Risperdal is not generally covered by hospice. Haldol is, with less side effects.
Actually, Risperdal is covered, but it is the one with less side effects, especially if you need to use it long term. Haldol works best for short times as it works faster, but the chances of nasty effects from it increase with the length of time used.
I had a patient who went bat-crap crazy from decadron. It had worked well for about 3 weeks, decreasing pain to a "0" and stimulating her appetite and for the first time since she had developed agranular necrosis of the jaw and sinus from chemo she was able to actually taste the food. In the span of a weekend, she went from a very nice mild mannered lady to a screaming, stripping casino freak! And the first sign was when she shaved her head, ran out of the house with no pants on yelling at her son that he MUST take her to the casinos in AC! All on 4 mg a day (and no, she had NO history of any psych issues) We used haldol and lorazepam for this lady until the decadron wore off. She never did go all the way back to "normal", and died about a month after the manic episode.
So I am wondering if your patients "manic" behavior is due to self medication with decadron as maybe he realized that is what is making him feel so "good", so if one is good, 3 are better?