I've posted a lot here about my husband's various behavioral issues over the years. His neuro called him a "handful". OK--so after two geripsych unit stays this year totalling 7 weeks, I moved him to an ALF. He was stabilized at the time on various meds--there really was a big improvement and he was calm and compliant. Fast forward to now (2 mos. after placement). I am happy with the care, he has done very well, but the psychiatrist who visits the facility reduced his meds. First one was about a month ago, no negative repercussions. Last week another was reduced and yesterday, the aggression resurfaced. I had a long conversation with the doctor, and I still don't understand why he is reducing medications for a patient who is doing well on the current regimen. He gave me answers like "we want all the residents to have the best life possible" or "we strive for fewer medications", etc. Those things sound good, but when a patient has a history of agitation that has been successfully treated, it seems to me that common sense dictates not to mess with success.
I am wondering if others who have placed their LO's have experienced anything like this? Is it standard operating procedure for doctors at facilities to adjust medications for the reasons stated above?
I expected the opposite to be true. That facilities would err on the side of overmedicating. It seems like a good sign to me that the one your husband is living in prefers to reduce if possible, but obviously they have to be willing to do what works, even if that means returning to the original regimen.
Okay, my message just magically disappeared. I'll try again. I would certainly hope that the doctor would realize that the reduction in dosage isn't working. I'm not sure about "rights" in this case. You certainly have the right to insist on the appropriate dosage, but I doubt the doctor is required to comply with your wishes. Anyone know how that works?
this is a good question for dr josh who works with alot of in patients. personally i would think it would be not of the best interest to the patient if they go OFF the normal meds for any length of time if they are controlling documented aggressive behavior. its hard on a person to have to start up with the on /off howmuch/when dosings and certain side effects that can occur while this is being sorted out. if it aint broke dont fix it, is an old saying down here in the south. i agree with marilyn why stop something if the patient is under control and not apparently overmedicated? decreasing medications that have a person stable seems radical to me. after 7wks of ironing out the right mix i would ask that they not mess with the doses unless he seemed unable to function due to over medicating. probably the excuse will be that they only want to dose these potent meds for a 'specific' timeframe due to side effect issues and CYA. i would speak to the dr who is reducing the meds and ask how they will react and treat DH if he becomes unruly and possibly hurts another patient due to their decisionmaking. ? divvi
I was told by several people (not the doctor) that there are government regs that require that doctors treating patients in LTC facilities periodically attempt to reduce the amounts of medications given. My sources (doesn't this sound mysterious?) say that the intention is to prevent overmedicating. Yes, Emily, I was afraid of overmedicating too--that's what we hear a lot about.
Divvi--the doctor reassured me that they will "work with him", which I presume means excuse any problems caused by this medication adjustment. I had sent him a strongly worded email and asked that they leave the meds as is, restating his history; that he is not having any side effects and the agitation is controlled. Of course, as Joan said, he doesn't have to listen to me.
Today I got a call from the hospice nurse, who reassured me that today Steve is calm, shook hands with her, sat and talked, etc. Hopefully, the situation is corrected for now.
My DH is on waiting liss for Placement. This topic came up, and I asked why mess with what's working. I was toldthat periodicsally they have to try weaking off--documenting the needs and restoring as needed--as proofthey are not over-medicating, or medicating for convenience. It's in the licensing rules and regs. because of the past history problems related to warehousing.Another case where the "fix" is not so great.
marilyn I checked with my daughter and she confirms it is govt regs that require periodic titration down of drugs. From her viewpoint the facilities don't like it either.
Marilyn, I too went through this when Lynn was placed. At first they did have to up his medication, but that was to try to comfort him, not over medicate. It is my experience that most places nowadays have better policies in place for things like medication and restraints. Most allow for no restraints and as little medicine as possible, at least here where I live. Once Lynn leveled out and transitioned well his medications were reduced drastically.
It is true that the medications are reviewed, they try to adjust and lower the doses. Here it is twice a year. Lynn had reached a place of comfort and peace that I was delighted with. They wanted to try to reduce him medication once again and I was adamantly against it. I spoke to the Ombudsman, a lawyer, and the doctor. The only way I could avoid the yearly adjustments was to write a hand written note stating that I did not want Lynn's medications changed. I also had to sign a waiver that said the risks were explained to me and I chose to keep him at the level he was on.
Since then, they have not had to adjust his medications. They can not be adjusted unless I request it. Perhaps that is something you can do as well. Best of luck.
Nora--your daughter is right--the facility nurse told me he doesn't like it and what happened with Steve has happened with others.
Nikki--thanks so much for the info. I can see that the waiver is a great idea and serves as a cya move to protect the doctor/facility. Yesterday, I attended a dementia conference for professionals, and one of the speakers was a pharmacist. She addressed this issue and said that a gov't report was issued in May on this topic and the issue is the concern with the Black Box warning that was put on antipsychotics use for dementia patients. I know we have discussed this issue many times here, and I think we all agree that it is worth the risk of potentially shortening lifespan to provide better qualify of life to the patient and caregiver. My husband's neuro said he was talking about perhaps a couple of months shorter.
marilynn, I don't have much else to add but it is my understanding too that it due to govt regs and licensing of facilities. My DH was recently in the hospital for aspiration pneumonia and had "unexplained" seizures which they attributed to his high dose of seroquel and they cut it back by 150 mgs/day. Interesting that none of the treating doctors in the hospital had ever treated him or never consulted the physicians who see him regularly.
Just wanted to let you know my dh was on this drug for maybe 9 months or so and his neuro has taken him off the drug. Took him off slowly. But, the good news my dh is just as calm and sweet as he use to be before he kind of went bonkers on me.