I’m afraid they’re going to baker act him. He’s always had an anger management issue and has been on strong meds to control it. When he went into nursing home for Parkinson’s they drastically reduced his depakote from 1500 mg to 500. I told them he was going to get abusive but they wouldn’t listen. I even took his prescriptions in so they could see I was right. Now he’s fighting with everyone and they’re looking for a new place for him. They said his Parkinson’s is no longer the main issue, but his attitude is. I don’t blame them but I don’t want him to end up in a state psychiatric hospital!
Call or email the Director of Nursing, the Social Worker and executive director. Tell them that you need to have a meeting or conference call with ALL of the and the person at the NH who has the authority to prescribe meds (this is most likely the Medical Director). THAT is the person who needs to be in touch with the doc who was previously prescribing.
Is a geriatric psychiatrist involved, I hope?
One of the possible factors in the facility insistence on reducing effective medications is that the commercial pharmacy that provides all medications to residents also reviews all the medication orders and makes recommendations for review/dose change/ discontinuation on any medication that is over the normal dose range for elders (depakote has lots of uses with varying normal dose ranges), has a high risk of falls (clonazepam), or are antipsychotics. If the 'suggested changes' are not made, more alerts go off. An MD or NP has to complete paperwork justifying the current med regimen. For 90 days. Then another review occurs and you have to repeat the battle. This is for quality assurance and risk management purposes.
Your spouse's med regimen does work for him, does not include antipsychotics, and you now have evidence that the trial of med reduction is harmful to him and puts others at risks. That will help a lot the next time this comes up, either at this facility or another one. Documentation from his original prescriber about the meds already tried that were not effective can help, too.
You can even print out the important info that is available to share with the staff. Much of it is importance of managing medicines.
Try encouraging the head administrator to check into this organization. https://www.strutherspn.com/front-page They have a program that educates organizations how better to work with Parkinson's patients. PD patients are all unique and too many times staff are not aware of how best to deal with PD related symptoms.
My heart goes out to you because once a PD patient's the longer meds are off track it can be difficult to get back... but know they can be if you stay a strong advocate. I just watched a webinar with Dr. Okun a renowned PD expert. One tip he gave is be sure we are talking WITH staff rather than AT them... and this can be hard when you feel like they won't listen, but it may help get your important message across.
I so empathize with you because when my husband was in rehab for a broken hip 20 years ago, I tried to tell the doctor that it was important to keep his meds consistent and I was shocked with his response. "It has been my experience that PD patients tend to be obsessive about their meds and they do not need to be." It went downhill from there.
to the original levels; you want a meeting with them and you want the meeting notes and medication notes to be part of his care plan. Not sure where you are located but in NJ, if they are reluctant to meet with you, the mention of the Dept of Health and/or the Ombudsman's office usually gets things moving pretty quickly...like within 24 hours. Also notify the physician who originally prescribed the working dosage of Depakote so he/she will be prepared for any contact by the NH or the State. If the NH admin doesn't up the dosage, I would still contact the Ombudsman's office because they, the NH, are willfully not meeting your husband's medical needs and that is a violation under any state law.
Good luck and please keep us updated.
With Parkinson's if he has been diagnosed with LBD violent outburst are a real possibility and changing medication or the dose can be a big problem.
And if he does have LBD it is NOT his Attitude it is the form of disease that he has that is doing this it is not a choice he is making.
*side note here if they are looking for a new place for him it is very possible that this is administrations way of not being able to properly care for someone that is their responsibility. And there is a good possibility that he would be better off in a facility that knows how to follow doctor's orders and deal with different types of dementia and the aspects of each. All dementias do not present the same and each person has personality that has an effect as well as the parts of the brain that are effected.
If this is not resolved I would contact the Ombudsman's office as well as making a comment on the Medicare website under reviews for that particular facility.
You can also contact the dr who wrote the prescription and ask him to call the Dr who works for NH (not the PA...the Dr) and see if he can help you get meds back on track. I doubt the original Dr started him off on the high dosage and it's possible he can explain to the NH doctor that hubby started with XX dose and had to be increased because it took that level to calm hubby down.
I think this is rather common for a facility dr (or PA) to change meds or add things. All too often family members do not question this or even know any thing has been changed because they don't visit..or just want to dismiss it as declining health because it takes less involvement.
Huge note here for others with loved ones in facility care -- if you see a change in behavior QUESTION the meds, compare to pre-facility care med list, and have a discussion with facility NURSE (not the aids). If meds aren't changed, always ask about doing a test for urinary infection. You can ask for list of meds and tests/labs that are being done. ASK. -- And have pity for those elderly folks sitting in facility care who have no one to advocate for them.