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I think my mom’s medication is affecting her negatively. How can I get her nursing home to adjust it? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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July 18, 2012

- Alzheimer's Care, Blog, Elder Law Articles

I recommend documenting what you have seen since your mother started the medication in question. You can also start out by directly calling the physician who prescribed it and asking about your concerns. Your mother could be experiencing a transition period, which might be expected. If you think you are getting resistance from nursing home staff members, you should speak with the facility’s administrator. You may also ask to sit in on the next care-planning meeting for your mother. This is where various members of the nursing home caregiving staff collectively discuss a resident’s health status and plan of care. By rule, you are to be informed of these meetings and allowed to attend them. If you are not satisfied with what you hear, then you have to make a further decision. There is the option of calling your state’s long-term care ombudsman. Ombudsmen have been trained to advocate on behalf of nursing home residents. This person can work as a mediator to help you and your mother’s facility work out any differences. You should feel comfortable enough that she is in a safe environment, with people who care for her around her. If this isn’t the case, you might have to move her to another nursing home. This is a difficult decision to come to because moving is hard, especially on a person with Alzheimer’s. Weigh the pros and cons. But the bottom line has to remain whether you are comfortable with the facility where your mother is living. If you’re constantly worried, then your qualify of life could go down. If all else fails in a situation like this and you are your mom’s power of attorney for healthcare, you can request a change in her medication. Just be sure to have spoken with her physician ahead of time to ensure that this is the best thing for her.  For more information, sign up for the Alzheimer’s Resource Kit here.
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The nursing home changed my father’s medications and now wants to evict him and have him checked him for possible inpatient admission because of aggression. Should I have him assessed if the odds are he won’t be taken back by this facility?

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June 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Extreme agitation is typically the source of aggression. If the agitation is under control, the aggression should lessen, if not stop altogether. If you believe the nursing home’s staff members did not handle this the best way possible, you can meet with the facility’s director of nursing and the care-plan team to discuss the situation. If that doesn’t bring satisfaction, you can take it further, to the state’s long-term care ombudsman program. Ombudsmen are trained volunteers who, upon request, advocate for nursing home residents and their families when there are problems with a facility. If you are confident that staff members did all they could, your father needs to be assessed. Outbursts of aggression are not only difficult on the people around the Alzheimer’s patient, but also on the individual himself or herself. There is little quality to life when one is agitated all the time. There are various good assessment programs throughout the country. You can learn about some at the Alzheimer’s Association website (www.alz.org). Look for a program near your area. One good thing about an inpatient assessment is the 24-hour-a-day observation. Its value is evident because there can be additions, deletions or changes to medications — and observation of any effects of these changes. You could learn that his medication is causing his agitation. Be sure to keep his doctor informed of what you’re doing and what is happening. When he is being assessed, you have an excellent opportunity to meet with discharge coordinators or social workers. They can help you find the right facility. They may not recommend any one facility but they can give you guidance. Another thing to remember is that environment can play a huge role in how comfortable a person is. If your father is not comfortable where he is, a move might be the best idea for him. Even though moving a person with Alzheimer’s can create confusion and possibly setbacks, the odds are he will recover. Your father needs an environment that feels loving and accepting to him. Staff members are usually the key in this regard. So if/when you wind up looking for another nursing home, be sure to meet staff and observe their interaction with residents. Additionally, if your father didn’t live on an Alzheimer’s unit before, look for one now. Their staff members are specially trained to deal with symptoms and issues that accompany Alzheimer’s.    
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My mother has Alzheimer’s. How can I help her manage her own medications and stay at home as long as possible?

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June 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

There are several ways you can handle this situation. Of course, it is very important she takes her medications as prescribed. Otherwise, there can be multiple problems for her, physically or mentally, and ultimately for those around her as well. How you tackle meeting her needs will depend on how much medication she takes, how often she takes it and also her ability to sort things out. If she just needs reminders but is otherwise capable of taking them herself, you can buy any of the various reminder systems available at a drug store or other retail outlet. These can be as simple as pillboxes with compartments for each day of the week. Then, you can just call at the beginning of the week to make sure she has things set up properly — and make sure she starts taking them appropriately, too. If necessary, you might have a visiting nurse or even a friend stop in and fill the compartments. There are also systems with alarms that will issue reminders about when to take meds. You will have to decide which is best for her, depending on her functioning level, possible level of confusion and other ability gauges. If having yourself or someone else phone her and reminder to take her medications at the appropriate times isn’t working, you definitely need to hire or appoint someone to do it in person. Adult day centers also can help with medications. If the center has a nurse, that person can assist with drug administration, should your mother need it. If this is the case, you are required to take the medication(s) in original packaging, with the doctor’s order on the container. This attention to her care will help her stay in her home longer.    
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How will I know if my father can’t swallow medications any more?

