I'm a nurse at an Alzheimers Assisted Living and I would like to get some of your opinions on whether or not alzheimers residents should have the right to refuse meds.
Some of our residents can be very combative and just a couple of days ago the 911 was called because a resident had attacked two other residents. Last night we had a resident poop on the hall way floor and refused to take a shower afterwards. The list goes on and on. I love my alzheimers residents and they literally light up my day when I see them. I would never be the type of nurse to want to violate or take away their rights, however there are just some residents that should not have that right to refuse.
Another thing that bothers me is that since they do have a right to refuse, why is it that we hide crushed meds in their soup, applesauce, or icecream.... just so that they won't notice that they are really indeed being medicated. I feel bad that I have to do this but I know its the only way they'll take it or so I'm told ( I'm a newbie). One night I crushed some meds for Mr. X and put it in his icecream and he said " What do you think you're doing" ( he thinks we try to poison him) and I told him I had a snack for him. He said whats in it ? I said icecream and water ( I put a little water in it to help mix the meds so I wasn't lying). Anyway, I felt terrible. I would feel much better if they did not have a right to refuse so that way I wouldn't feel so guilty " hiding" the meds in applesauce or some other food.
How can a resident that don't even remember their name have the right to refuse?
How can a resident that attacks other residents have a right to refuse?
How can a resident that poops openly in the hallway have the right to refuse ?
Thank you all for your insight and input.........I am just having a hard time with the fact that these people are in your hands......the nurses, doctors etc. and if there are meds that they need to take every day in order to keep them in check. i.e. diabetic. high or low blood presssure, etc. heart conditions .....I just dont get it.....so no one can do anything and you just have to basically stand by and watch them deteriorate etc.........So what are you all saying then........?? that if you dont have some kind of legal document to help them from a court of law.........my hands and your hands as caregivers are tied and we just watch them die? It sounds to me from some of the previous statements and comments on here that this is not a new problem or occurance? and again I say ..........if I needed to be made guardian to then say ok give him his meds in food which he was taking with no objection then again is it my responsibility to have hired an attorney and again I didnt know anything about this........i know call me stupid and I also didnt have money for an attorney and court costs.........but you would think as well that upon admissions this would all be discussed in great length..........it was in my case and i was assured from a few people .......sure no problem........we will put his meds in his food......which they did..........and then stopped.........but again they should not have done this in the first place then..........so its a double edged sword no matter which way you look at it...............I dunno just doesnt seem to make sense to me that so many medical professionals hands are tied......something needs to be done with patients suffering with these diseases..........i just feel like its my fault.............and since I have never been thru something like this and the entire process was overwhelming to say the least.......and no one wants to help you in the process of finding a place......my father was on medicaid /medicare and it was a joke the whole thing......so sad .......well anymore thoughts and or comments are welcomed.........thanks for listening..........
thank you all for your insight and input.........i am just having a hard time with the fact that these people are in your hands......the nurses, doctors etc. and if there are meds that they need to take every day in order to keep them in check. i.e. diabetic. high or low blood presssure, etc. heart conditions well, sometimes, we have a hard time with the fact that these people are in our hands, too....it's not easy for us knowing that they need care from us that they will just not physically let us do......i just dont get it.....so no one can do anything and you just have to basically stand by and watch them deteriorate etc sadly, yes, we basically have to stand back and watch them deteriorate....what do you suggest? how much force should a medical professional use to gain compliance from a demented patient?.........so what are you all saying then........?? that if you dont have some kind of legal document to help them from a court of law.........my hands and your hands as caregivers are tied and we just watch them die? it sounds to me from some of the previous statements and comments on here that this is not a new problem or occurance? alzheimer's and other conditions that cause dementia are not new, no. and even having a legal document doesn't always mean much. i can't hold someone down and shove medication down their throats. and again i say ..........if i needed to be made guardian to then say ok give him his meds in food which he was taking with no objection then again is it my responsibility to have hired an attorney and again i didnt know anything about this ........i know call me stupid and i also didnt have money for an attorney and court costs an attorney wouldn't necessarily be