Wednesday, April 17, 2024

Addiction/Overdoses Long Term Care

Mom’s old Skilled Nursing Facility "loves" PNR medications!  Especially the kind that are for "pain" and "discomfort", emotional as well as physical. Many facilities love these types of medications.

There are many ways to "medicate" in LTC. Depending on when a "medication" is given, the facility can play a game "assigning" different categories in different sections of reports depending if they're "as needed" or "prescribed daily dosages".

These loopholes mean big opportunities to facilites. 

They’re a part of the infrastructure of LTC's we never really notice, don’t pay attention to and don’t realize how extensive they are as a practice.

What happens when you take narcotics? You generally get drowsy, often sleep a lot and you almost always “mellow”. Seniors often sit or lay in bed and require a lot less attention – giving the facility the ability to operate with fewer staff.

I’ve witnessed many Nurses ask: Patient A, Do you need anything for pain? Patient A, on a scale of 1 to 10, how’s that pain you’ve been having? Would you like to have a “B” that’s been prescribed for you …."
 
Meds can build up tolerance and require heavier dosages or types to gain the same effect causing other challenges.

Just like we’re being advised NOT to take antibiotics because of raising of tolerance and immunity of bugs built around frequent usage of certain kinds:THOSE PILLS CAN BE ADDICTIVE. 

Who advises the residents about this “side effect”? 

That’s the Dr’s place to answer questions and explain but he’s not there; he’s only available through the Nurse contacting his office and not able to “speak with the patient” when the Nurse calls to request “something”.

I’ve heard these same nurses on the phone to the Dr’s office saying, “Patient A could use something to calm down, she seems to be agitated, doesn’t appear to be getting enough rest.”  

I’ve had the Floor Nurse call and try to convince me Mom needed “something” to calm her down; she seemed “more agitated than usual” or “a little more difficult to work with”.

Some Seniors are traumatized by a "loss of control" and a "feeling of helplessness" with many medications.

Another side effect is dizziness which can lead to falls and that can cause broken bones or other physical damage.

With Lewy Body Dementia, there are types of antipsychotic drugs that carry the warning MAY CAUSE DEATH.

Mom's "Assigned Doctor" . . .  
Never diagnosed her with Dementia of any kind --
Never connected with us and --
Seldom came in person to actually "examine" or "interview" their "assigned patients".

I understand: Many of us have to work and do not have the funds to get "in home Nursing" -- especially when it becomes around the clock.
  
How do you handle these “offhand” requests if the floor Nurse calls and wants to get an "as needed" prescription for "mood changing" medication? 

You’ve been caught at a time when this is the farthest from your mind or daily schedule. It would be so easy to accept what you’re told, to just this once let it happen.

Long Term Cares are for many of those who need various types of medical oversight.

It's important to understand the basis on which some drugs can be given. There is no mandate the resident has to ask for it. 

The Nurse or the Licensed Medications Distributor can access the patient's need for the medication and can try to "administer" it to her/him. 

Think about it. How many aged men and women do you know who DO NOT take some medications? Very few.

BE VERY CAREFUL. This request can also include a sliding scale of levels of medication. 

We had that happen and almost lost Mom. She was limp as a rag doll from too high a dose and we were very fortunate it did not kill her -- that we were vigilent and arrived in time to take her from the facility to the ER and to have confiscated the drug before it was administered yet again by the same Licensed Medications Distributor.

CAUTION: Ask questions. Probe. Ensure safety.

Your loved one’s life may hang in the balance.

Require in writing follow up with details on the meds including name, dosage suggested, dosages administered, details on frequency and maximums and for how long. For this you will probably need a Power of Attorney.

Here are some ways we responded

 We suggested "alternative methods" provided by Teepa Snow and others who are in the forefront of care giving for Seniors and especially those with Dementia.

Questioned what was being done in the facility to provide activities and interests Mom would enjoy, occupy her mind and body, that would give her "something else" to focus on.

Suggested Action: Leaving the room, standing just outside and returning after a short time.

What would a parent do with a child that didn’t want to cooperate with a direction that was for their safety and well being or in their best interest? TRY A DIFFERENT APPROACH.

Change The Environment. Take her/him something new that’s “tactile”. Touch intrigues many people.. For Mom, we involved her in being busy with folding stacks of washcloths and when they were done, take them out of the room take them apart and go back and ask if she’d like “some more” to do.

Mom needed and many Seniors need, to be active and to be positively accomplishing something. 

Sitting around playing games, putting together puzzles, cards or even TV was never their lifestyle. 

They can’t change now. Their minds are “set” and the best action to take is to honor and recognize their habits and their interests and work with them.

Frustration and boredom are catalysts for people of all ages to do and say things that are counter productive. It doesn’t take much professional training but it does take common sense to look, listen and learn from our Seniors about what values and interests make their days positive.


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