Without his medication, my husband is becoming combative with nurses and other residents. Any advice?

1500 or even 2000 mg of Depakote daily, is not unusual in manic-depressives. The same dosages can be used to control violent agitated behavior in general. People who suffer from explosive personalities, do get treated with Valproic Acid or Depakote too. Your husband needs to be back on it. Doctors who aren't psychiatrists worry that 1500 mg of Depakote is too much and will cut it down. As long as there are no contraindications, like liver disease or thrombocytopenia, he should go back to taking 1500mg daily in divided doses. Depakote is not an anti-psychotic or tranquilizer. It will not over-sedate the patient.

Contact Ombudsman…the phone number is by Nurse’s station. File complaint that they’re trying to kick your husband out & they caused his agitation decline. You warned them what would happen if his meds were changed…they refused to listen. I believe that their rating will go down if more patients are on antipsychotics. They’re more interested in that then taking care of your husband. Stand your ground, but remain calm…demand care plan meeting with all involved
Hugs 🤗

Who authorized the change in his meds. You need to get his doctors involved immediately. We cant help you, only his doctor. But I would be asking who authorized it

Acanesfan: I did see your update of nine hours ago wherein you stated that you went to the executive director and that some of his medications were adjusted just last Saturday. It could be possible that these medication changes may take a bit for his system to adjust to them. Prayers and hugs sent.

In my experience long term care facilities own the person on Medicaid and reduce the meds. Nothing you can do. They always reduce meds even after n insurance for short term stay.

Thanks to all of you for your help. I went to the executive director with the actual prescriptions and had her compare them to what he was getting. She was surprised (supposedly) and said she’d get it taken care of. Last Saturday they finally upped his anger meds, got back the clonzapam, and are adjusting his antidepressants back up to where they were. He has shown a lot of improvement but the NH is still looking for a possible change of facilities. They really don’t want him there and I can’t blame them because he is still threatening to "get back" at the other resident he fought with and is still saying he’s going to get out of there. So frustrating!

Please have him admitted to the local hospital for evaluation and treatment to get his behavior back under control. While he is in the hospital, ask case management or social services to help you with placing him into a skilled nursing facility - one that will abide by his doctor's prescriptions.

This facility obviously cannot handle dementia… unless it’s the quiet placid gentle type !!!
if your husband used to being In charge type A … he’s not going to accept what’s happening to his brain that easily and will fight !!!
they need to continue his meds … not up to new GP who doesn’t know history to switch Willy nilly… you need to advocate for your husband …get meds back on track … start looking for another facility … in meantime they can’t throw your husband out … until you find another
facility … don’t let them push you around …..

Get the doctor involved. If he is still seeing his previous doctor and he/she is still the one writing the prescription then the facility is not following doctors orders and that is a violation. (Getting just 1/3 of his previous dose is a BIG change)
With Parkinson's if he has been diagnosed with LBD violent outburst are a real possibility and changing medication or the dose can be a big problem.
And if he does have LBD it is NOT his Attitude it is the form of disease that he has that is doing this it is not a choice he is making.

*side note here if they are looking for a new place for him it is very possible that this is administrations way of not being able to properly care for someone that is their responsibility. And there is a good possibility that he would be better off in a facility that knows how to follow doctor's orders and deal with different types of dementia and the aspects of each. All dementias do not present the same and each person has personality that has an effect as well as the parts of the brain that are effected.
If this is not resolved I would contact the Ombudsman's office as well as making a comment on the Medicare website under reviews for that particular facility.

You talk to the DON if you get nowhere with them then you ask for the doctor who gives the med orders. No DON or staff member can change a dosage without Dr. orders. A doctor associated with a NH is probably a GP. He should not, IMO, be fooling around with your husbands meds. You have a right to take your husband to his specialist. You have a right to call that specialist and ask that he talk to the GP.

Really, they lower his med and immediately he gets aggressive and the DON does not put 2 and 2 together and call the doctor and ask for an order to take it back to where it was?

You told them about his meds, they wouldn't listen. They must take responsibility for their actions.

Anger is a result of his struggling liver, because no proper action is being taken to restore his health, his liver gets worse as does his anger. Have a look at eastern traditional medicine, it's very clear about the liver. Brain disease is what happens after a liver has suffered for decades and can no longer cope.