required. two physicians can make a declaration of incompetence. the next of kin for the patient (spouse, kids, etc) are then the decision-makers. however, even when you are that decision-maker...just saying "yes, give him is meds" doesn't mean it's that easy..........but you would think as well that upon admissions this would all be discussed in great length..........it was in my case and i was assured from a few people .......sure no problem........we will put his meds in his food......which they did..........and then stopped.........but again they should not have done this in the first place then..........so its a double edged sword no matter which way you look at it...............i dunno just doesnt seem to make sense to me that so many medical professionals hands are tied......something needs to be done with patients suffering with these diseases a cure would be wonderful; however, there isn't one. all we do is provide them with the best care we can. we do what we can to give them their meds. we keep them clean, and safe, and happy as much as possible, by appealing to what still holds their interest and makes them smile. we watch them for signs of problems, such as pain, by using their non verbal cues, and intervene accordingly. ..........i just feel like its my fault......it is not your fault. you did nothing to cause your father's illness, and could have done nothing to change or reverse the course of it. it is devastating to watch someone you love go through it, but there truly is nothing that you could have done differently.......and since i have never been thru something like this and the entire process was overwhelming to say the least.......and no one wants to help you in the process of finding a place it's not generally a matter of not wanting to help...there isn't always that help to give......my father was on medicaid /medicare and it was a joke the whole thing......so sad .......well anymore thoughts and or comments are welcomed.........thanks for listening..........
i am sorry for what you went through with your father. alzheimer's and advanced dementia are devastating, period. there is no cure; all we can do as both health professionals and families is care for the person and the situation at hand. if they won't eat, you offer them snacks frequently and find out what they like and want to eat, and offer those things. if they wander, you use alarms, etc, to keep them in a safe area where they can be supervised. you keep hallways and walkways clear so they don't trip. you keep the lights on so they can see. when they are restless, you involve them in activities. usually simple ones are the most effective: when i've had elderly patients that are confused and cannot comprehend that they are in the hospital or why, something as basic as giving them a stack of washcloths to fold keeps their hands busy, and makes them feel useful. it distracts them from what scares them, what they don't understand. if they appear to be in pain, you offer medication to help alleviate that pain.
when it's that advanced, it's about managing the things you can manage. the little things become the most important, because you just can't change the bigger picture. hopefully someday, research will find a cure. don't blame yourself, though, there is no place for that and will accomplish nothing. even if you had said, yes, put the meds in ice cream and give them to him....if he spit out that ice cream, for example, there's nothing else you can do about it. it just is what it is, unfair as it is and seems.
I agree. What should be done about this ??? This is a problem.
I suppose we could go by the book and use the same or similar process used on psych patients. That could get expensive in a hurry, but the RN and facility would be protected from a lawsuit that they violated a patient's rights. Cause that's what we are doing.
I vaguely remember the practice at my old nursing home being that the RN would call the proxy and ask if they can "make" the patient take their medication.
I'll check the databases for this. A quick google search brought up a few legal and ethics articles on the subject.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
well let me ask this.............if someone is refusing to take their meds and the nurses started out hiding it in his ice cream, pudding etc. and was working and then stopped...........and of course they said oh he said no and we cant hide it..........why the heck doesnt someone then inform the relatives that someone should then become the legal guradian.........i was the poa but no one ever gave me the option to become the guardian and now its too late..........my father is dead...........but i think its absolutely ridiculous when you see that they are in stages 2, 3 etc. cant say a complete sentence let alone an audible word.........etc. and they can refuse the meds and they know what they are doing? this is absolutely a disgrace and i wish someone had informed me................didnt know i had to have a lawyer tell me this..............a professional so called doctor or nurse couldnt suggest this to me or is this against the law too?
you can read my response to the original question upthread. i wrote it two years ago.
my godfather died recently, after years of hell. his second wife and her two daughters (both nuns) insisted upon keeping him alive at all costs no matter what his son knew he would have wanted. they kept him alive until the bitter end. he was in hell two years ago when i wrote that post -- and they kept him alive for two more years of hell.