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June 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Alzheimer’s progressively creates difficulty swallowing. This is due to the brain failing to signal the throat to enact swallowing muscles and reflexes. As you imply, this can become a problem and caregivers need to remain alert to the situation at hand. If your father is past the beginning stages of Alzheimer’s, you need to closely observe him when he takes his medication and is eating. Notice whether he chews for long periods of time but doesn’t swallow. Watch for whether he pockets medication or food in a cheek and leaves it there for quite a while. There are some steps you can take if this becomes an issue. First, make sure medication issues are taken care of. Speak with his doctor and see if the medication can be eliminated. If not, see if it is available in liquid form. This goes for vitamins and other supplements, too. However, some liquid medicines might have a bad taste and your father might refuse to take it. Again, carefully observe what he is putting in his mouth and actually swallowing. Another consideration for medications is whether the doctor can prescribe something that can be crushed. Some medicines lose their effectiveness if crushed, so be sure to ask about this. If crushing is OK, you can then mix it into yogurt, applesauce, pudding or something similar. Watch the progression of the swallowing situation and note if it worsens. Remain in contact with the doctor so you can always stay on top of what medications are actually being ingested, which are not making it into your father’s system and which could be discontinued, if necessary. For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.  
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Incontinence is starting to become a factor with my mother. What should I do?

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May 24, 2012

- Alzheimer's Care, Blog, Elder Law Articles

This can be one of the more difficult aspects of dealing with Alzheimer’s. Beyond its usual challenges, incontinence typically sets in during the middle to late stages of the disease. It can be a permanent or temporary condition. Discuss the situation with your physician. Have him or her check for possible contributing conditions that could be causing the problem. This could include a bladder infection or urinary tract infection. Once health-related possibilities are ruled out, it can be assumed the condition has set in permanently. In that case, it’s time to consider incontinence products. By being prepared with proper adult briefs or other products, your mother can avert embarrassing episodes if she has an accident. Consult a physician or other clinician for how to deal with the incontinence — many people incorrectly stop trying to conduct regular bathroom visits just because their loved one is wearing a brief, for example. When a brief gets wet, it should be changed as quickly as possible, to avert skin irritation and breakdown. At this time, the skin should be thoroughly cleaned with a wet cloth and dried. Red or irritated skin can be a warning sign of further problems down the line. Observe this condition closely! Should sores begin to develop, seek immediate medical help! Nothing good comes of compromised skin integrity, and once it starts to go, it can be a quick decline. If your mother sits in one place for long periods of time, have her shift positions frequently to redistribute the pressure on affected areas. The weight should be repositioned somehow so it doesn’t remain in the same place for too long. Get your mother up and have her walk — even a short distance — around the house or yard. This will relieve pressure bearing areas and get blood recirculation, both of which are very helpful. Changing chairs and lying down (if previously seated) also can be helpful. If her physician writes an order for an evaluation from a home health agency, take it seriously. The agency can make home visits. A nurse will take stock of the overall situation and set a plan of action in place accordingly. These recommendations should help everyone involved — your loved one as the “patient” and you and others who are caregivers. More success will mean less stress, and that, too, is very desirable. For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”
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How likely is it that my loved one with more lucid days and less lucid days with Alzheimer’s?

