Assisted Living facility trying to force my Mom onto pricey 'medication management'

[John Galt III]

Looking for an angle with which to refuse this 'medication management'.

Background: Mom is currently in skilled nursing, scheduled to go back to assisted living in 2 days.

Someone assessed her as not being able to self-medicate. I told several people at the CCRC she is in that I think she can self-medicate. Told the social worker, a few nurses, the housing director, and one of my voicemails was forwarded to the Director of Nursing so she knows too.

I asked the social worker if we could refuse the med mgmt program ($450 to $850 per month, depending on how many visits they say needs per day). A nurse brings a pill or pills to the room in a cup, to give to patient.

Social worker went blank, said I could escalate to Director of Nursing and to Director of Health Care. She also said they might say it is a 'safety issue' which causes them to not let Mom self-medicate.

Mom has a poor short term memory but can manage these pills, I believe.
She has done it before, just a year ago, with the 7 day pill box.


She only has synthroid, an iron pill, colase (stool softener), and omeprazole.
Iron pill is for anemia.

She already takes her synthroid every morning without being coached.

A nurse told me she would be OK with Mom self-medicating, as long as a family member were there for the first few days to monitor her.


I plan to talk to the Dir of Nursing tomorrow about it, and possibly the Director of Health Care.

My assumption is they will not concede any ground unless I say the right things. Don't know what those right things are, other than 'I think Mom can self-medicate. I disagree with the assessment'.

And possibly "We have the right to refuse medication'



And for clarification about this post, * we are fine with taking the meds.*

We are not fine with paying them $450 to $850 per month to administer them.

Ideas welcomed !

edit to add: The social worker told me they might not release Mom from skilled nursing if we refuse med management for this supposed 'safety' reason. Her insurance coverage will have ended for her skilled nursing, at that time. That, apparently, is their bludgeon in the argument.

 

[LateToFIRE]

My experience leads me to believe you're going to have a tough time escalating for the following reasons:

1) Assisted Living facilities are paranoid about liability and don't want patients/residents that require more than minimal care. They are not lacking for demand for rooms, so anyone (or their family) who gives them a bit of hassle tends to find they are not welcome pretty quickly.

2) Of course this is probably a money grab too. But, no one is going to overrule a nurse or doctor or social worker who has documented this need. Think about how that might look down the road in a wrongful death lawsuit.

3) Family members are often the last to accept that their aging parents need help with such things. I am sure you are sure you are right. But, the medical professionals have seen this story many times over, so they will significantly discount your opinion.

Hope things work out for the best one way or another.

 

[RetiredHappy]

Since your mother has poor short term memory, the risk is that she will repeatedly take the same medications because she would have forgotten if she had taken them, even if out of a pill box.

It is a risk that the assisted living facility does not want to take on. I can see why they insist that your mother accept medication management.

We used to run an elder care agency and understand dementia very well.

 

[Walt34]

While I'll grant that the charge for administering pills seems high (okay, outlandish) consider what happens if you go and watch her take her pills, and all seems fine, and they let her self-medicate.

Then two months later she fails to take the pills when she's supposed to, and as a result she has a fall and is either injured or worse. Doesn't that leave the facility open to charges of neglect? It may be a CYA move on their part to insist on having someone handle medications but one really can't blame them if there's any doubt about her ability to self-medicate.

To be clear I have no issue with calling them out on the excessive charge for handing out pills. That's clearly just a money grab and I'd call it that to them.

 

[calmloki]

Dang - they make automatic timed feeders for dogs - how is it there isn't something similar for people? Is this a million $$ idea just waiting for someone to Sharktank it?

Well duh - they do:

https://herohealth.com/manage-my-me...N862WxJ37i8bFeZN7u4mR8bROwGA1dhsaApNjEALw_wcB

https://www.alzstore.com/electronic...m_campaign=High+Priority+-+PLA&utm_medium=pla

A bit of reading and it turns out they have wired and cellular connected dispensers - Mum doesn't take her pills, someone gets a call. Not that I need it. now. but very glad to learn of this option.

 

[MichaelB]

If it is over the counter med she might get by self medicating, but prescription meds need to be administered by a qualified aide. There is little likelihood the facility will give in on this.

The $450 charge sounds pricey. The facilities I’m familiar with (aunt, mum, uncle) all charged in a scale depending on the number of meds, and 2 a day is a low level. My mum paid $250 monthly for 4 meds per day.

 

[John Galt III]

If it is over the counter med she might get by self medicating, but prescription meds need to be administered by a qualified aide. There is little likelihood the facility will give in on this.

