My SO has been on 23 mg Donepezil (generic Aricept) and 20 mg of Namenda. He is one who has done really well on these drugs. I was hospitalized at the end of June with my own health crisis, and have been catching up with paper work. In the process, I read my SO's drug summary from the pharmacy and saw that his Aricept generic was 10 mg and his Namenda was now a generic, also 10 mg. I had noticed huge deficits the last two months in what little speech he had. I called the nursing home and was told that the Dr. would call me - the nursing home Director told me that 10 mg of Donepezil was = to 23 of Aricept (not true) and that it was reduced because it was an over dose, not true. He was originally recommended to be moved to the 23mg dose by the memory impairment clinic that did the trials on the higher dose.
She said has been off the Namenda 20 mg for a year (also not true - he was on two10 mg a day as of June this year). These drug changes were done in July - I called and had a nurse there look it up. These drugs are not something to be casually messed with. They do work for him, and do help him. His behavior went off the edge when the last nursing home made big mistakes with his medication. The director of the nursing home seemed to be resigned to this cannot be changed and it has to do with the insurance companies. Well Ohio went to some combination of Medicare & Medicaid, with new choices for his drug insurance. Ever since the change, in July, I get letters that indicate the Dr. at the nursing home needed to pre-approve his drugs and isn't. They say they'll only supply 14 days and need an appeal by her. She is no one I can reach, and after a go round about who to give these to (I was told first his nurse, then his case nurse, then the billing person, who had told me which insurance the home wanted me to choose). I get these repeatedly. Wondering if the are going into the trash. I was assured that it would get to the Dr. and none of his medication would be interrupted, even if they had to pay for it. Well it looks to me like the Dr. is not arguing the case of what he has been on that has worked. And I am stuck here and heartbroken tonight. I was also told that I had been informed of and agreed to these changes, which is not true- the only changes I have been informed of and approved were in his coumadin dosage. I am so upset tonight - I am resigned to lose him to Alzheimers, but not to some completely unnecessary withdrawal of a drug that helps him, and with Aricept I understand that the gains you can get can be lost with withdrawal. I am wondering if I need to move him to where our old family Dr. can visit. He won't go into the town the nursing home is in. No one can ever tell me when this nursing home doctor will be there, and they won't let me have a phone number to reach her or email address. I was told I could not bring in another doctor unless they would be on 24 hr call (which violates nursing home bill of rights). But I don't know how to get another one to see him anyway. These situations make me feel so inadequate to take care of him the way I want, and so powerless and angry. In addition, they are keeping him in bed more, and when I ask him he says he is bored. He likes to be up in his wheelchair watching the people, bird aviary and nursing home dog. They aren't taking him to breakfast, just some instant drink, and putting him to bed after meals, which is the only time I am seeing him gotten up. One aide said it was this same doctor's orders, and it was to avoid pressure sores, of which I am not aware he has had any. I hate to call in the Nursing Home Ombudsman - at the last nursing home they got sick of my complaints and trumped up some untrue things to throw him out. WIll another nursing home take a medicaid patient?

mariposa, Don't waste your time arguing with the nursing home Director about whether s/he is correctly stating the drug amounts. That is a matter of fact, not of opinion. Before you present your arguments, you should arm yourself with the facts that are reflected in your SO's medical records. Look at the medical records with your own eyes and take notes of what is in them. Or else ask for a copy of them. (You may have to pay for the copies.) I don't understand why you are hesitant to call in the ombudsman - isn't that what they are for? Also, the Directory of the facility might not be the best person to deal with this. Is there are Director of Nursing?

When my husband had a behavior issue last winter and was taken to the ER for three hours, I hired a geriatric care manager to go in with me and review his medical records and explain to me what they meant. After we were armed with the facts, we had a meeting with the Director of Nursing (NOT the Director of the facility) about what had happened and what the medical plan would be for the future. That worked perfectly. Although the mood of the meeting was tense at first, we were all in friendly agreement at the end. Frankly, I think the very act of demanding to look at the records established that I was serious and the act of bringing in a care manager (who was an R.N.) showed them that although I was a layperson, I was not going to be bamboozled by pseudo-medical BS. We have not had any serious problems since then.

So it looks like this was carelessness, rather than a deliberate attempt to switch his medication behind your back. It might be best to first address the situation as it is (rather than on focusing on what has already happened). Is your SO on the correct dosages now? Is he being harmed by the manner in which they have been reinstated? (Based on a previous discussion on some other thread, I think that Namenda has to be titrated but the same may not be true of Aricept.) I see these as the most important questions but the R.N.s on this site may disagree.

This sounds like a mistake that violated all sorts of protocols and that could have had very serious consequences if other medications had been involved. They probably realize that. Just remember that the more you berate then for their stupidity, the more defensive they are going to get. If everything is now as it should be, maybe your focus should be working with them to ensure that this negligence does not happen again.

I can sympathize with how upset you must be about this. I was actually half-crazy for weeks about my husband's situation, but somehow I managed to act in a calm and non-confrontational manner as the issue was investigated further. The Director of Nursing later assured me that it would not happen again.

I keep remembering the old saying "you catch more bees with honey than with vinegar". When I got to the rehab today, they had put Johnie on a chopped, liquid diet.??? After we finished our Long John Silvers carry in lunch, the dr. came by and I asked why they had changed it, as he isn't choking. He looked thru his notes and said no change had been ordered.
Everyone tries, but things get so messed up.
So far his medicine hasn't been TOO messed up.