schizophrenic brother discharged by his case worker

PAERRN20 · Sep 10, 2009

Could you check into getting him a home health aide? I don't know if he is on disability but schizophrenia is certainly a dx that would qualify him and would pay for HH. If not, I would say that $10/day would be reasonable for TID med administration. That is assuming the person lives close to your brother. I may be guessing low because I live in a very rural, low cost of living area. Maybe you could hire a retired older person? I have gone through this with a schizophrenic family member and I know how difficult it is. Best of luck.

iwanna · Sep 10, 2009

Thanks for reply. Yes, he is on SSDI. He applied before the age of 22, so he got Social Security based on my dad's. I am not sure if he would qualify for home health aide, but I will look into it. I haven't talked to his caregiver, yet. I think that she wants rid of him because of his smoking. He smokes outside, but he does not have much money left to buy his cigarettes. I think that cigs went up, he complains that he does not have any money left. Most of it goes to her, and not much to pay for his habit. He smokes 3 packs a day. He will not give up, no matter what. That is his only enjoyment in life. It is really sad. He is very anti-social and just lays around listening to music and smoking cigs all the time. I know not healthy, but that is his life! He used to get a ride to recreation center,(which was mandatory at home that he was at) but budget cuts, have affected that, too.

Whispera, MSN, RN · Sep 10, 2009

He's smoking 3 packs per day but doesn't have money to buy them and that's the reason his caseworker is wanting to discharge him? I think you must have left something out here! I can't imagine a caseworker giving a flying fig that a client smokes, other than knowing it's not healthy and wishing, hoping, educating so the client might decide to stop. His money goes to the caseworker? Since he's on SSDI, doesn't that pay for those services?

I don't think most home health aides could give him his medication. Agencies don't let their general aides do this. They might have medication aides though. It will cost alot of money to have one come to give him his meds 3 times a day though. Is there a nearby neighbor who would be willing to help out? Even for a fee?! If you use a non-medical person, though, make sure he or she understands the medication regimen thoroughly so the right dosage and right meds and times are followed....

iwanna · Sep 10, 2009

No, the money does ot go to the caseworker. It goes to the caregiver of the personal care home. My brother does not have much money left after his room and board are paid for. He gets a $60 allowance.

I don't believe that he is being discharged because he smokes, but more because there are budget cuts. We live in PA and its a financial mess, here. His caregiver has commented several times, how much his cigarettes are. I am assuming that my brother is asking for cigarettes when his allowance is used up already. She has reported that my brother has been no problem.

But, the problem is just making sure that he is compliant with his own meds. He cannot be trusted to do it on his own. Being a frequent flyer to the psych unit has proved it.

Jules A, MSN · Sep 12, 2009

Sadly this is a huge problem with patients like your brother who become stable when their environment is stable. Is there an adult day care that he could attend? Or could he get dec shots? Can your family help him financially? Good luck.

rachelgeorgina · Sep 16, 2009

In australia nursing assistants and aides in home health (like in the hospital and residential setting) cannot administer medication. My gran with stage one dementia lives at home on her own (with a lot of support) we have RNs from the community nursing team who come by each day to give her her meds.

morte, LPN, LVN · Sep 16, 2009

aides cannot administer, but can remind.....but it sounds like this may not be enough.....unfortunately, it sounds like you bro is one of those that needs long term (life long) institutionalization......and that isnt going to happen.

talaxandra · Sep 16, 2009

Just an aside on the smoking - it can reduce some of the symptoms of schitzophrenia, as well as side effects of some of the meds.

morte, LPN, LVN · Sep 16, 2009

Just an aside on the smoking - it can reduce some of the symptoms of schitzophrenia, as well as side effects of some of the meds.

i would like to share the facts about this with some one, could you point me in the right direction for article etc? tia

talaxandra · Sep 16, 2009

the causes of the very high prevalence of cigarette smoking in individuals with serious mental illnesses are complex and multifactorial. most of the literature examining reasons for the association between smoking and schizophrenia focuses on the neurobiologic effects of nicotine, such as its interactions with dopaminergic circuits.[11,13,17-19] consuming nicotine may ameliorate some of the negative symptoms of schizophrenia, such as amotivation, anhedonia, and social isolation. nicotine also may improve auditory gating impairments in persons with schizophrenia, which in turn may enhance attention, sensory processing, and the ability to interact with their environments.[17,18,20] - http://www.medscape.com/viewarticle/516304 (p. 3)

there's been a lot of research into smoking (particularly cannabis, and heavy tobacco consumption) and mental illness, particularly schitzophrenia - some estimates put use in this population as high as 80%. much of it has focused on correlations (does heavy tobacco use indicate propensity to or severity of mental illnesses; does cannabis use increase the likelihood of developing a mental illness), genetic predispositions to mental illnesses and to nicotine dependency, the effects of nicotine use on psychotropic & neuroleptic drugs (generally decreases medication half life, requiring higher dosing), and smoking cessation or reduction in the mentally ill.

only a handful of studies have focused on why so many people with mental illnesses, particularly schizophrenia, smoke and so heavily. here are links to a few of them:

http://ajp.psychiatryonline.org/cgi/content/abstract/150/12/1856

http://archpsyc.ama-assn.org/cgi/content/full/62/6/649

http://md1.csa.com/partners/viewrecord.php?requester=gs&collection=env&recid=5317099&q=tobacco+schizophrenia&uid=788272896&setcookie=yes

i had no idea about this until a fellow master's student presented her research in class. she has schizophrenia, and became interested through her own use of tobacco to relieve side-effects of her medication. hope this helps.

apologies to the op for this partial thread hijack.

Ekstasis · Oct 20, 2009

Is it possible for your brother to get a long-lasting injection form of his schizophrenia medication? That would eliminate some of the possible chances of relapse (sorry, if that is not the proper term).

Is there any possibility he could get into a Adult Day Care program? That would prevent social isolation and there might be some assistance with medication.

You are in a tough situation.

Good luck to you!