Irreversible Consequences of Drug Restraints in Memory Care?

Irreversible Consequences of Drug Restraints in Memory Care?

by | May 17, 2015

Drug Restraints and the Haldol Shuffle

Drug Restraints and the Haldol Shuffle

Adult children just want their parent with dementia to be okay. Most do not have a clue on psychotropic (mind altering) medications or how they work. Families rely on professionals to recommend doses and medications for their senior parents. If a professional doctor or memory care community says that our mom or dad needs these medications, we tend to accept their wisdom. We are programed to not question authority. Yet when a parent is sedated in a drugged stupor over an extended period of time, more adult children are starting to ask why. At this point it can be too late for a senior with dementia.

Psychotropic medications can have a lasting affect on a senior with dementia.

Seniors may never be able to return to their baseline, before taking psychotropic drugs. My mother-in-law was given Haldol and now does the Haldol shuffle. It is a continuous stand up, walk, sit down and then it starts all over again. It is so sad to watch and they can’t stop. A professional told me it’s like their skin is crawling and they have to keep moving to make the feeling go away.

When we recently brought my mother-in-law her favorite Greek food for lunch, she sat down in front of her favorite foods at the table and then immediately stood back up and started the Haldol shuffle again. She had no desire to eat her favorite foods.

It has taken four months for the family to get her off the Haldol. My sister-in-law had to physically take my mother-in-law to her primary care physician and demand for the Haldol to be discontinued last week. The doctor was shocked my mother-in-law had been on Haldol for such a long period of time, with no recorded outbursts requiring such a strong medication.

So what happened?    

My father-in-law, Bill, and mother-in-law, Amy, refused to move from their home of 56 years. Bill had been Amy’s caregiver for the last four years because she had dementia. When Bill had a sudden heart attack and went to the hospital, Amy was in jeopardy in the family home. The local children rallied around the dad in the hospital. For all intensive purposes, Amy was left alone for three days and three nights. My husband and I live 1000 miles away and we hired a geriatric care nurse. Amy was having delusions, not recognizing her own children, making unsafe choices, refusing to take her medications and eloped (she walked away and the police brought her home).

No community would accept her without medications

No assisted living would take her, because she had eloped. A memory care community came to assess whether they would accept Amy and said they would not take her unless she was medicated. The family understood drugs were a requirement at this point. My sister-in-law called Amy’s doctor’s office and explained Amy symptoms of delusions and etc., they did not want her in the clinic. Are you kidding me?!!? Amy’s doctor’s nurse said to take her to urgent care. But according to urgent care she was not bad enough to be admitted to the hospital. They sent her home with five pills of Adavan. Now what? Medications were required live in the memory care community. What could we do? She was not safe at home by herself and she didn’t want her adult children (she no longer recognized) to be with her. Finally a geriatric nurse provoked Amy to hit her. Then the police came and Amy was taken to the hospital by ambulance. There was no room in the psych ward so she was drug restrained in the emergency room for three days and two nights.

So the psychotropic nightmare began

The hospital said strong medication was necessary and started the Haldol. She was in the hospital for three weeks. Both memory care communities said the medications were necessary for Amy too. The family stupidly believed the professionals. Amy’s HMO had poor communication between the doctor, the hospital, the memory care communities and the home health professionals that saw Amy in person.

The first memory care community recommended making no drug changes for one or two months. When my husband and I flew to Seattle and saw Amy’s level of sedation, I said, “No way,” and fought to have the Haldol reduced by half. After the family figured out that the memory care community had no intention of supporting the reduction of medications, we moved Amy.

The second memory care community promised to reduce the psychotropic drugs and get her off the Haldol. Within two weeks they reduced the Haldol by half. Yet Amy was still in a drugged stupor. She was on a mix of AM and PM psychotropic drugs. This secure memory care community had a staffing ratio of one staff to ten residents.

We have since learned that drug restraints in memory care are common, particularly if they are short staffed.

I wrote this article to warn others adult children to demand reductions in psychotropic medications immediately. I am so sick of professionals saying to wait a month or more to see what happens with the medications. Then it’s too late. Amy went from fully toileting herself to incontinent. She went from eloping (walking away and the police brought her back) to barely walking. She went from smiling and talking to having a blank look on her face and staring into space.

We want to find Amy’s baseline again. She will never be at the same level of cognition from four months ago. There are moments and sentences were her personality returns. It is so sad to see her in this reduced state.

I am not saying that I am anti-drugs, but a Power of Attorney (POA) needs to be informed of the consequences of psychotropic medications. My own mother with dementia benefited from psychotropic drugs when she became very anxious and delusional in the later stages of her dementia. The price she paid for taking those psychotropic medications was permanently losing the ability to walk. I wish I had known then what I know now. Now my mother-in-law can barely walk…

Any hope? Have you had a similar experience with your parent? What happened? Have you witnessed drug restraints in memory care communities or hospitals? How can we stop it? How can a family find a good memory care that does not require drug restraints? What are the proper questions to ask?

Don’t wait until you’re in a health care crisis like author Diane Masson’s in-laws. It has been a nightmare for her in-laws and all the adult children. Research your future choices NOW to avoid being “put” somewhere, or having decisions made for you by others.  “Your Senior Housing Options” is a new resource book available on Amazon.com with a 5-star rating. It offers a step-by-step guide to the options, including staying home. 

