My husband has been in memory care for two months and over all, I am happy with the facility and he has adjusted very well. He has a history of agitation and is on Mirtazipine, Lexapro and Depakote (very low doses). He started the Depakote one month before moving to the facility and I think it made the move easier. I have not seen agitation since he's been there and I am amazed at how cooperative he has been. Two aides who care for him, mostly in the afternoon and evenings, have told me they have no problems with him. However, I've been told that he has been combative and actually hit some of the aides In the mornings when they are trying to get him up and dressed. He has limited mobility in one leg and needs assistance. I have felt pressured by the nursing staff to add or increase medications. It's mainly two district nurses who don't even know him well, and they just got a new DON two weeks ago so she doesn't know him either. Because I was afraid of someone getting hurt, I finally agreed to Zyprexa 5mg. It was prescribed by his doctor at the request of the facility. After two weeks they still had incidents and want to increase it. His doctor agreed to double the dosage of the Zyprexa and the Depakote. We get them by mail so he hasn't started the new dosage yet. The last few days he is doing so well and one of the aides who had trouble with him has told me he is doing so much better. He is alert, happy and cooperative. He is walking better and talking better. I got the meds in the mail today and I really don't want to make the change when he seems to be doing so well. The doctor said the increase should not be enough to make him groggy, because he is a big guy. I'm thinking about talking to the new DON tomorrow and ask if they still think he needs it. I suspect they think I am being too controlling but I do not feel they have given him and the aides enough time to adjust. Am I making too big a deal about this?
I am sorry you have to cope with all this-it is not easy to rely on others to care for someone you love.
First, please do not feel you have to apologize for being "controlling". I have been a RN for over 20 years and I know that we can really bulldoze family members with that threat. This is your husband and you love him.
You can always approach the situation with this:
"I appreciate the care he is getting and know we all have the same goal for him" then state your concerns.
If the morning is the difficult time, are you able to go there in the mornings to observe/help? Does he need extra sleep and that is why he is grumpy?
You agreed to change the meds and that change seems to be working. I think it is very reasonable to say you want to wait at least another week to see how he is doing.
You can talk to the DON and say that you are aware that older people process medications differently, and that medications that affect the nervous system often affect them longer than they would younger patients. Older patient's bodies do not clear the drugs as quickly.
Therefore, you are hesitant to make a change until the current dose has been tried for 2 weeks. And be sure to thank her for helping you to ensure your husband's safety!
I encourage people to use this sort of language with health care professionals so that the health care professional feels that you have some basis of knowledge and that you will not be railroaded by their explanations.
I think you are doing everything correctly!
You took their concerns seriously and changed the meds, you followed up with the staff and now there is improvement. So I would encourage you to follow your instincts and hold off on any further changes until you are comfortable.
All of that is said assuming he is not combative, because he cannot be allowed to be a danger to himself or to the staff.
i wish you well, please feel free to reach out for support anytime!
Best
Margaret
Has he always been groggy or crabby when he first wakes up? Some people seem to be only able to grunt until they've had their first cup of coffee. Does he need more sleep? You certainly don't want him combative, and the facility cannot ignore that for the safety of their staff and other residents. Medications may be a partial solution. But I like your wait-and-see approach after a change in meds.
This is soooo hard! My heart goes out to you.
It is very clear from what you say that you are working well with the facility and giving due thought to their concerns. But you are your husband's advocate and you are right to ask for caution.
The aide's comments are encouraging! After all, they're adjusting to him as well as he to them; so perhaps things will improve naturally as they all get more used to one another's routines - and, for example, he doesn't feel he's being wrestled out of bed half-asleep by complete strangers.
Do by all means talk to the new DON and ask to keep the situation under constant review. Might think you're being too controlling? You're not being controlling, you're being responsible. Nothing wrong with that.
I am very glad the head nurse is understanding and respectful. Work with her!