LTC Drug Addicts

Hellllllo Nurse, BSN, RN · Jun 10, 2003

This is a great thread.

I have seen the issue from both sides.

I am a nurse, in chronic pain, 24/7. No doc has ever prescribed a narcotic to me for it.

Last year, I got my finger crushed in a fire-door at work and the ER doc gave me 30 Lortab. I didn't need it for the finger injury- I used it for my chronic back pain.

How wonderful it was to finally be free from the pain, and be able to sleep through the noc without being awakened by pain.

Although, now the Lortab is gone. At least I had some relief for a short while. Almost makes me want to crush my finger again.

MRI and X- ray show nothing, so no one will give me anything for my back pain. I have asked about cortisone injections and lidocaine patches. Every doc just blows me off. My chronic back pain was caused by an on-the-job injury 8 years ago. I have been accused of drug seeking r/t this injury and r/t my chronic migraines.

I have also taken care of LTC pts who are obviously not in pain and are addicted to the many meds they are on.

I've also had LTC pts who are obviously in a great deal of pain, but despite having tried many, many times, I can't get their "doctor" to prescribe anything for them.

Yes, there are drug seekers out there. Yes, there are addicted pts in LTC. There are also pts in pain, not getting treated for it.

All points are valid in this discussion.

gizzy76 · Jun 11, 2003

Thanks, I'm really enjoying the discussion that this threat has generated. Myself, I could not imagine being in chronic pain. My normal, daily aches and pains are sometimes aggravating enough let alone to have a pain that would interfere with my daily living.

More info on the lady in question...she decided once upon a time that she would not be joining the rest of the residents in our unit for supper in the dining room anymore and that her supper was to be delivered to her room each night. She would have a fit as well if her medications were not delivered to her room before the "med nurse" went to distribute supper meds in the dining room, rather than waiting to get them after the others.

I looked into this situation upon starting at the facility and found no sound reason for this to be happening. Policy states that each resident is to come for all meals unless bedridden and sick, to which this lady is not.

She was raging mad at me when I discussed this with her and informed her that staff would no longer be bringing her a meal to her room if she was not going to come to the dining room at supper time. Her reasoning was that she was tired after being in her w/c all day and after participating in physio and ceramics, (Physio is 2x/week, and Ceramics is Friday afternoons) and she wanted to rest in her pajamas in her room and have supper. Let it also be known that the only times she would be in her wheelchair in a day is at breakfast and lunch in the dining room unlesss she went to physio and ceramics. She would not look at me then either and her actions toward me reminded me of my 3 year old godchild. Sad but true. It has been 2 months since this was enforced and she is talking to me again as though we are friends.

This woman gets info from staff members and uses it against other staff members. She also sleeps every night in her lounge chair in front of the television. I have learned from other staff that the only time she will get into her bed is on her birthday and she will ring for staff to bring her breakfast in bed.

Her husband is crippled and uses 2 canes to hobble around and when he visits, he has to push her around the unit in her wheelchair and you can tell he is in obvious pain but does it anyway. Meanwhile, she sits in her chair with a smug expression.

It breaks my heart to see. She is known as the Princess on our unit b/c that's how she acts and expects to be treated. She will ring at 0500hrs for her medicine, her teeth, clothes and cup of hot milk. The staff don't mind assisting her, it just gets to be too much after awhile.

I suppose it sounds as though I am venting, and come to think of it, maybe I am. Thanks for listening. I feel much better now.

CoffeeRTC, BSN, RN · Jun 11, 2003

Speaking of undermedicating res.... A few yrs back had a 95yr old little lady with Breast Ca with a malignant mass that was just the nastiest wound I have ever seen..... came in to work one day res took a turn for the worse and was in sooooo much pain. Guess what she had ordered? Tylenol 1000mg!!! I immediatly called the md..he stated "she has Dementia and her wound isn't painful she doesn't need anything..I just saw her yesterday... I hit the roof he refused to give me anything.. asked him if maybe the Board of Health would be interested in this case.....Well, I got an order for MSIR and oxycontin really quick..... What gives with some of these MDs?

Another question how does culture/ ethnicity affect pain perception?

Huq · Jun 11, 2003

Check out.

http://www.tamethepain.com

angelbear · Jun 11, 2003

gizzy76, I do not at all mean to come across nasty or snide so please do not take it that way. In My state anyway you would be violating the residents rights to force her to go to the dinning room for her meals if she is of sound mind and prefers to eat in her room that is her right. In my state we also have 1hr either way in giving meds another words if med is ordered @ 4pm then we have from 3pm to 5pm to get them there meds. Now this does not in anyway mean we can purposely withhold giving meds in a timely manner. It is there because we usually have rather large med passes and could not accomodate every res getting their meds right at 4pm. Obviously this women should get her meds in a timely manner but she needs to understand that she is not the only res you are caring for. I understand your postion been there myself it is not easy but you just have to be careful that you do not violate their rights. Good luck with your resident.

gizzy76 · Jun 11, 2003

AngelBear - I realize that yes, maybe it could be a violation of rights, but I discussed the matter with the Site Manager of our unit and she was in complete agreement with me about this woman coming for meal times. Also, it is policy in our facility and this woman is quite aware of that. Thanks for the well-wishing with this resident. I'm sure she would be a very pleasant woman had she not been spoiled rotten her whole life. Deep down I kind of feel sorry for her.

