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Hi, all,


First, a belated thanks to this board for all the support the past 2 years. Dad is in Assisted Living now (went in last November) and Medicaid was approved two weeks ago. Yay. This board was a huge support to me even if I did not post often. So thank you.


My question now is this: The facility has allowed my father to manage his own medications but recently he is getting more confused and not storing/taking his meds correctly. The nursing director gave me the heads-up that he is going to switch the meds to being administered by the facility. I am fine with this. But dad is going to flip out over it. How do I convince him that it's the right thing to do? The last time the facility was going to do this they gave him one more try. Obviously it didn't work. At that time my father was livid that they were taking away this part of his control and would rant to me all day for a week. Any advice?

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Let it be the facility has more experience with the behavior of these type patients than you.
he will be livid only for so long and likely start liking that he does not have that responsibility anymore. By the way, medicine can be dangerous when self administered....
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You might try a conversation that is about other people in facility and not him. Like, if someone was to come in your room while you were out, they might take your meds and make them very sick. Now we have to lock up all of the meds.

Not sure how many he takes a day, but they have 'pill packs' that can be ordered with all of his meds put into sealed wrappers to take at certain times, am, lunch, pm. They are dated so if he forgets if he took or not, the date on next pack would remind him. They also have dispensing machines that sound an alarm when it's time to take and all of the meds for that time period are dumped into a cup at one time. He could keep those in his room and it would ensure he had a pack of pills to take at the designated time without having to open multiple bottles to get his meds. This is really all about taking one more thing away from him and his independence. If there is any way to maintain his usual daily tasks, it's worth a try.
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that's another step in taking away his independence and he knows it.  however you should sit down and discuss with him the importance of what happens IF he mixes up or misses taking his meds.  Maybe the facility can work out a plan where they come to his place with his meds and let him take them out of the bottle (which they will know which one to hand to him) and take it while they stay there.  not sure if that can be done or would help.  None of us wants to lose independence, its the one thing we can control, but in time hopefully he will understand that it is necessary to stay as healthy as he can be.  wishing you luck.
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Let him rant and rave if he gets confused. Don't give in. In the worst case, get some simple NON-medical pills and pretend he is in charge. It can be done. Otherwise, just ignore him. He will never give in and understand. Don't even try to talk to him.
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Mayday, its not a can of coffee beans, its a can of fresh coffee grounds. The wet grounds dissolve the pills and neutralize them. When I worked for a Visiting Nurse Assoc, that is what we told clients. Now police stations and hospitals will take old pills and dispose of them.
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DAD, You Did Not Follow The Rules....
Or, I am sorry, dad, I did not know this was going on... I will try to talk to the director, but in the meantime, please cooperate..

New manager - new policy --- (That is good.)

Love You Dad. GoodNight

my neighbor asked where he could dispose of his parent's meds. Parent died, and he found a couple of huge zip lock bags of meds... no idea what they are. He is afraid to take them to the police station. There is a bin for drugs--legal, illegal, just dispose of them there. I told him I would drop them off.. He is concerned about video?/// why.....Someone said put them in a can of coffee beans... like that is going to absorb them?... possibly... but then what, take the coffee beans to the police station and make them dream of donuts all day? I just don't know. donut holes? :)
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Let me confess – I don’t manage my own meds, my DH does it for me. I take 5 at breakfast, and he fills the Webster pack and doles out the day’s ration. My problem was that I swallowed the handful on automatic, and almost immediately couldn’t remember whether I had taken them or whether I was remembering the day before. The idea of it being a big deal seems crazy to me. Skate over it until it becomes the new normal.
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As someone else stated he must agree to it. More than likely there will be an upcharge for it. At my parents facility it's an extra $450 a month when the nurses give the medication. My mom has her medication administered to her and they want my dad to do the same, but he outright refuses. I also agree to let the facility take the fall for it since they are making the decision. I am sure it's not the first time they have had to do this.
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Imho, the medications may have to be managed by the staff. Case in point - my late mother had terrible medication management by herself. The pills were lost to the cause and on her floors. I took over the management with the direction by medical professionals to get cassettes - one color for day and one for night. This is a little off topic from your post, but this did not even work because my mother insisted on removing the pills and placing them on a teaciup saucer. Ugh. Good luck.
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I'm surprised the AL have allowed you Dad to manage his own meds. My Mom hasn't been in AL long, but it's policy to have their nurse dispense meds. Any way you can tell him it's a new policy because they had an incident with another resident?
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My run-around for the day is done... for now...

