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I ended up in the long-term care rehab facility after I had a stroke and about profession I'm in. I have chronic pain and I'm prescribed pain meds but they think I no longer need them so they're decreasing them and changing the prescription my doctor wrote. Who's allowed to do that?

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I went to a facility for rehabilitation and training after an emergency colostomy and the first thing they did was cut my pain meds in half.

I’m told it’s standard procedure but I didn’t see the staff doctor except for a minute halfway thru my six week stay.

The nurses were stuck holding the bag and they couldn’t explain anything in the face of my fury.

Not only did they cut it in half, they only gave it out on demand, so that by the time they got the request I had to wait til they had run the gauntlet doling out meds to all the patients, which was hours after my next dose was due.

If I asked in advance, they told me I was too early, regardless of the reasons why.

There were a lot of things that were handled differently by virtue of being in a home. One I can think of was full dental procedures I could have gotten if I’d stayed. Procedures that I’m unable to get on Medicaid as a nonresident.

I was not a happy camper and I made enough of a ruckus it seemed SOMEONE should have responded somehow. I even threatened to leave the facility but I was advised that I would get no medical services from that point on as I would be classified as refusing treatment.

I would not have gotten any medications or any ostomy supplies from that point forward. It was a tuff bird I had to swallow after that.

Charlotte
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I wish you would call your primary Doctor, ask questions and see if they can help. Mom’s Dr told me that he was the captain and got all the reports. But when Mom went into rehab they changed all her meds, she got worse and worse. Unfortunately they never called him as I asked them to. By then it was too late.
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You're going to have to be very cautious with narcotic pain medss. They are all being heavily scrutinized now. Speak with the facility doctor.
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You may know all this, but just in case… There are old and new opioid drugs for pain developed over about 100 years. The new ones particularly (eg Fentanyl) can be very addictive. The old ones started with opium, then morphine, then heroin, then codeine. The addictive qualities of most of them took a while to be clear – heroin was originally touted as being non-addictive! Codeine was and is the least addictive – it is not so strong, and doesn’t give the druggie ‘high’ (it just sends me to sleep). The new ones have been pushed by all the BigPharma tricks, and there is now a massive move against them which is fully justified. Much of the abuse has come from people who left hospital with a script for them, then became addicted when their GP just repeated it.

Unfortunately, the opioids usually get lumped in together – our Bureau of Statistics doesn’t list drug details for deaths, only ‘opioid related' (I’ve forgotten the technical expression). Because of fear of addiction, codeine is only sold here in combination with either paracetamol (low strength tylenol) or ibuprofen (nurafen). The fatal dose for both the latter is lower than the fatal dose for codeine, so most hospital admissions and deaths are due to them and not to the codeine at all. Yes, I’ve checked.

As a result of this history, there is now a big clamp down on doctors to limit prescribing any opioid. Here doctors’ scripts are registered centrally, and they get told if their prescription rate is over average, then potentially investigated. It is possible that you have the ‘bad’ variety, have become addicted, and really ought to be weaned off them. It is also possible that you have just been shoved into a ‘one size fits all’ reduction strategy. Check what you are actually taking, not just brand names.

I have an unlimited script for 30mg of codeine with 500mg of paracetamol. I have very difficult pain episodes from scoliosis, that usually take at least a fortnight to resolve, and then I take tablets as needed. When the pain goes, so does the codeine. I haven’t taken any now for over 4 weeks. My doctor knows well that I am not addicted and has no qualms about my use - in fact he is scathing about the current witch hunt so far as it affects moderate codeine use.

