Should Alzheimers Clients have the right to REFUSE medication ?

[NurseLoveJoy88]

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 ?

Am I missing something here ?

[nurseprnRN, BSN, RN]

these are the published criteria for hospice care in dementia. they indicate progressive disease and no hope of recovery. natural death is expected of this condition and no efforts to forestall it will be effective. imnsho, none should be attempted. we take better care of our old pets, in terms of preventing suffering, than we do c our old people. (my italics for emphasis)

dementia

inability to ambulate or dress without assistance

urinary and fecal incontinence, intermittent or constant

no consistent meaningful verbal communication

one of the following within the last 12 months:

- aspiration pneumonia

- pyelonephritis or other uti

- septicemia

- decubitus ulcers, multiple stage 3-4

- inability to maintain sufficient fluid and calorie intake

- fever, recurrent after antibiotics

[CrunchRN, ADN, RN]

With dementia I feel it is up to their legal representative. I also think that they should be allowed to say no to any drug unless it is needed to make their behavior safe for others.

I think we are still way too interventional and aggressive for these patients. Cholesterol meds really? When you are institutionalized because of dementia? Please don't do me any fovors like that!

[cherrybreeze, ADN, RN]

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................

I was sympathetic in my last post to you, and tried to make things make sense....now I'm just getting angry. You still haven't said exactly what you think the staff should have done to *make* your father take his medications.

As far as alarms....you don't seem to understand how fast someone can move. A patient can be on the floor 2 seconds after an alarm starts to go off. Basically, if you are not literally sitting next to them, you're not going to get there fast enough. Your thoughts on this are just that we (as medical professionals) DON'T CARE, and are just collecting a paycheck. This is so insulting I don't even know what to say.

Yes, they were in charge of his care. That only means so much! They couldn't cure him. It sounds like YOUR expectations were unrealistic. Part of me wishes you had had the opportunity to care for him in your own home to see how "easy" it should have been. The only way to keep him from falling is to stay awake and sit by him around the clock. Don't get up to go to the bathroom, even, since that could be all it would take. Give him his meds, have him spit them out....when you try to give them again, what if he hits you? How are you going to FORCE them in him?

That might be the job of the facility, but when there is, say, one RN for 30-50 patients, and maybe 4 CNA's for all of those patients....it is JUST NOT POSSIBLE to prevent every fall. It's sad, but it's not possible. Does that mean we don't wish we could? When I was a CNA in a nursing home years ago, we would go RUNNING when we'd hear an alarm. Whoever set it off might have been on the floor by then, but that doesn't mean we didn't try; it doesn't mean we didn't feel terrible even if we reacted as fast as possible. Do you know how HELPLESS a feeling it is, to be in a room with another patient, in the middle of a transfer to the toilet, and to hear an alarm go off? To not be able to get there immediately?

You mention 8 falls in 50 days. That sounds like a lot, yes. HOWEVER. Have you stopped to think of how many falls WERE prevented? Your dad may literally have attempted to get out of his chair or bed on his own HOURLY. If that many falls were "successful," I can only WONDER how many weren't. Some people do nothing all day long but try to get up. We're talking every 10 minutes. Short of tying them to where they sit, there is no effective solution to stop every fall. What quality of life would your dad have had, being tied down all day, wanting nothing more than to get up? How awful.

You can want all you like for him to get the meds that might help him sleep, or whatever. If he won't take them, I can't make him. It's just that simple. We don't always get what we want, ever hear that saying?

I also echo Ruby Vee's sentiments about your phone calls to them, so I won't go in to that subject.

I have tried to see where you are coming from, I really have. I wouldn't wish the entire situation on anybody. But you also have to understand OUR side of it.

[MunoRN, RN]

If a nurse doesn't consider someone competent enough to refuse a medication, how are they competent enough to consent to it?

[TheCommuter, BSN, RN]

If a nurse doesn't consider someone competent enough to refuse a medication, how are they competent enough to consent to it?

At the nursing homes where I have previously worked, the family of the demented resident signs the 'consent to treat' form upon admission. Therefore, the resident's responsible party is consenting to the medication.

[nurseprnRN, BSN, RN]

"if a nurse doesn't consider someone competent enough to refuse a medication, how are they competent enough to consent to it?"

short answer: once a person has reached legal age of consent (generally 18, although there are provisions for emancipated minors), s/he is considered competent until proven and determined by a court to be otherwise. since you ask.