I am a little concerned, I posted earlier that mom was placed Sunday in a memory care facility.
She is about beginning of stage 6, but in excellent physical shape and continent.
Dad is terminally ill, I got a call that my mom has been very agitated, crying. She apparently thinks another resident is my father. He doesn't respond when she talks to him, so she grabbed his face today to get his attention. I was told they called her doctor to order some sedation for her.
Now, I called the doctor, got the run around from the recetionist and was told that I would have to talk to the facility about any med questions( what is it, how used? etc)
I finally got ahold of the nurse there who told me that mom is being put on Haldol for her agression. She has never been agressive or combative. She was vague about how it would affect her, and said she would give it to her when they determined she needed it.
Now , I looked it up, and haldol seems pretty strong as a first line of treatment, or maybe I am being over protective. Mom has only been on ariceppt, namenda and takes prozac 20 mg. We have worked with her behaviorally to control emotions as well. Hug her when she cried, give her time to cry in her room and she would generally perk up. I wish I could talk to her.
she can't see her husband of 53 years, I have talked to her everyday that I have not been there. And I have been there alot in the last 6 months. Just spent 2 weeks there. I think any person would go nuts.
And I am not sure how haldol will work to help her not cry..It doesn't seem to be a sedative. The thing is my mom comprehends more than she can communicate( aphasia) I have been in on all the treatment, meds, symptoms from the very beginning.
I did not realize that we would be relinquishing control over the treatment of mom's disease.
I don't know what to think, and am feeling really bad.

Dear Petunia,

I would not relinquish control over your mom's treatment. You are still her advocate. I'm sure you didn't sign anything saying you wouldn't be. Some facilities may want more control over behavior-modifying medication for their own benefit. I had one instance with my mother where the nurse at her facility asked the doctor for a specific drug and started her on it without telling me. I wasn't happy about it and asked that I be told of any future changes immediately.

I guess what I'm saying is to stand your ground with the facility as well as the doctor. If you aren't happy, ask where you go to complain.

I can't speak directly to your question about Haldol, but there are several nurses on here that can. If you don't get an answer soon, try the 1-800 number at the top of this page. They should be able to help.

1) You almost certainly signed paperwork allowing them to treat her without notifying you.

You can revoke or modify that paperwork to require prior notification at any time.

I'm like you - I won't allow any med changes for my mom without my prior approval.

2) Very small doses of antipsychotics and antidepressants are routinely used to decrease agitation and crying in people with dementia.

It would not surprise me that, with all the changes in your mom's life recently, she might need a little medication to help. I emphasize LITTLE.

Haldol is older, therefore cheaper, but can have unpleasant side effects. These days most docs who treat dementia would start with 25 mg of Seroquel or the smallest dose of an antidepressant like Celexa, and see how that worked. Those meds work well for many people with little risk of side effects.

And while your mom would probably be super-sleepy the first few days, she'd adjust back to her normal alertness level pretty quickly.

Thanks to you both. I did find out that my mom has not been taking her regular meds, including prozac. So, she is going through prozac withdrawal, which could account for some of her behavior/emotions. So, if they can't get her to take her regular meds, I wonder how they expect to get her to take hadol.
I am going to write a note to her doctor and go through the paperwork again. I did not realize that the nurse there could just request such a drug without asking us first. This is an education.
I am also wondering if they keep records of when she took her meds, and what she took. And if I can have access to them at any time.

Ma's petunia. Yes they have to keep records of all medications (including vitamins etc.) dispensed and yes, as POA you have a right to review those records ... and actually should review those records on a regular basis. If my memory hasn't failed me, I believe they call those records MARS reports. And I'm with you, I think they need to concentrate on getting her to take her previously prescribed meds first.
Marie

Oh, yes. You absolutely can request to see her chart. You should see not only what is ordered, but the med sheet showing what was dispensed and when.

I signed a sheet that states the NH must notify me AND have me sign off on any mood-altering medication within 24 hours. They missed that once. While I did not go in screaming and ranting, I did meet with the DON. Everyone now knows that they will be held accountable and we've not had a repeat of that problem.

They may be planning to use injectibles rather than pills. But she absolutely must be going through some kind of withdrawal if she is not getting her regular meds. I know this is so difficult for you. And I am so sorry.

Since going into the facility, is your mother's medication and care being managed by her usual doctor or is there a new facility MD managing her care?

Why was she not getting her routine medication? Was it because someone forgot to write the medication transfer order to the facility?

One NEVER stops Prozac cold turkey. Ever. That is why I'm wondering if they erred in omission in getting her routine medications on board.

It is no wonder that she is acting out and having new issues.

It is true that you can mandate NO change in medication and no new medications without your PRIOR approval. You also want to be notified immediately of ANY changes in her condition. Do this in writing. Give a copy to the Charge Nurse on the unit and also give a copy to the Director of Nurses.

Also, if her regular MD is following her in the NH, then it would be appropriate to call the office back and ask him/her to contact you.

If your regular MD is not following, then it is appropriate for you to request the facility MD writing her orders call you. If this is the scenario that exists, you will want to tell him/her what medications and doses your mother was routinely on and that they worked well for her.

I am so very sorry this is happening. This is not only difficult for your dear mother, it is also extremely difficult for you.

Let us know how this is working out, we will be thinking of you and hoping for a good outcome.

Johanna C.

Thanks Joanna,
Here are the answers to your questions.
One: we were in charge of getting mom's meds there, I bagged and labeled the prescriptions. Apparently, my mom refused to take her meds, my aunt was told that mom has the right to refuse to take them. She was told they can only offer them a couple of times and then no more. I don't know how true this is.
I did look up about prozac- every symptom and behavior she was having was a withdrawal symptom of prozac.

They do not have a doctor, it is a memory care section of an adult living community. They only have a nurse in charge of meds, it was the nurse that requested the meds from mom's dr, off site.
This is a new doctor who has only seen her once for health checkup to be able to get into the facility. She is a gp. I guess the prescription was just faxed to the facility.

I am writing a memo to that doc listing meds, concerns and a request that we be consulted before any new meds are given. I am hoping that we have that right.

I live 3 hours away so it is tough to be there right now. My dad is ill with terminal cancer and is having a rough time physically right now.
Family is rotating in to care for dad.

I have tried calling the facility today, but I only get voicemails and have left messages. I do not know how mom is doing today.

This whole thing is so new to me and happened so quickly. I appreciate all of this excellent advice.

See if the doctor can write the prescription to require that the Prozac be dissolved in coffee.

Or perhaps it can be compounded into a lotion by a compounding pharmacy and applied via a scheduled skin-rub.

Many drugs can be dissolved with no problem or mixed into lotion.

It sounds as though you are on top of things. If this does not resolve by mid-week, you may have to make a trip there on a weekday to get everything straightened out in the facility and also in the doctor's office.

Let us know how it is going, I wish you well.

Johanna C.