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. :)
If you have healthcare POA, then I think it is worth having a conversation with his doctor or neurologist and discussing the pros and cons of the medications. You need to fully understand the consequences of him taking or not taking the medication. Could he stay where he is if his behaviour is not under control? Is he a risk to himself, staff or other residents?
His wishes were made when he was of sound mind. His mind is not sound now. Would he have wanted to put other people at risk when he was of sound mind?
You mention alternatives, have you fully explored them with the MC and doctors? They may have tried them in the past with other residents and found them lacking, or they may be willing to try something new.
You are in a tough position.
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.
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.
However, if they are medicating him to keep him compliant - what will be the ultimate outcome if he is not longer compliant? Will the facility put him out as too hard to handle?
It's definitely time to speak with the Administration and possibly an Elder Attorney.
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.
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.
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