The $450 charge sounds pricey. The facilities I’m familiar with (aunt, mum, uncle) all charged in a scale depending on the number of meds, and 2 a day is a low level. My mum paid $250 a day for 4 meds.

Is that $250 a typo? Was it meant to be $25? My Mom's price for 3 or more visits per day, no matter how many meds, would be $28 per day.

And yes, everything is over the counter, except the synthroid. She has been self-medicating with the synthroid for decades, and still is.

 

[MichaelB]

Is that $250 a typo? Was it meant to be $25? My Mom's price for 3 or more visits per day, no matter how many meds, would be $28 per day.

And yes, everything is over the counter, except the synthroid. She has been self-medicating with the synthroid for decades, and still is.

Yes, a typo, since corrected. She paid $250 monthly for 4 meds. For 9 meds it was $450 per month. The charge was in line with what other facilities were charging.

 

[LateToFIRE]

Dang - they make automatic timed feeders for dogs - how is it there isn't something similar for people? Is this a million $$ idea just waiting for someone to Sharktank it?

Well duh - they do:

https://herohealth.com/manage-my-me...N862WxJ37i8bFeZN7u4mR8bROwGA1dhsaApNjEALw_wcB

https://www.alzstore.com/electronic...m_campaign=High+Priority+-+PLA&utm_medium=pla

A bit of reading and it turns out they have wired and cellular connected dispensers - Mum doesn't take her pills, someone gets a call. Not that I need it. now. but very glad to learn of this option.

if the issue is memory or dementia, the machines don't really work so well. Many times I caught my parent leaving the pills on the counter even when they were handed to them.

 

[LateToFIRE]

OP, you noted that synthroid is the only prescription med. What happens if she takes too many pills daily for several days. Just pointing out (as I learned the hard way) that not just a matter of them remembering to take the pills, also a matter of preventing overdose as they forget whether or not they've taken the meds and keep popping pills. Agree, the fee is ludicrous, but the service need may well be relevant, if not quite critical now, then soon. The thing that caught us off guard was how quickly they can go from functioning well to not functioning so well (but hiding that really well).

 

[LateToFIRE]

Since your mother has poor short term memory, the risk is that she will repeatedly take the same medications because she would have forgotten if she had taken them, even if out of a pill box.

It is a risk that the assisted living facility does not want to take on. I can see why they insist that your mother accept medication management.

We used to run an elder care agency and understand dementia very well.

You truly deserve the best retirement!

 

[HarveyS]

if the issue is memory or dementia, the machines don't really work so well. Many times I caught my parent leaving the pills on the counter even when they were handed to them.

Unfortunately, +1. Mom had dementia and a auto pill dispenser. She would "save the pill until I have my toast". It just didn't work because we could not get her to take the pill when the machine beeped and dispersed the pill.


$450 seems like a big charge. But, that is $15/day. Pills 3x/day and it's only $5 per visit. Does not seem so bad now.

 

[RetiredHappy]

You truly deserve the best retirement!

Thank you!!!

 

[John Galt III]

Unfortunately, +1. Mom had dementia and a auto pill dispenser. She would "save the pill until I have my toast". It just didn't work because we could not get her to take the pill when the machine beeped and dispersed the pill.


$450 seems like a big charge. But, that is $15/day. Pills 3x/day and it's only $5 per visit. Does not seem so bad now.

$450 is the *minimum* charge per month. That's for 1 visit per day. 2 visits per day bumps it up to $620 per month. 3 or more visits per day is $850 per month. On her current regimen in skilled nursing, she gets 3 visits per day for meds, and they want to continue that regimen in assisted living.

Maybe I can convince them to lop off the stool softener or the omeprazole (a antacid), but if not, the're gonna get the maximum profit out of me, $850 per month.

 

[tmm99]

Yikes, that's expensive. But it sounds like she needs help. Even if she doesn't now, she may soon. The only thing you can do seems to be to try to consolidate her meds to fewer times a day.

 

[retire to nature]

Can I ask what the nursing home admission for? from there, the recommendation can be different. I am not sure why she was in nursing home facility from reading. But, for seniors, those thing can make quick declines. You mentioned she could do it a year ago. To me, a year is too far away assessment. it can be a big change after admission to nursing home admission condition. There is a level of care. So nursing home means some high level care needed.

 

[youbet]

OP:

1. If your DM is "touch and go" between needing either full nursing or assisted living with extra assistance, you might consider the fact that having someone visit her 3X a day, even if briefly, would be worth it. Are there other things going on that would provide frequent checks on her? Does she go to a dining room for meals? Are there other well-being checks being done by staff?