mamita is still alive and physically thriving. the nurses in her memory ward make sure she gets her pills every day. she's lost all of her english now, and not even her children can understand what she's ranting about. and she is ranting, about 20 hours of every day. apparently she cries the other four. she's already outlived two of her children and, unlike my sister-in-law, shows no signs of slowing down. she's pushing 90. she could live another ten years. she's in hell, too.
and my mother, who was in the middle stages of alzheimer's two years ago when i wrote that post has deteriorated significantly. she's had to leave her lovely assisted living and all the wonderful people there; she's in a locked memory ward as well. she doesn't know where she is or why she's there, and she just wants to go home. she's still looking for my father -- he's been dead for two and a half years. she doesn't recognize my sister anymore -- although she does know who i am when i call. she can't figure out which end of the phone to talk into, but it probably doesn't matter since she's not coherent any more anyway. the past six months, as she slid downhill rapidly, she begged me to just take her out and shoot her. she knew what was happening to her and she didn't want to live like that. she wants to die. i'd love for her to die. but my sister is poa.
there are worse things than dying, and i think the later stages of alzheimer's are much worse.
as far as i'm concerned if neither my mother or my mother-in-law never takes another med prescribed to keep them "healthy" it would be the best thing that could ever happen to them.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
thank you all for your insight and input.........i am just having a hard time with the fact that these people are in your hands......the nurses, doctors etc. and if there are meds that they need to take every day in order to keep them in check. i.e. diabetic. high or low blood presssure, etc. heart conditions .....i just dont get it.....so no one can do anything and you just have to basically stand by and watch them deteriorate etc.........so what are you all saying then........?? that if you dont have some kind of legal document to help them from a court of law.........my hands and your hands as caregivers are tied and we just watch them die? it sounds to me from some of the previous statements and comments on here that this is not a new problem or occurance? and again i say ..........if i needed to be made guardian to then say ok give him his meds in food which he was taking with no objection then again is it my responsibility to have hired an attorney and again i didnt know anything about this........i know call me stupid and i also didnt have money for an attorney and court costs.........but you would think as well that upon admissions this would all be discussed in great length..........it was in my case and i was assured from a few people .......sure no problem........we will put his meds in his food......which they did..........and then stopped.........but again they should not have done this in the first place then..........so its a double edged sword no matter which way you look at it...............i dunno just doesnt seem to make sense to me that so many medical professionals hands are tied......something needs to be done with patients suffering with these diseases..........i just feel like its my fault.............and since i have never been thru something like this and the entire process was overwhelming to say the least.......and no one wants to help you in the process of finding a place......my father was on medicaid /medicare and it was a joke the whole thing......so sad .......well anymore thoughts and or comments are welcomed.........thanks for listening..........
your post made me so angry i'm almost incoherent.
if someone is in the latter stages of alzheimer's, why in the world would you want to keep them alive longer? unless, of course, you hate them and want to torture them, which doesn't say much for your humanity. or unless you care more about what you want than about what is best for them.
i would love, love, love to stand by and watch either my mother or my mother-in-law refuse their anti-hypertensives and their anti-arrhythmics and their oral hypoglycemics and deteriorate. i pray for that to happen. they're already in hell, both of them. they don't know where they are, but they know they don't want to be there and they don't know what's going on, but they hate it. mamita spends most of her day ranting and the rest of it crying. my mother spends her day crying and searching for my dead father. for the past six months -- until about a month ago when she lost her ability to express a coherent thought -- she begged me to take her out and shoot her, push her off a bridge, take an overdose. i don't understand why either of them should take any medication that isn't solely to make them comfortable. i don't understand why anyone would want them to.
i realize that i don't know you or your situation, that your value system may be totally different from mine and that i'm reacting from a place of raw emotion because of my own family situation. and i also realize i'm not really reacting to you, per se, but to my godfather's wife and her daughters who insisted -- against the protests of his son -- upon keeping him alive at all costs and to my sister who "isn't comfortable" making my mother a dnr. but it seems that you're angry that your father died -- and i'd be so relieved if my mother could.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I'm guessing you use a different staging system than I am used to. The one I am familiar with has 7 stages with 7 being the most severe. Stages 2 and 3 include mild, often unnoticeable symptoms that can include forgetting someone's name after meeting them, or losing things, which means I could already be classified as a stage 3 myself, although I don't think I'm too far gone to make medical decisions.
