues for other residents safety but there’s other alternatives to immediately throwing serious antipsychotics at him. Can a doctor go around me and work with the facility directly and give him drugs that I don’t approve of. Where do my rights as POA stop? I do my best to research and understand the doctors recommendations but if I don’t agree with the dosage or with giving the facility PRN with drugs, do they have to abide by my wishes (which I know are also his)? I appreciate any input or suggestion of where to turn. A couple different attorneys have told me the laws in this situation are gray and suggested I talk to knowledgeable people in the medical field. Those I’ve talked with in medical field (including the Alzheimer’s org) suggested I talk to an attorney. :)



First of all staff in any institution can not give any medication without a Dr's orders, although there may be standing orders for all patients which does give staff a choice.
This is especially true for hospice patients which allows staff to do something like place a urinary catheter which usually needs a Dr's order. They are also allowed to use the medications where provided in a hospice comfort kit. This kit contains a very limited supply, just a few doses and further supplies have to be prescribed. It allows the RN to have immediate access to a medication when a patient develops severe pain or continuous vomiting.
I do not know if such standing orders exist in residential institutions.

As far as antipsychotic medications are concerned has anyone considered what happened in so called "lunatic asylums" before the invention of these drugs.

Psychiatriic hospitals are a very different place these days thanks to modern science as are all branches of medicine and many people who formally were confined can live productive lives these days in the community and hold responsible jobs

Everyone needs to be vigilant about their loved one's care, but try and look at both sides of the picture.

If you refuse medications and your loved one is uncontrolable and the facility discharges him are you prepared to control the behaviors at home without meds?
It is not enough to hide the knives, he could pick up that heavy lamp and hit you over the head, push you into the fire, set the house on fire. How about getting the garage and cutting off this feet with the lawn mower or maybe warming the cat up in the microwave when you thought he was heating water for tea.
There is no end to the things that someone with a damaged minds can do.
Helpful Answer (2)
Reply to Veronica91

Actually there is a book out called a person's rights in a nursing home. I saw it on Amazon, considering getting one for myself---if need be!! Not sure it will help---but it might!!
Helpful Answer (0)
Reply to wwpwin

You have to love "A couple different attorneys have told me the laws in this situation are gray and suggested I talk to knowledgeable people in the medical field. Those I’ve talked with in medical field (including the Alzheimer’s org) suggested I talk to an attorney." As said in the animated movie The Point, a point in every direction is the same as no point at all... Soooo true.

If you indeed have a medical directive POA, you should at least be included in the loop. I also found out after the fact (when the BILL came) that they ordered a mild anti-anxiety med for our mother when she moved into the MC unit. I was okay with the decision to do this, but I was not pleased for several reasons: 1) I was not consulted and 2) her insurance uses a specific pharmacy, which limits or eliminates copays! I inquired about this before committing to the place and they were okay with me continuing to manage her medications (BP only.)

I had to make a ruckus, because they also ordered her BP meds through this place, at ridiculous cost! Sorry guys, I provided a 90+ day supply when she moved in - what did you need to order that for right away?!?!?!? I had them send it back, but we still ended up having to pay a 'restocking fee'. After several phone calls to find out what the residual charge was for, and asking several times that they ensure NO orders are filled via them unless they talk to me, I finally sent the payment with a letter telling them I have advised the doctor's office, MC staff AND you to NOT fill any prescriptions and if you do so, I will NOT pay a dime, not even the restocking fee. Their cost for presumably one month was ridiculous, I want to say it was at least $150, whereas mom's plan now provides 3 generics at $3 each for 90 days! We would go broke just paying for medications with this other place!!!

That said, Alz org and attorneys do not have the facts and details. You will have to inquire with the nursing staff, and perhaps even better the doctor who ordered the prescription(s) as to what they are and what they are needed for. Once you have that information, you can better weigh the pros and cons.

As others have said, if these medications calm him down, preferably without making him semi-comatose, they might be in everyone's best interest. I am a proponent of less drugs being better, but if he is unruly, a hazard to himself or others, including staff, residents and visitors, they are likely a necessity. When residents are too unruly and cannot be "redirected" easily, you might find yourself in a situation where they will ask you to move him to another facility. THAT would be unfortunate. It is hard enough to find a decent place with available space and it is hard on the resident to have to move. I do know at least one resident where our mother is had to move (unclear if it was staff directed or spouse) - I believe he had fronto-temporal and was not easy to work with.

If you feel the medications are too strong, perhaps you can work with the staff and/or doctor to reduce dosage or try a change in medications.
Helpful Answer (0)
Reply to disgustedtoo

Try looking at this a different way. The meds are to help him be comfortable which also helps with behaviors. Nobody likes the feeling of being agitated or confused with people trying everything to calm them down which for many only causes more agitation.