2. Regarding the issue of avoiding "medication management," I doubt there is a way out as long as the facility's recommendation is that she needs it. You would have to find some fool proof way to guarantee they are not responsible regarding your DM's ability to self-medicate and for the consequences if she does not do well at it. I can't imagine what that would be.

Tough stuff. Good luck.

 

[Sunset]

It's a tough situation.

OP - can you visit to supervise / give the pills each day ?

I can see there would be issues, with overdosing as possibly the worse, a lot of iron will block stuff up.

A lot can change in 1 year, which is how long ago you know she managed the 7 day pill container.

I was going to suggest getting the pills in the daily plastic bubbles, but of course that is mostly common for prescription pills. Of course a person has to know the day to use them.

 

[Tetto]

For my mother (has profound dementia) they give her the meds crushed into pudding. When my dad was alive, and they were in the assisted living facility, i paid then as well, because moms memory was so bad, she often couldn't remember from day to day she even had to take meds. Maybe that's not your moms issue, but trust me, its peace of mind for you knowing she'll get what she needs.

 

[sparky08]

That does seem like a lot. But it's been a few years since we had a loved one in assisted living.

$850 works out to $27 per day. Three visits at 10-15 minutes is about 1/2 hour labor, maybe more. Add in liability insurance and record keeping...I wonder if it really is a big money maker for them?

 

[John Galt III]

Can I ask what the nursing home admission for? from there, the recommendation can be different. I am not sure why she was in nursing home facility from reading. But, for seniors, those thing can make quick declines. You mentioned she could do it a year ago. To me, a year is too far away assessment. it can be a big change after admission to nursing home admission condition. There is a level of care. So nursing home means some high level care needed.

She moved from ind living in this ccrc to assisted living in Aug of last year, because she felt weak, and had other problems. She has bladder cancer, which bleeds sometimes and makes her anemic. Has gotten 3 transfusions in the last 6 months. Drs are talking about palliative care and hospice care. Mom is not in either of those yet.

 

[harllee]

My mom is in a CCRC, age 94, short term memory loss. For now she is still in independent living. We have caregivers come 3 times a day for 6 hours, 2 hours morning, 2 hours lunch, 2 hours evening (CNAs furnished by the CCRC). The family buys her pills and puts them in a pill box and the CNAs administer them morning and night. In addition the CNAs assist mother in activities of daily living--dressing, showering, food prep, etc. The best thing about the CNAs is that they give mother companionship--she loves for them to come. So far working good. Fortunately mother has long term care insurance paying for the CNAs (I had to battle the insurance company for moths to get them to pay). There is no way my mother could stay in independent living if she did not have help.

 

[athena53]

That does seem like a lot. But it's been a few years since we had a loved one in assisted living.

$850 works out to $27 per day. Three visits at 10-15 minutes is about 1/2 hour labor, maybe more. Add in liability insurance and record keeping...I wonder if it really is a big money maker for them?

That's an interesting analysis- it almost makes the price look reasonable. Medication mistakes do happen, even in relatively alert seniors. DH was 78 and on a bunch of meds. The only other sign that his cognitive skills were failing was that he wasn't as sharp with technology as he used to be, but I'd find a pill here or there on a table and he couldn't remember if it was one he was supposed to take that day, or the day before. I finally gathered them all, made a chart and gave them to him at the appropriate times and watched him take them. DDIL's Dad made an almost-fatal mistake by taking too much of his blood thinner. Her mother posted a pic from the hospital after they'd stabilized him and someone asked what his MCT was. I looked it up- Minimum Clotting Time. It was so high they couldn't measure it. He could have died of internal bleeding. He also was a very smart man, no other signs of cognitive decline, who just made a simple but serious mistake.

 

[Texas Proud]

Not part of the OP discussion but I see people talking about giving pills to seniors and over medication...


We bought my mother a pill dispenser that has a clock and will turn to when the pills are needed... can only get the pills that are needed... the only downside is that if they miss the time it is 'open' they do not get a chance to take them later...


Here is an example pic..

 

[Tadpole]

Looking for an angle with which to refuse this 'medication management'...

And for clarification about this post, * we are fine with taking the meds.*

We are not fine with paying them $450 to $850 per month to administer them.

I wish I had ideas. The charge is excessively excessive. My husband was in an upscale assisted living facility. He had Parkinson's which means he needed med delivery several times a day for the Parkinson's med and twice a day for his other meds. The charge window says these additional ones were "more than 10". He could not do any of it himself. Nevertheless, even with this abnormal circumstance with meds, the charge I agreed to was $289/mo for the drug maintenance part of the contract.

Of course, I don't know but my knee jerk reaction was that, now that she needs the hands-on care, they would rather you decide to move her so they can get a low maintenance client.