Click on the website link below to read about the staging system that I use (stages 1 through 3, with stage 3 referring to profound impairment of all cognitive functions).
Click on the website link below to read about the staging system that I use (stages 1 through 3, with stage 3 referring to profound impairment of all cognitive functions).
I just did a shift last night, where I had a discussion with a colleague (EN). I was the RN in charge, and she was TELLING me (not asking me) that I had to FORCE medication into resident's mouths - because if I didn't, some of them would be up all night and the night staff wouldn't get a 'break'. I told her I didn't care what she or anyone else thought about whether the staff 'get a break' on night shift - I explained that you cannot force medication into ANYONE - with dementia or not, as it's highly illegal and some families have placed cameras in residents' rooms to catch out these nurses. How would you like it if that was your Mum or Grandma and I was forcing their jaws open, clamping their lips shut and tipping their head back to get them to swallow? I don't think anyone on here would say: "Oh yes! Go ahead and do that, that's fine, as long as the night staff aren't disturbed!!" BTW night staff, you are there to WORK, not sit around hoping all the dementias are so sedated that they're comatosed - we have to put up with it on days or arvos, so you can too.
The way I tried to tell this EN was that if you steal a car and are caught, it's illegal. Well, forcing meds into a dementia's mouth is also illegal - they are one and the same. Dementias have rights, like any other person whether they have their faculties or not. I told her that the law would not see what she did differently to a nursing home resident, compared to stealing a car. Believe me, if ur caught, you WILL be prosecuted and will probably lose ur license.
In this situation, I told the oncoming RN that she needed to tell day staff to contact the patient's Drs to review their meds for something alternatively if they won't take oral meds.
Dementias are still people, we should all try to remember that.
My situation is not like yours.......BUT I didnt deserve that lashing..............And yes I only touched on one aspect of my situation or more so my Pop's.......I loved my POP with all my heart...and I was in charge of taking care of him. Its not just the meds.........and what I am talking about is the fact that they did one thing and then stopped. Did I want my father to continue on with such a dreaded monster..................NO! But at the same time I wanted him to have some dignity with his final time here..........and to be kept comfortable.........when there are meds to help him sleep or keep him calm yes I wanted him to have them. And its the over-all care or should I say non care he got.........There are many examples I can touch on and I guess in the end............if things bothered me so much then mabye I should have removed him from this facility...........In 50 days........he had a total of 8 falls............oh excuse me........tumbles as they called it.............he was wired for sound.......but no one ever got to him in time..........and we were told that the staff becomes de-sensitized to the alarms..........all on saturday night's .............and wanna know what the reply was from the head of nursing? well we arent perfect! so what is the point of having alarms if no one is going to respond t them? and because he didnt break a bone it was no biggie to them...........the list goes on and on..........so it wasnt just this one thing....it was a combination of situations ...........and I am thankful he is not suffering anymore.............another example...........i dont drive and they knew this........he was 1/ 1/2 hours away from me............my mom is the one that called most times to check on him.............and i would get reports from her.................BUT on the rare occasion that I would call and want to speak to someone I would be greeted on the phone well I dont have to give you my name? dont know if your father ate.....wasnt told otherwise...............dont know how his day was........just got on shift..........want more? I absolutley went ballistic on them and had a meeting with the head of nursing and social worker........who apologized and said well we are going to have a phone class ?? are you kidding me? these are so called professionals and you have to hold a class? Three occasions tried to have a meeting with the administrator .......she was never to be found...........the day my father died......he was rushed to the ER and hours later my sister and I went to the home since it was close by to gather his belongings.........got to the front desk of his floor.............no one looked up for a few minutes and when they did............oh you must be the so and so family..............there are 3 boxes in the hallway for your fathers belongings.....and that was that.......no gee sorry for your loss..........NOTHING !!! I always felt when i was there ..........that I was the only one living in reality and that the rest of the people were in a bubble............talk about de-sensitized..........so im sure with hearing some more of my story...agagin you are saying why would you want to have him live..........I didnt ..........BUT there is something terribly wrong with this picture.............my husband has since talked to someone who has their mom in a country club......paying thousands of dollars and they had their own horror stories.....so I dont really think it matters whether you are rich or poor......I just feel that too many look at it as a paycheck.............those that care are far outnumbered by those that dont.............and they eventually turn a blind eye to things as well......i just think these homes are short staffed and people get neglected in care because of this...............its just sad............when i first took my pop there i had such a positive feeling and outlook and things deteriorated rapidly...........but I am happy that is his truly not suffering anymore..............when i went to the hospital to see him..................I was so upset and scared.......but when i went behind the curtain.........he actually for the first time in over 50days looked at peace................