Having read more, including Nanulinda1's post about her sister breaking into the drawer... perhaps the dispenser isn't such a good idea. It would be very easy for him to break.

So, alternative, make up a document with a table listing all the meds and when/how much to take for him. The heading should have his name and the top line of the table should have the information for each medication at the top of the column and the first column heading is the date/time, to be filled in by him with a check mark under each medication taken that day.

If he has this, he can check off each medication as it is provided, giving him *some* control, in a sense. More like busy work, but if he's going down the dementia path, it might work... Of course he could end up just writing whatever and checking everything... Dementia is just SO much fun...

Blaming the facility, his doctor(s) or even the government would possibly take the heat off OP... It's really a discussion that should be diverted to something else, whenever possible as you will NEVER get him to agree... just go along with him, commiserate and point fingers at who/whatever you can as to being the source of this change! Promise you will meet with whoever and get to the bottom of it. One useful upside to dementia is that they will forget, so you can promise every time... Preferably it would be an entity outside the facility, then his railing to you or staff can be challenged by telling him it is the doc or gov't directing this. Have him write letters to his doc and/or rep (never to be sent) to complain to the doc or gov't! More busy work!
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Let Dad rant. Eventually, he will get tired of it and stop. You can just say it's not your doing, it's the rules of the place. Others have said it here and I agree - tell him it's facility wide. All residents are having their meds dispensed by the staff. This way, he won't feel like he's being singled out. Little white lies that protect someone sometimes are needed in these situations.
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CM, point taken about the facility explaining what meds they are giving to the patient each time they give them and refusal being of course allowed. This was certainly the way it was done in my mom's Rehab, AL and NH. It certainly reassured ME!

I think that our point is, Dad's argument should not be with his daughter; this is not something that SHE is taking away from Dad; it's the facility that is doing is (with her agreement). Dad's fight/rant, if he wants to have one, is with the facility, not with his daughter.

There is always a fine line, isn't there, where a client's "independence" is concerned? We want them to be independent, but we'd much rather that they not end up dead because of that independence.

If dad refuses the Medication Management services, he is free to move elsewhere. And his daughter is well within her rights not to help him do so.
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My sister had the same issue .. Her meds were in a locked drawer in her little kitchen .. Staff would stop by in that AM and PM To give them to her.. She broke the drawer open a few times and over medicated he self .. It was shortly after that that she was moved to a locked unit .. It was wonderfully run . She complained for a while but found another woman that she ( while she could ) spent time with. They took wonderful care of her .
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You could say it is a policy change, which in his case, it is. Of course, many people need some help with medications. I remember how fuzzy-headed I was after surgeries and wouldn't remember unless I had written down what I had taken. Let him know that in this time of COVID-19, that they have been seeing an increased problem with managing medications and are trying to help all their residents cope until the pandemic is over. When it is over, he may have become used to the new set-up and not remember to ask for control back.
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Well hold your horses a second - who is consenting to this, you? Because somebody has to.

Whoever does, though, there are - as you have already identified - several steps to Medicines Administration. What the ALF ought to be doing is involving your father in as many of them as is practicable, in line with the end result that: the Right Person gets the Right Medication in the Right Dose in the Right Manner at the Right Time.

So, counting them off...
Ordering repeat px's.
Collecting same.
Storing.
Dispensing.
Following directions.
Taking.
Recording.