Like others, I also recommend that you talk to the facility doctor, and perhaps the above information might help. Your local position may be different, but from what I’ve read it’s much the same as here. Yours, Margaret
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Riley2166 Aug 2019
I too have horrific pain from a spinal injury as well as other severe pain from other sources. My last doctor retired - gave me the lowest dose of a narcotic pain pill - one pill every six hours. However, I never took the four pills - only took one if the pain was off the charts so I was able to function. I live in a facility and no matter what I do or say, no one will give me more than several days worth of pills - taking only one a day. Now I can't even get a refill for one a day and my pain is off the charts. Nothing seems to work except that one drug. So I have found two new doctors - a pain medication specialist and a new doctor. I can't live in this constant pain and will never be a druggie. If the facility won't cooperate, seek out a doctor who will work with you. These places are horrible - you are all lumped together even if what most people do and are is not you. I hate this type of living so I will just keep looking until this problem is solved by a decent, caring doctor.
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Often pain medication orders are written "PRN", "as needed", with maximum doses and frequencies. If that's the case, the nurse has the discretion of whether or when to give the med.
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Riley2166 Aug 2019
While I don't know the brain ability of other residents, they may have to suffer at the discretion of the nurses. I am 10,000% with it and handle 99.9% of all my personal affairs. That means I work with doctors who are helpful and who are willing to listen and work with me and respect me. And, I order and maintain and take care of anything to do with my medications. I do NOT allow the facility to control me - I take care of myself. See if that is an option for you. It would solve a lot of problems.
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Normally the physician in charge of your care in your facility, if that is not your own doctor, would be the one to adjust pain medications as he or she thinks necessary. Hopefully this MD discussed adjusting the medications with you?
If your own physician is the one still caring for you, and not the facility doctor, then the prescription should stand as he or she wrote it. However, if the facility feels that you are having side effects or symptoms they may have their own nurse call your doctor, requesting that the prescription amount or timing be changed.
You almost cannot know exactly what happened here without asking how this happened.
I hope you are not experiencing more pain.
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When my mom was in rehab after her stoke the facility had a hospitalist, like the hospital did, on duty (it was really a group and they took turns being on for 4 or 5 days at a time as I recall) who was essentially her PC while in rehab. My mom is diabetic and one of them decided he knew better than the doctors who had been working with her and managing her care for years and had a much better plan for managing her diabetes. One of the others decided to change around her depression medications (again she had been on them and managed by both a therapist she saw weekly prior to this event and a prescribing psychiatrist who saw her regularly and worked with the therapist, she had been seeing them both for 10 years or more). When the first change was suddenly made I insisted that they discuss any new plans with me and her regular specialist and or PC before making any changes from then on. I then contacted each of her regular doctor's myself about planned or discussed changes and gave them the contact info for the hospitalist as well. I made sure I heard from the doctors I knew and trusted about any changes and only agreed if they concerned but mainly I found that once I put my foot down about her regular team being consulted before medication changes were made that either happened or the hospitalist lost interest in experimenting on Mom. I shouldn't be so snarky, I do think they each had her best interest in mind and believed they were making positive changes however they weren't considering the variety of other factors that may have gone into the plan she was on and the factors that would come back into play once she went home, they were messing with medications that take time to fully know the effects of changing and a fine balance that took years with constant tweaks to balance. They were hospitalist though and in many cases if not all, only had experience with patients in the very controlled environment of a hospital setting with nurses administering meds and daily vitals. I imagine they aren't often questioned by patients and families either and often send patients home on programs that just don't work for them in their home environment which is why so often when you make the rounds to your personal physicians again (something they have you do when transferring care back to your regular team) adjustments are often needed or made all over again. It is infuriating and I can see how it might cause real issues sometimes, all reasons we as caregivers and concerned family need to pay close attention, ask questions and advocate for our loved ones during these medical event's, IMHO.