Seniors, Boomer children, spouses, family members and caregivers are desperate to learn how to truly differentiate good senior housing from mediocre at best. Diane Masson’s new book will answer these heart-wrenching issues in an easy, simple, story telling format with humorous illustrations. 

Diane has worked in senior housing for 17 years and is the regional marketing director for two debt-free Continuing Care Retirement Communities in Southern CA (Freedom Village in Lake Forest and The Village in Hemet).  Her first book “Senior Housing Marketing – How to Increase Your Occupancy and Stay Full,” is being utilized by senior housing professionals across the country.

For weekly tips and advice go to www.Tips2Seniors.com and learn more from author and senior housing expert Diane Twohy Masson.

Drugging and Diapering Seniors??

Drugging and Diapering Seniors??

by | Mar 15, 2015

My sedated mother-in-law

My sedated mother-in-law

Apparently drugging and diapering seniors in the hospital is common knowledge in higher levels of senior living care, such as assisted living, memory care and skilled nursing?!!?

This is horrifying new knowledge for me. I am all about exposing dirty secrets in my new book, “Your Senior Housing Options.” So let me share what I have recently learned through my mother-in-law’s experience. My mother-in-law, Amy, has dementia and was cared for by my father-in-law for the last several years. Three days after he had a heart attack, she became psychotic. My husband and I had to hire a geriatric care nurse to help her because we live 1000 miles away. Learn more of the story HERE.

It took over two weeks to get Amy admitted to the hospital (it’s a long story). Initially, we were relieved that she was going to get the psychotropic drugs she needed. Since Amy was in crisis mode, we didn’t dwell on her being diapered because of diarrhea. She’d had colon cancer 25 years ago and has self-managed her own colon care with diarrhea medications for years.

Costs for Incontinence

As she was in the process of transferring to a secured memory care, I was promised that they would be diligent about avoiding Amy’s trigger foods (that cause the diarrhea). My assumption was that she would surely regain continence again. This was vitally important, because incontinence can cost an additional $300 to $1,000 per month depending upon the assisted living community.

My Mother-in-law Was Over Sedated

We flew to Seattle to see Amy and to help find a reasonably priced memory care community for her. She was so sedated that she could not keep her eyes open and kept saying, “I am so tired,” over 25 times. She apologized that she needed to lie down and take a nap. She was in a wheelchair and needed a one person transfer to get in bed. What?!!? One month ago, she was walking around. My husband and I were shell-shocked to see her so drugged and lethargic. We talked to the memory care community and they said they would contact the doctor immediately to reduce the medications.

The next day, we arrived to see Amy again. After being told that she was engaged and walking around, we found her asleep in a wheelchair in the middle of a singing class. It was heart wrenching to witness. Again, she spoke of her sleepiness.

Advocacy is Key for a Senior with Dementia

The administrator came over and had the nerve to tell me, “My team feels we should follow the doctor’s recommendation of not changing Amy’s drugs for one or two months.” What?!!? I asked the nurse, “Do you see Amy’s lip trembling?” She said, “Yes.” I inquired if she saw both of Amy’s arms shaking too. She agreed. Then I said, “Do you see how sleepy she is and how her eyes can’t stay open?” “Yes,” she said. I simply said, “That is not Amy.” “Oh,” she said, “Then she is on too much medication.” “Exactly,” I said and was relieved that someone finally understood.

It took till the next evening for the community to contact her doctor and reduce one of her medications by half.

At this point Amy has been drugged and diapered for five weeks (between the hospital and the memory care community).

Conclusion:

That was five weeks too much of over drugging and diapering a senior with dementia. Can she ever come back and resume continence again? Will she be able to walk freely like she used to in her own home? My own mother was given psychotropic medications in skilled nursing care. Four months later, her walking had decreased dramatically; a few months later she became wheelchair bound for life. Was it the drugs or aging decline? I will never know, but I want to protect my mother-in-law from being over sedated and permanently wheelchair bound. I hope she has a fighting chance to walk again.

Drugs as Restraints?

I have talked with several administrators of assisted living and skilled nursing communities. They say it is common for seniors to arrive from the hospital drugged and diapered. The hospital can’t use restraints, so they use drugs as restraints. My mother-in-law was prescribed haloperidol twice a day and trazodone four times a day as needed.  Why did the hospital dope her up so much?  It is an advocacy nightmare to get it reversed.

What have you encountered?  Has you ever witnessed the sedation and diapering nightmare of a senior?

Diane Twohy Masson’s new guide book for seniors, “Your Senior Housing Options,”  is available on Amazon.com with a 5-star rating.  It reveals a proactive approach to navigating the complex maze of senior housing options. It will help you understand the costs and consequences of planning ahead or waiting too long.

More related articles by Diane can be found at  Tips2Seniors.com or like Tips 2 Seniors on Facebook.

Diane Twohy Masson has worked in senior housing since 1999. She is an award-winning certified aging services professional and the author of Senior Housing Marketing: How to Increase Your Occupancy and Stay Full for senior living professionals.

Among the thousands of seniors she and her teams have assisted in finding the right senior living community, the most difficult case has been helping her own parent. Masson spent two years exploring senior housing options with her mother before finding the ideal Continuing Care Retirement Community for her. After eight years in this independent living setting, she helped her mother transition into an assisted living community. Seven years later, even as a senior housing expert, Masson struggled with the decision to move her mother into a skilled nursing community.