What cannot be done BY your father must be done in front of him, and explained to him as it is done, each and every time. Your father's right to refuse a particular medication, and his right to know what he is being offered and what it's for, must be respected.

The explanation must be comprehensible to the person expected to understand it. So for example: with some clients, you'll say "this is the Apixaban" and they know much better than you do what it is and what it's for; with others, you might tell them "this is the medicine to stop dangerous blood clots in your circulation."

The facility ought to have some sort of Consent to Medications Administration form which explains how the process works, and which somebody ought to be asked to sign. This would also be an opportunity to reassure your father that his material rights - to be treated only with his informed consent - will remain intact.

There are two extremely sound reasons for people to be uneasy/resentful/livid about their medications being taken away and then handed to them by staff. One, they may not have that much confidence in the staff. You say your father's not storing/taking his meds correctly? I'll bet he'll come right back at you with "what makes you think THEY will?" Two, they may not be happy that they know what they're being offered.

They are *right* to have these concerns, and the facility must reassure them by explaining their safe handling and administration protocols.
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SZHNJ1023 Aug 2020
I'm all for them taking control. He has either overdosed himself to the point of running out of heart medication and not telling anyone to misplacing prescriptions to just not taking them at all. It was all okay for some time, but lately he's getting foggier so I see why the facility wants to step in on this. For him the issue is control, not confidence in staff or not trusting what they are giving him. Thanks for the reply!
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I only skimmed the responses, so if this is repeating someone else, apologies - I am in a bit of a rush today!

When mom was still living in her condo, but having difficulty remembering to take (or maybe even over-taking) her meds, we were in process of starting to bring in aides. The nurse sent to evaluate her confirmed what I knew - early dementia. Her recommendations included getting a timed locked dispenser. For only 1x/day, it would be probably a month's worth. It can have other times set, so some morning, some evening, then it would be 2 weeks before refill.

The aides hired would not be able to dispense the meds, but they could check the dispenser and remind her that she hadn't taken them yet (she would not hear the alarm or miss the blinking light.)

The staff can keep his meds and set up the dispenser, checking on him to be sure he takes them. This way he would still have some "control".
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I would just point the conversation in another direction...."Dad, this is what we pay them to do, let them do their job.  That way we don't have to worry about such things and can spend our time doing other stuff."  Or as someone posted previously, blame it on the lawyers and tell him that everyone in the facility has to have their meds given by a nurse...it's the law.

When I noticed mom wasn't bathing herself regularly, I asked the facility to come in and help her in the mornings and mom resisted in the beginning.  I finally told her that the hand held shower sprayer was really difficult to use and everyone was complaining so they have to have someone come in and help everybody in the morning to make sure they can manage the sprayer and not slip and fall while doing it.  She seemed to go along with that...

It's hard to get into the mode of "fabricating" stories to our parents, but if it's in their best interest...I feel justified.

Good Luck
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Exactly what Barb said. Dad had been controlling his own medications when he lived on his own but when he moved to AL, I told him that it was their rules, out of my hands, I couldn't help him, etc. and then I'd change the subject and go on to something else. Of course, they finally did get tired of the ranting, too, and let him control his own Tylenol. In hindsight, I think they regretted that decision. Now that he's in skilled nursing, all of that is behind us.
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Blame it on lawyers. Tell him that the facility can't risk even one mistake made by one tenant, or the lawsuits would bankrupt the place. Let him rage at lawyers; they can take it, and he'll get tired of it quickly when no one argues with him.
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ear plugs? Sorry, but you may have to just leave when he starts. Just keep telling him you are "sorry, but there isn't anything I can do about it." over and over and over. Then find an excuse to end the visit, phone call or however he's talking to you.
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With my father it was laxatives. When he lived at home he sent me to the store to buy senicot, a case of fleet enemas and prune juice. I was never so embarrassed at the check out. Told the guy checking me out that now I know how they felt when they had to buy tampons for someone else. He told me everyone knows the tampons aren't for him.

