My father is at a nursing home, prior to that he was in AL and then the memory care unit. While at the assisted living, he was given Depakote by a company which basically sends out PAs or Nurses to give a psychiatric assessment of the residents. My father, who was always extremely affable, outgoing and fun was prescribed this medication based on I'm guessing a very quick "assessment" by this traveling, outsourced psychiatric team. It was actually one person. Luckily, the nurse at the AL caught it, and called me to say she and the doctor at the AL felt it was ill-prescribed, and that it affected my Dad so that he "wasn't himself" and that they would discontinue it after 1 day. So he was on it just for one day.
I was pretty shocked that this company could just walk in, having had zero experience with my father prior, and prescribe a strong psych med based on one encounter with him. But, I was happy the nurse caught it and called me.
So about a month later, my Dad suffered mini strokes which landed him in the ER, and which DID affect him so that he needed to be moved to a nursing home. Upon first admission to the nursing home he was on ZERO psych meds. However I will say, he was very poorly, and I didn't even think he'd survive the weekend. But low and behold, within a week he was in a wheelchair and seemed to be rallying.
But then I learned this SAME company came by and put him BACK on Depakote. And then a week later started him on Trazodone. The nursing home said my dad had been "agitated" and not sleeping so that was why. I was never given the head's up about this - I only found out when I asked the Director of Nursing to give me a list of his meds.
I was able to get him a hold of the company to ask why he was given the Depakote - and their explanation was that "he was on it while at the AL" - to which I replied "actually NO - he was only on it for a day!" As for the Trazodone, they said this was to help with sleep. But now everytime I see my Dad he's unable to open his eyes, can't walk and is hallucinating.
Granted - SOME of this may also be due to the mini strokes - it's hard to tell. But I'm super frustrated with the way this is all being handled. I feel like I can never reach this company when I have questions. When I ask the PA at the nursing home he's like "I don't prescribe the psych meds - you have to talk to ____________." But when I call that company, I just get an answering service and it literally takes DAYS to get a reply if I get one at all.
Does anyone else have experience with this? Is this common in the nursing home world? To farm-out the psychiatrists? I don't even this an actual psychiatrist is coming to the nursing home - pretty sure it's a nurse or nurse practitioner.
Maybe you need another suggestion for a doctor who could suggest a better match for this situation. You should try both the head of nursing and the doctor on staff.
But yes thanks for that information - I agree - he needs something to take the edge off, but not drugs so strong he's rendered a vegetable (which he was!).
We did discover though that the shrink was charging for nonexistent visits, and that's when I reached out to get him off the gravy train. His visits had declined "hello, how are you today?". Period. I also reported him to Medicare, and after an extensive review and initially amounted to "hello, how are you today". Period.
He was an outside contractor. During Dad's long term stay care, I don't recall if the psychiatrist was in house or a visiting shrink.
It happened again with my father, in a similar situation. By then I knew more about meds, and asked to look over the planned meds on entry to rehab. I didn't agree that he needed all that crap, and met with the visiting doctor who removed them from the list.
The only time I was unsuccessful in getting unwanted meds removed was in in long term hospital care at a Select Specialty Hospital. This was shortly after my sister died, Dad was close to death from a variety of complications. The nurse did make a good point though. Dad was stressed, over having lost Mom the year before and my sister 8 weeks before his own physical breakdown. The nurse explained that they helped calm him, and therefore could hasten his recovery. That did make sense to me.
My LO required a psychiatric evaluation when she entered her AL, and there was a practice recommended to us by the social worker.
The psychiatrist did a sensitive and well planned assessment with me present, prescribed a trial of a small dose of a geriatric appropriate anti depressant that also helped her anxiety, and the same therapist saw her every three months on schedule, maintained contact with her caregivers and me on a regular basis, and followed up every time I had a question or request.
When COVID struck there were still consultations every 3 months, sometimes by teleMed service, and all in all this was a major part of her excellent adjustment to residential care.
Every dementia patient deserves this sort of service when it’s needed. I’m truly sorry the institution failed your LO.