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
the fact that someone has a bed alarm doesn't necessarily prevent falls -- and even if the staff responded to it instantly, he could still fall. rather than tying him into a chair or paying for 1:1 care, there's really nothing that can be done about it. did you want him tied in a chair? could you pay for someone to sit with him at all times and attempt to redirect him every time he looked as if he was trying to get up? you said they knew you didn't drive -- what were you expecting them to do about that? and you admitted that you didn't call very often. then when you didn't immediately get the responses you sought, you admit that you "went ballistic on them." i can see why perhaps they'd be reluctant to interact with you. i'd be reluctant, too. in fact, i could understand the temptation to make something up just to get you off the phone -- did you want them to tell you he had a good night and ate fine even if the person you talked to isn't the one that might know anything about your dad?
i've called regularly and established a relationship with my mother's caregivers. if they don't know how she did with supper, they'll ask the aide for her table. if the person who answers the phone doesn't know how her day went, they'll find the person who does. from what you've written, it sounds as if you called sporadically and then went off on them.
your writing style isn't very clear, and i'm not sure that i understand all of your complaints. there is no perfect situation, and no one -- not even you -- can take perfect care of your loved one. perhaps you didn't understand that.
you just sound very unhappy, and i'm sorry for you.
"sorry, but these people no longer have the mental capacity or cognitive functioning that is necessary to make an informed refusal. therefore, i do not feel that they have the right to refuse medications, treatments, and basic care."
you are entitled to your opinions and feelings. however, sorry: you do not have the legal right to act on those opinions. competence is a legal term with a very specific definition. any patient whose mental status appears to prevent safe or effective care should have a legal guardian, who is then the person with the right to refuse care; a competency hearing will determine the need for this and a relative may request this status or the court may assign a guardian ad litem if family members are not in agreement. do not put your licensure at risk by working without a good understanding of your responsibilities in this.
houseoflove214
3 Posts
Thank you all for your insight and input.........I am just having a hard time with the fact that these people are in your hands......the nurses, doctors etc. and if there are meds that they need to take every day in order to keep them in check. i.e. diabetic. high or low blood presssure, etc. heart conditions .....I just dont get it.....so no one can do anything and you just have to basically stand by and watch them deteriorate etc.........So what are you all saying then........?? that if you dont have some kind of legal document to help them from a court of law.........my hands and your hands as caregivers are tied and we just watch them die? It sounds to me from some of the previous statements and comments on here that this is not a new problem or occurance? and again I say ..........if I needed to be made guardian to then say ok give him his meds in food which he was taking with no objection then again is it my responsibility to have hired an attorney and again I didnt know anything about this........i know call me stupid and I also didnt have money for an attorney and court costs.........but you would think as well that upon admissions this would all be discussed in great length..........it was in my case and i was assured from a few people .......sure no problem........we will put his meds in his food......which they did..........and then stopped.........but again they should not have done this in the first place then..........so its a double edged sword no matter which way you look at it...............I dunno just doesnt seem to make sense to me that so many medical professionals hands are tied......something needs to be done with patients suffering with these diseases..........i just feel like its my fault.............and since I have never been thru something like this and the entire process was overwhelming to say the least.......and no one wants to help you in the process of finding a place......my father was on medicaid /medicare and it was a joke the whole thing......so sad .......well anymore thoughts and or comments are welcomed.........thanks for listening..........