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May 11, 2012

- Alzheimer's Care, Blog, Elder Law Articles

It is very likely he or she will be just like anyone else: The person will have good days and bad days, clearer days and foggier days. Sometimes it will seem like nothing is wrong; others, there will be no doubt Alzheimer’s is at work. On a good day, the person might remember things like he or she once did. Patients might appear upbeat and say they are feeling good. You should savor these times. Such lucidity is a blessing you should embrace. You might begin to question whether the Alzheimer’s diagnosis is accurate. This would be false hope. Realize these times should be savored, for they will pass. Caregivers tend to go through a grieving process and that can lead to fantasizing. It might seem like everything is just a bad dream, or that things will go back to the way they were one day. Denial might set in. We look forward to our loved ones “snapping out of it” any day. If and when lucid days come around, they can validate such fantasies. But then reality will hit us squarely between the eyes. While you must let yourself grieve, you also must remember to enjoy each moment of the good times. It might be a few good days, or even just a few moments. Enjoy them regardless! “Quality” is more important than “quantity.” This is what you have to remind yourself. If your quality time is limited, at least you have those moments to draw from. Look at them as a blessing — and look back to them to help you get through bad times. For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”
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Haldol as a medication for Alzheimer’s has me worried. Is it safe for my mother?

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March 15, 2012

- Alzheimer's Care, Elder Law Articles

One of the first psychotropic drugs introduced to the market was Haldol. Its goal was to subdue young and healthy — but violent — psychiatric patients. It is a successful drug when used for the appropriate purpose and at the appropriate levels.  But when used on elderly or Alzheimer’s patients, many questions seem to arise. Can it create confusion? Can something else be given for agitation with better results and fewer side effects? How long does it take for Haldol to leave the system once it is subbed out? And the list goes on.  Medications affect people differently. What works for one individual might not for another. To some degree, prescribers will tell you, it becomes a guessing game. All medications have side effects. Some people will feel them differently, or not at all. There might be, for example, a medication to treat anxiety that … creates anxiety. This type of reaction may be fairly common among older individuals. If taken for a long time, Haldol (Haloperidol) can create many side effects. (Typically, it is prescribed for people who hallucinate and/or act aggressively.) Ask your doctor to try other prescriptions to see if they work reasonably well as an alternative.   Keep in mind that some individuals tolerate Haldol well. Regardless, it builds up in the body, so complete removal from body systems might take a few weeks, depending on how long a person was already taking it.   To allay your concerns, the best strategy is to talk with your mother’s doctor. Tell him what your observations are and ask what the options are. There are numerous medications out there created to treat these same conditions.   As always, if you aren’t satisfied with the response you get from one physician, consult another. Geriatric psychologists and neurologists are usually on top of the latest and most effective medications available. As an aside, older patients are usually started at the lowest doses possible and then inched up as needed.   Another route you can take is to have your mother admitted to a gero-psychiatric unit. These are specialized places for observation of behavior and monitoring or adjusting medications specifically for elderly patients. Doctors get a much more complete picture than usual thanks to 24-hour observation and monitoring over several days.   Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.    
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Does medication cause the confusion and unsteadiness found with Alzheimer’s or are they just part of the disease’s progression?

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February 23, 2012

- Alzheimer's Care, Blog, Elder Law Articles

The short answer is both the disease’s progression and medication can be responsible for confusion and/or unsteadiness in Alzheimer’s patients. Since Alzheimer’s is a neurological disorder, it causes confusion; it also can affect a person’s ability to move around, or ambulate. Alzheimer’s effects on the brain can cause a person to have difficulty with perception, which in turn can affect how a person walks. Black strips in carpeting may appear to be an opening in the floor or something else that needs to be stepped over. A shiny floor might give the impression it’s wet. Perceptions like these understandably can cause unsteadiness. Unfortunately, medicines’ side effects also can cause unsteadiness or confusion. That’s why family members and close friends are so important. As firsthand observers of a person’s behavior, they can notice changes easier than others. It is particularly important to watch for side effects right after a new medication or dosage has been introduced. Any sudden change in behavior most likely will be due to medication because Alzheimer’s typically does not progress quickly enough to create such changes. Ask your pharmacist or visit the website of a specific medication (e.g. www.namenda.com) to learn about possible side effects. These websites have a lot of useful information. Keep in mind that there also could be physical difficulties that arise that have nothing to do with the Alzheimer’s or any medication. Difficulty walking or any sudden confusion could be caused by an infection or another source of pain. Careful observation followed by some “detective” work will help discern what’s going on. It’s not uncommon for this to become second nature. You might not even realize you’re taking these steps after a while. Always remember, though, that if you have investigated and tried various options and nothing seems to work, symptoms such as confusion or unsteadiness could just be part of the disease’s natural, unrelenting progress. To help cope with caring for someone with Alzheimer’s, you might want to obtain a copy of this free resource, The Indispensable Alzheimer’s Resource Kit.    
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