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Is this a science experiment? It took me 6 years to get my father diagnosed with dementia. After 9 months in NH, he has really calmed down and no longer spews hate, paranoia and accusations in every sentence. Largely because he was finally prescribed an anti-anxiety drug. The results were really wonderful and I actually could have a civilized conversation with him that did not involve negativity. I was informed today that "the government" insists that his dosage of this wonder drug be decreased by half. What? It is not that he is sleepy or out of it. I thought it made him much better. I am just really disgusted at this new development.

Anyone here have this experience? Any thoughts?

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I think DHS in each state must have their own rules. Especially if the drug has known side effects in dementia patients. My mom's Risperidone Rx was up & down like a carousel horse for months. DHS had a policy against letting a long term care patient be on the "higher" dose for more than X days because of side effects. So they'd let me know they had to reduce her dosage. Inevitably her behaviors came right back just as before (and every other time) and they could put the dose back up to where it helped her. Over & over & over & over. Believe me, it makes the nurses' lives a lot more complicated to keep tracking this vs. leaving well enough alone. It can't be good for the patient to never be stable for more than a week or so.

Like others have said, I would insist on being told what part of the government has this requirement. The nurse who said this to you may not even know herself, which is very sad (and not good enough in my opinion).

My guess is it's for state DHS med audits.
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Thanks all for the input. He is on Celexa, and it has made a world of difference. At 95, I am not really bothered addiction problem. I would pay out of my own pocket for it if it comes down to it. I am willing to see if the half dose they want to do is ok. He is on Medicare not Medicaid, so I was a little surprised by this new development. He pays out around $300 copay for all of the drugs he is on as it is. I will keep you posted. Trying to stay positive!!!!
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Thank you Misslauri, that's very interesting!
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There are now in place new laws restricting the amount of addictive medications that are prescribed. ( class 1 I believe) klonipin is one of those, OxyContin is another. It just depends on the medication he was receiving. My nephew is bipolar with several other mental and medical issues and his meds have been all adjusted since ADA.
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Hi Mincemeat, I agree completely with Babalou here. The only possible entity that could dictate the level of a prescription would be Medicaid or Medicare, and even then I would think it would be about the amount covered, rather than the dosage. (For instance my mom has a prescription for a migraine pill for which her Medicare gap insurance insists on only covering 9 pills a month. But they have nothing to say about how many pills she can take in a week.) If I had to make a guess, I would say that Medicare (or Medicaid?) informed the facility that they would only reimburse a certain number of pills per prescription refill, and the doctor has interpreted that to mean that he will need to cut the dosage in order to have it covered by the insurance. Many people are skeptical about the Affordable Care Act, and I've noticed that some entities are using that skepticism to blame the ACA for any and every decision that affects patients negatively. The other thing you could do, if the doctor doesn't give a satisfactory answer, is contact whoever your state's ombudsperson is for nursing homes. They should be able to tell you what recourse you may have. Do ask good questions, and let us know what the doctor tells you!
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I think that there is a push from CMS (Center for Medicare, etc) to reduce behavioral meds. I'm sure there are lots of folks who are on higher doses than they need to be. But I would never, ever accept The Government being blamed for a medical action that a doctor wanted to take with regard to my mother's medical care.

If they are reducing your dad's meds, you want to find out what the plan is for monitoring his behavioral changes, how he's handling the change. What is the half life of the med they are considering reducing? Have they considered how long it will take for the changes to show up in his behavior? Who do they intend to take data on the changes? You want to make sure that the changes they see are documented by data and not anecdotal.
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Babalou, this came from the visiting physician that is the medical director for the NH. This was relayed to me via his nurse. I asked specifically what reason for this action since he seemed so much better. "The government" must be some state oversight?
I asked who several times and it was blamed on "the government". Good question, I will ask if "the government" is the State Health Department, State Social Services, etc.?
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Recently, my mom's psych aprn called. She wanted to take mom off her bedtime klonopin and substitute Melatonin. You know what? It worked.
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What government entity? Who informed you of this?

I'm all for patients being on the correct dosage of any drug. Talk to his doctor.
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