ktwlpn, LPN · Jun 11, 2003

I currently work in a county run facility(call it the poor house) and residents seem to have less rights there.In my experience in private ltc's in this area if an a&o residents wants to eat in their room there really is no question-Without those people in those beds we would be without jobs and the staff accomodates within reason...it is their home and we really work for them.I really don't see a problem with starting the med pass with her when she is in her room-I don't think that is an unreasonable request as she has her pain controlled on this strict schedule-who knows what can happen while you are passing meds in the d/r that can hold you up?A fall,a choking episode or even a death in the soup(not fun) I don't know what type of facility you work in but it sounds like your site manager and some of your co-workers see the residents special needs as inconveniences.I can imagine what it must be like to live in an LTC and be dependent on others....and years of chronic pain must effect the personality-as does any illness and just being in an institution...If you are lying in bed and can not get up without assistance I imagine it is easy to focus on your own problems and try to control the few aspects of your life that you still can.Do you think that maybe this is part of what she is doing? I can't say that I would act any differently if I were in her shoes.I know a woman in her early 60's-was working just a few months ago -and is now in our LTC-food is a major problem for her.She almost always requests the cold lunch and then when she sees what others have she changes her mind and the staff are aggravated with her and want to stop her behavior.My simple solution is-order the hot plate everyday and if she does not like it we can substitute a sandwich-we keep an array on each unit.By trying to deliver an ultimatum to her the staff escalates the situation and she ends up in tears and the whole d/r is in an uproar...Why? Cut her a break-look at her life....We try to make the residents in LTC be little round pegs each fitting nicely in their little round hole-we don't like the school doing that to our children-why are our elders treated any differently? I don't know-I hope I am never dependent on others or demented......Imagine how they must feel....I know when I was younger I had a different perspective and a lot less patience but my yrs of experience have changed me.....As I get older it gets way easier to see myself in one of those beds....and I have lost my parents,too.I don't know what exactly changed my attitude and I would love to say something here that would get across to you exactly what I mean...I hope I am not coming across holier then thou because I am NOT that...I b*tch and moan my share every day...but I do try hard-and some days it is harder then others....

Tookie · Jun 12, 2003

Good post ktwlpn

We must never forget the individual - it is very hard and we in LTC/ nursing home /hostels (I use these words as that is what they are reffrred to here) have heavy work loads and often people who do not have a lot of training in behavourial management - It gets back - to peoples rights. their dignity and their individuality -

We had a very similar resident who never ate in the dining room - for a couple of reasons - (she too was mentally alert) - she was embarrased by the fact that she might occasionally spill her food and that managing the knife and fork etc showed everyone in the world that she was becoming dependent and disabled-

Yes she was a very proud and spoilt lady - never had children - always had the comforts - She also did not want to sit in the dining room with others, as she couldnt eat with the noise of the other residents and she didnt like to look at other people who required assiatnce (feeding) with their meals - it made her aware of her own vunerability

We had a number of issues with this woman and a lot of the staff had a lot of trouble caring for her - Good luck with your lady -

I guess an alternative view is that at least she has the spunk to say what she wants and expects and wouldnt we all like to think that her age we would have our say and expect the best for ourselves

However that dosent make it easier does it

Cheers Tookie

ktwlpn, LPN · Jun 12, 2003

>>>>>>>>>>>>>>>>>>>>Yes she was a very proud and spoilt lady - never had children - always had the comforts - She also did not want to sit in the dining room with others, as she couldnt eat with the noise of the other residents and she didnt like to look at other people who required assiatnce (feeding) with their meals - it made her aware of her own vunerability

We had a number of issues with this woman and a lot of the staff had a lot of trouble caring for her >>>>>>>>>>>>>>>>>>>>>>> How was your resident handled,Tookie? I imagine that I would not want to eat out around people if I could not feed myself without problems.And it is so common for higher functioning residents to be uncomfortable around the lower functioning for many reasons.I really think the "old days" before case mix in LTC was better especially for the alert and oriented.Verbal abuse between these residents is very common,too.We have a&o residents in rooms with trachs....(we don't have many private rooms) I go home with my nerves on edge after listening to a screamer for 8 hours-I can't imagine living with it 24/7.I think that the type of residents we are talking about here require us to look past the pain issue to the deeper causes for their behaviors-It can be as simple as gaining trust-If you say you will bring the meds at a certain time then you should...If you don't then the resident sits there worrying and getting more uptight by the minute which causes more pain and makes the pain med less effective when she does get it...

kathi yudin · Jun 17, 2003

psych sounds like a good idea for your resident... she is on too many meds... pharmacy consultant should make request for the dr to justify all of the need... duragesic patch may not really be the answer... seems that if the pain is real.. and remember.. she is feeling it..not us... the ms contin is the way to go for more regular control with roxinol for breakthrough pain.. she probably needs to detox and start fresh... and the dr that started this... should be shot!!!..sorry..

kathi yudin · Jun 17, 2003

my last reply went to the wrong thread i think.. anyway.. it was said earlier that the residents are in long term care and are going to die anyway.. i agree with this but to a point.. the patient in question is only 67 y/o.. she still has a long time to live.. i also have chronic back pain... i went through the chymopapane injection yrs ago that failed.. i have 2 discs in my neck.. one at t2 and one at l5.. so ... i know pain.. i didn't work for yrs. because of it.. now.. i work as don at a long term care facility... i do understand pain.. we do pain management and do it well.. however.. 67 is toooo young... to be so addicted.. she needs help to control the pain.. to live with it and deal with it... let her control the pain rather then the other way round.. i am in pain daily.. right now my hips are killing me.. but.. i KNOW that i can't work if i use anything.. so.. i deal with it.. we need to work with our residents to help them through the tough times... psych is a good start..

sueb · Jun 17, 2003

Wow...this is a great thread and I must add my 2 cents worth...I know nurses who will RUN down the hall to give an Ativan or Xanax to a patient who is simply talking too much for their liking,but who would make someone waits hours(literally) for a pain med. Makes me really angry!!!Grrrrr!