In your case do advocate for yourself, insist your regular doctor be consulted and whoever is making the changes explains the reasons and details of them to you until you understand and feel comfortable with the plan. I would urge you to include a trusted family member or friend as well if at all possible because this is really too much for a patient to be doing all on their own.
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rovana Aug 2019
Excellent post. Thanks.
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Talk to the doctor AT the rehab. He is the one changing your meds at this point. You might need to call your own doctor and have him get in touch with the doctor over your care at this point.
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When you go into rehab you are under the care of the rehab doctor. You should have a talk with him/her regarding this. Ask for a meeting.
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I would leave pronto.
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Your should contact the prescribing doc or have your representative do so. See what the doc says about their orders not being followed.
I'd be very mad if my meds were abruptly changed by someone that was not my doctor. Did they even ask you what your pain levels were? How would they know you needed less/change of meds?
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My own experience in a rehab center was also that the rehab doctor/facility was in charge.of medication and it was not an ideal experience. Prescriptions might be changed and actual delivery of even those medications was poorly managed. Being in a rehab facility implies that you are participating in a rehabilitation with a goal of enough improvement to leave. When you say "LTC rehab" it sounds more like extended skilled nursing care in which case the facility doctor has final day in medications.
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I know that opioid pain medications are being loked at very closely these days, and the way they had historically been prescribed has been called into question by research. You don't mention if the meds you're taking for chronic pain are opioids, but I've read that this class of medication is advised for acute short term pain (as in after surgery) or for intractable pain in conditions such as end stage cancer. They should no the used for chronic pain, but other alternatives should be tried (other meds, acupuncture, even marijuana if it's legal where you live). It would be well worthwhile speaking with the facility doctor, who's presumably the one changing the medication, to see what their plan of action is. Many pain meds can't be quit cold turkey but need to be tapered. Have you ever seen a pain specialist? If not, maybe you could get a referral to one. Best of luck!
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The facility doctor has the final say and can override a surgeon or primary care doctor's orders. I just appealed a facility decision for my sister and was denied bc Medicare accepted the facility over surgeon orders for a double amputee. The system is broken and it's not in favor of the patient!
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Countrymouse Aug 2019
What did the surgeon have to say about that?
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I expect the rehab facility has its own qualified and licensed medical practitioners who would be fully competent to revise and adjust your prescription. Have you tried asking who signed off the new prescription? When you say "they" think you no longer need the same level and type of pain relief, who is "they"?

Wherever you are living, you're still a patient and you still have a professional relationship with your doctor. If you're not happy with your treatment or medical care, that's who to speak to. If you're not happy with the *doctor*, then there are other things you can do about that.
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A doctor can write anything they like and even discontinue your pain meds.
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Riverdale Aug 2019
She states the original doctor did not change the order but that staff at the facility did. I feel she should contact the doctor who first prescribed the medication. At the very least she should be given the truth regarding any change to a prescription. My mother in AL is prescribed medication by the staff doctors but if she sees a doctor outside the facility for a more specific issue whatever might be prescribed is honored by the facility she is in. They have never overridden this and that is the same with 2 different AL places she has been in.
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What are their reasons when you discuss the matter with them that they think you should reduce? Seems if they wish to change and Dr did not put any suggestions for a reducing regime on the prescription that they should discuss with him before doing so - unless they have an agree drug management for pain protocol in place with the Dr for all his patients.
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My mom is in the same predicament. The Dr.’s at your long term care facility are now in charge.

Are there medical records cords that can be faxed to your facility or the Doctors showing why you need the meds?
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Riverdale Aug 2019
A resident may still have to see specialists outside of the facility. My mother has to see cardiologists ,urologists,dentists,eye doctors for appointments outside the AL facility she resides in. They often prescribe medication which the AL facility has filled with the mail order pharmacy they are in contract with. They don't make changes without consulting the doctor who has prescribed medication for any specific issues my mother may have or has developed.
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Truth be told, every narcotic pain med prescription written is being scrutinized these days.

Maybe they don’t offer that particular medication in that center’s formulary and they had to write a substitute.

I encourage you to make an appt and meet with the rehab doctor to tell him your concerns.
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If you are in a rehab facility, then there's a doctor in that facility that is your doctor while your are there. They take over the prescriptions.
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