I can understand a medication review when entering a nursing home. Many residents may have been placed on meds long ago, hardly reviewed, more & more pills added, some not interacting well together or newer, better versions available.

But I do not understand taking a PD patient off his PD meds.

Agree to advocate for your DH with the prescribing Dr/Specialist.

I agree with BarbBrooklyn in that you definitely need to get the Administrator, DON and mostly importantly the Medical Director on board to restore the depakote
to the original levels; you want a meeting with them and you want the meeting notes and medication notes to be part of his care plan. Not sure where you are located but in NJ, if they are reluctant to meet with you, the mention of the Dept of Health and/or the Ombudsman's office usually gets things moving pretty quickly...like within 24 hours. Also notify the physician who originally prescribed the working dosage of Depakote so he/she will be prepared for any contact by the NH or the State. If the NH admin doesn't up the dosage, I would still contact the Ombudsman's office because they, the NH, are willfully not meeting your husband's medical needs and that is a violation under any state law.

Good luck and please keep us updated.

Talk to the dr who is at the nursing home directly and show him the bottle if you have not done so already. Don't rely on the nursing staff at the NH to do it. Don't rely on a dr's PA if only a PA makes rounds for a dr at the NH. Show Dr the bottle and dr's name who originally prescribed it. Make sure you tell the NH doctor that you gave NH a heads-up on this info when he was admitted and, sure enough, he did become more out of control.

You can also contact the dr who wrote the prescription and ask him to call the Dr who works for NH (not the PA...the Dr) and see if he can help you get meds back on track. I doubt the original Dr started him off on the high dosage and it's possible he can explain to the NH doctor that hubby started with XX dose and had to be increased because it took that level to calm hubby down.

I think this is rather common for a facility dr (or PA) to change meds or add things. All too often family members do not question this or even know any thing has been changed because they don't visit..or just want to dismiss it as declining health because it takes less involvement.

Huge note here for others with loved ones in facility care -- if you see a change in behavior QUESTION the meds, compare to pre-facility care med list, and have a discussion with facility NURSE (not the aids). If meds aren't changed, always ask about doing a test for urinary infection. You can ask for list of meds and tests/labs that are being done. ASK. -- And have pity for those elderly folks sitting in facility care who have no one to advocate for them.

Find out when the psychiatrist will be there and ask to be there so that you can have a conversation about medications. If you cannot be there in person ask for a phone call from the psychiatrist. Staff can do nothing about the meds. Go straight to the prescriber.

I am so sorry. That would be horrible for him to end up on a psyche ward. Why won't they give him his normal dose? It's scary to think they can raise or lower doses to whatever they want. Can you get an appointment with his regular Dr?

If you do not have one, order the Aware in Care kit from the Parkinson's Foundation. https://www.parkinson.org/Living-with-Parkinsons/Resources-and-Support/Hospital-Kit

You can even print out the important info that is available to share with the staff. Much of it is importance of managing medicines.

Try encouraging the head administrator to check into this organization. https://www.strutherspn.com/front-page They have a program that educates organizations how better to work with Parkinson's patients. PD patients are all unique and too many times staff are not aware of how best to deal with PD related symptoms.

My heart goes out to you because once a PD patient's the longer meds are off track it can be difficult to get back... but know they can be if you stay a strong advocate. I just watched a webinar with Dr. Okun a renowned PD expert. One tip he gave is be sure we are talking WITH staff rather than AT them... and this can be hard when you feel like they won't listen, but it may help get your important message across.

I so empathize with you because when my husband was in rehab for a broken hip 20 years ago, I tried to tell the doctor that it was important to keep his meds consistent and I was shocked with his response. "It has been my experience that PD patients tend to be obsessive about their meds and they do not need to be." It went downhill from there.

Depakote or Valproic acid is an anti-convilsive drug that is used to control bi-polar disorder. Also, it's used to regulate unstable moods. You're right. Cutting down his Depakote, has released his unstable mood. He needs to be put back on it.

Who is "they" that you are talking to?

Call or email the Director of Nursing, the Social Worker and executive director. Tell them that you need to have a meeting or conference call with ALL of the and the person at the NH who has the authority to prescribe meds (this is most likely the Medical Director). THAT is the person who needs to be in touch with the doc who was previously prescribing.

Is a geriatric psychiatrist involved, I hope?