Assisted living did not like his laxative addiction. He'd want me to sneak out and buy him some. I'd compromise and buy them from Amazon and have them shipped to him. They would help him open the box and they would confiscate them. This way I was not the bad guy.
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SZHNJ1023 Aug 2020
Oh my god when my father was living in his own place I also was sent out on the llaxative/PRUNE JUICE MISSION :) Since moving him to AL all those requests have stopped. Thankfully.
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The facility is not as emotionally attached to Dad as you are. He will just have to rant. Mom lost her control a few years ago. I don't play with meds and neither should you want to. As they get older, change takes place. Dad messed up. Has to own it. You mess up meds, that's it. That is zero tolerance its not personal its safety.
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This was a rage point for my dad and he would actually buy and hide bottles of tylenol, his other meds were delivered by me, so that was not a battle. But he was insistent that he could handle his meds, yet I would have to clean up the spilled tylenol if I beat the caregivers to it that go around. Then he figured out what was giving him away and started kicking the spilled pills under the bed. Oy vey!

Let him be angry and rant for a time, I have loved ones that I have a time limit set for this behavior, after that time is up, on to another subject or I am gone. As humans we need a safe place to vent, but we don't need to be allowed to obsess about what it is that we are venting about. So give him a safe ear and move on after a set time or whatever you are willing to do.

Best of luck, this is a battle for sure.
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Ahhh yes, their independence is gone anytime one more thing is taken away. 1st their car, their home, their shopping, their cooking...the list goes on. His cognitive issues have caused this. Explain, it’s going to happen no matter what. He can be angry and you can tell him it’s OK. But under no uncertain circumstances is he able to self medicate himself anymore and he needs to accept this help from others. You can also tell him because of new rules in the ALF they are the ones required by law to dole out the meds...
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What Barb said and just tell yourself he will get over it in time.
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My Moms AL never allowed medication in residents room not even OTC drugs. The Nurse handled everything with a doctors order. Tylenol was administered "when needed". To me this made sense, the AL was protecting themselves and the residents.

Tell Dad that the ALs policy has changed by State law. Residents are no longer able to have medications in their rooms. Violation of this policy could mean penalties for the AL and his rent going up. 😊

Then if he rants let him. Nothing u or he can do. You can always walk away.
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I would say let him rant, and that mostly because there is no way to stop it. Tell him "Dad, you are right, it is one more loss, and I am so sorry for it. But the facility cannot let you take your medications when it goes wrong too often, because they are liable if something happens to you. It is the rules. I don't like it and you don't like it and it is one more loss, but from the time we are born we are born into rules, and we die in rules as well. I am sorry. You are angry and I understand this. It isn't your fault. I already have periods when I forget whether I took my pills or not. (lie!) and the time will come when I need help, too." That's it. Then he will rant some more. When my brother went into assisted living he had a diagnosis of probably early Lewy's. He ASKED me to take on his finances, to do POA, to be Trustee of his Trust. BUT he also admitted how hard it was to have all his controls removed one at a time, with nothing to look forward to but more loss. Your Dad has had another loss. It is worth raging over. Then it is just one more thing to "live with". Isn't it so hard to see? For me at 78 it is even harder to know I am "going there". Remind Dad he once had to listen to you when you didn't listen to rules, and you will listen to HIM, but that you will only listen so long, because you can't "fix everything", and then take Barb and RainMom's advice, and take your leave.
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SZHNJ1023 Aug 2020
Thank you, well put.
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Yes, Barbs suggestion is a good
one.

This was one of several tips I learned from the smarty folks here. It came late in my caregivers journey - unfortunately I found this site in year five of six - but nonetheless...

The act of politely saying “... I’m gonna go now. I’ll come back on day when you’re more up to a visit” works wonders iIn a variety of situations when the elderly loved one is attempting to take their anger and frustration out on you.
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Barb said what I was thinking, don’t take the blame or listen to the anger. “It wasn’t decided by me, I’m sure it will be fine, how was your night’s sleep?” Or whatever other topic. No need to take on what you can’t change or fix
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