My mom was kicked out because of behaviors that no combo of meds would help. Sometimes we, as caregivers, need to be more compliant.
Helpful Answer (1)
Reply to gladimhere

PrairieLake, not sure what you mean by the facilities "for very aggressive patients" having "lots of oversight with medications used for behavioral management"; that's the type of facility I understood dil's grandfather to be placed in when I took her up there and talked with them; they told me they don't - at least as routine, understood at the time not at all, thinking in terms of the "alternatives" that I was told about by the local "Alzheimer's Association", though don't think that's really who it was, but somebody like that that you're supposed to talk to who're very opposed to "serious antipsychotics" but that would require the 24 hr. supervision like was talked about in another post; the fact of their being agitated themselves by their agitation either doesn't seem to be addressed or - now, they weren't talking about keeping the patient restricted but, in a sense? but beyond just mentally, entering into their world, as in pretty much whatever they wanted to do, do it with them, now I'm not sure what the behaviors are in this situation, but in the one I'm referring in particular it was - not sure if you'd say "wandering", as in wandering off, but just wandering/walking around the yard, etc., just being up for 24 hrs., so, obviously one person cannot stay up for that long, so if there's just one person to do what are they supposed to do? and is that what this facility meant they would do if they were opposed to medication, but then he did more than that, or maybe not, in that sense, since he was inside and didn't have a yard to "wander" around in, he was going in other patients' rooms, so then what were they - or did they have a protocol - had they not ever had that happen? makes you wonder, because then "all of a sudden" this facility, which talked like they knew how to handle a patient like that, couldn't keep him any longer
Helpful Answer (1)
Reply to debdaughter

I agree with Lassie & Prairie Lake, my mother has dementia and had to be strapped down at the hospital, because of the agitation. It is painful to watch but I know that it was for everyone's safety. There is nothing wrong with medications to calm him down; imagine yourself living in a state of agitation, it is exhausting. I understand the reasons that they must medicate. Dementia/Alzheimer's is heart breaking; why make it any worse for the patient. It is hard to move past the anger and guilt especially guilt that these diseases bring to family members, but you have to; if not for yourself then the person that is suffering. What I did with my mom is called the Alzheimer's Association for an assessment, as I had so much guilt with her being in memory care. They told me under no circumstance should I let her go back home. Her moods switch on a dime, and it is dangerous. It was the best decision I ever made, and freed me of the guilt. Once the guilt is gone, you can make the right decisions. Remember, safety for staff, others, and the patient comes before anything else.
Helpful Answer (2)
Reply to Honeybunch

This reminds me of 'One Flew Over the Cuckoo's Nest'. Jack Nicholson decided, 'hey there's nothing wrong with these people, they are being stepped on and held down by Tha Man! I will set them free! Free as birds! They will go out into the world and live rich, full lives, unhindered by shrinks, or medications, nothing wrong with them that a fishing trip won't cure!'........No, they were in a mental hospital because they were very ill. Not just troublesome, but mentally ill. Today most of them would be living on the street, or in a cheap motel room, and who would be looking out for their best interests???.......If the man you have POA for has advanced Alzheimer's, so what if he gets medications to 'make him compliant'? He is never going to get better. He has no big jolly loving family to make his life better. Do you want him to live in a state of agitation, and possible endanger his living arrangement, not to mention the other people around him? Why??? Doctors do not (supposedly) go around over-medicating people just to make the institutions lives easier. I have a friend who was hired for a few days to sit by an Alzheimer patient's bed for 8 hour shifts, NO BREAKS, to watch and make sure they didn't get up and try to open the window, calling over and over for someone from their past life.  My friend was ready to get over-medicated herself after 8 hours of that!  It was excrutiating and a lot of noise and angst for...for what?....it would have been a mercy if that patient had been properly medicated, but the family thought hiring my poor friend to sit there watching him for 8 hour stretches till the next shift was 'better' somehow.
Helpful Answer (4)
Reply to Lassie

If family refuses meds that control the agitation, and patient becomes unruly or dangerous, they WILL get rid of the patient. Maybe not overtly, but they will send him to the ER for something and then refuse to take him back. It happens all the time.

Also keep in mind that the agitation is also very difficult for the patient. Delusions and hallucinations are difficult for the patient. Sometimes medication is for the patient's good.
Helpful Answer (4)
Reply to jjariz

I think it might help to have him evaluated by another doctor. One that is not associated with the facility he is now in.

If that doctor says the drugs are NOT necessary then you could have a law suit, if they continue to give them to him.

Yes, some workers in these facilities will over medicate to keep the patient compliant, whether or not the patient is violent or hurting himself. This should be uncovered and stopped, if it is happening.

However, it might be that he is aggressive and may either hurt himself or others, unless medicated.
Helpful Answer (2)
Reply to Heather10

I have medical POA for my father who has just been evaluated and is no longer able to make medical decisions. I had to make the decision to place him in a secure facility with dementia services.
I am a speech therapist that has worked in nursing homes for 20+ years. I have never seen nursing just “throw” psychotropic drugs at a patient just because they are a little difficult. I have heard patients screaming through a shower, refusing to let anyone bathe, dress or direct them. I have seen patients strike out physically at staff that are just trying to change their sheets.
I suggest you take some time and go spend the afternoon and evening with your charge and observe what is happening.
Nursing staff is not allowed to stop or start any medication without notifying the healthcare POA. However, they can refuse to keep caring for him if he is endangering himself or others and you refuse something that might help him. They do have some facilities that are for very aggressive patients, but they have lots of oversight with medications used for behavioral management. Well, all SNF’s have oversight for medications.

I am curious as to alternatives that you would like to try. It may be they would try them also.

It is a very difficult responsibility that you take on out of love and caring. None of it is black or white. And each person has their own unique situations. Comparing them is like comparing apples to zebras.
This is no responsibility for the faint of heart.
Helpful Answer (5)
Reply to PrairieLake