Advice on medication in Care Home

[SusanH]

I wonder if anyone can help with any advice on the situation we find my Mum is in at the moment? Mum has been living in a residential Care Home for the past four months. The home seems excellent and she seems content and far more relaxed than when she was at home. She is visibly well-cared for, although she has lost a lot of weight (she had plenty to lose). She rarely speaks now and the medical staff think she has suffered further deterioration with her vascular dementia.

My Dad had a worrying phone call from the Care Home today to say that Mum is refusing to take her medication. They have contacted her doctor to ask if the medication can be given in liquid form, but he says not and that it is the right of any patient to refuse medication. The Care Home have other patients (with another doctor) who have been given liquid medication and my Dad thinks the doctor's refusal may be linked to added cost. (If this is the case I will be furious!) Does Mum have the right to refuse medication,even though her medical condition is such that she lacks capacity to make judgements?

Has anyone else on TP had problems with their loved-ones refusing medication whilst in a Care Home? Any advice on how we should proceed with this? Do we have a right to talk with the doctor ourselves? I am so upset for my Mum. Dad says she seems to have problems with the capsules as she finds them hard to swallow and when she chews them they taste horrible. He has suggested to the Care Home that they contact the consultant at the Memory Clinic if the GP is being unhelpful.

Any advice would be very gratefully received.

Sue

 

[jenniferpa]

While there could be an issue with capacity you may well be right about the cost issue - liquid meds often cost more, sometimes a lot, lot more than tablets. What medications are we talking about? Under the circumstances the doctor "should" be willing to discuss your mother's medical with your father, but I'm sorry to say this, sometimes doctors hide behind the confidentiality wall when they are just being lazy. Have you considered moving your mother to the doctor who seems more receptive to making accommodations for the home residents?

 

[Lanie]

I wonder whether it may be better and faster if your Dad contacted the consultant at the memory clinic and explained what is happening.

Take care

Lanie

 

[fearful fiona]

I had the same situation with my Mum in the first care home she was in. I asked if she could be given her medication hidden in food/drinks and was told that it was illegal and a breach of her human rights.

This is obviously a very controversial issue, and understand that if this were made too easy, it could lead to all sorts of abuse. However Mum deteriorated and was sectioned, and on the approval of the psychiatrist, the GP and me as next of kin, she was given her medication "covertly". She was discharged and is now in an EMI home where the medication is hidden in a glass of orange juice, and also given a fast dissolving pill that they put on her tongue and it has dissolved before she can spit it out.

I have a suspicion that Mum would still have the right to refuse medication and that the turning point was her being sectioned, so I'm not sure if this is much help to you. I do hope however that you manage to find a solution to the problem.

 

[SusanH]

Thank you both for your swift responses. We can't switch my Mum to the more receptive doctor, because his list is full and he won't take on any more patients from the Care Home. The Care Home had terrible difficulty finding a doctor who would take my Mum onto their list So much for the caring profession

We are talking about medicines for high blood pressure and statins for cholesterol, also an anti-psychotic and galanthamine for the dementia. Without the medication Mum is not only at increased risk of a stroke, but also more fearful and aggressive.

I will suggest to Dad that he speaks with the consultant at the Memory Clinic, but I know he will want me to speak with them instead. He seems to find it difficult to deal with "officialdom". I'm not sure they'll speak with me, but I can try.

Thank you for your support and suggestions.

Sue

 

[SusanH]

Thank you Fiona too - I posted at the same time as you and didn't see your reply! I hope it doesn't come to Mum being sectioned Dad had had terrible problems getting her to take her medication when she was at home, but she appeared to be much more settled at the Care Home, so it is so disappointing to hear of this development today. Apparently Mum is spitting out her tablets, or throwing them at the Care staff. I do hope it doesn't mean the Care Home won't have her as she seemed so much happier there.

Thanks for sharing

Sue

 

[Sandy]

They have contacted her doctor to ask if the medication can be given in liquid form, but he says not and that it is the right of any patient to refuse medication. The Care Home have other patients (with another doctor) who have been given liquid medication and my Dad thinks the doctor's refusal may be linked to added cost. (If this is the case I will be furious!) Does Mum have the right to refuse medication,even though her medical condition is such that she lacks capacity to make judgements?

Hi Sue,

From I can gather, the patient's capacity to make an informed decision is the key to what can and cannot be done.

If you Google the terms "covert medication" you will find a range of documents that are relevant (I list a few below). If you add to the search the name of your Primary Care Trust, you might even find the guidance that relates to your part of the country.

Here are some documents to review (all PDF's):

http://www.rcpsych.ac.uk/files/pdfversion/cr126.pdf (Royal College of Psychiatrists)

http://www.dorsethealthcare.nhs.uk/Portals/3/Policies/CP-096-08.pdf

http://www.nmc-uk.org/aDisplayDocument.aspx?DocumentID=69(Nursing and Midwifery Council)

Your plan to contact the consultant seems the best way to go. I read one online article that assessed various health professionals' understanding of capacity legislation/guideance - GP's got it right 20% of the time and psychiatrists got it right 58% of the time.

One of the factors in the guidance I read is whether or not the person willingly took the medication when they did have full capacity.

Also, it's worth mentioning that liquid medication does not necessarily need to be disguised - it can be given openly. However it will quite possibly have a disagreeable taste, so your mother might still come to reject it.

Take care,

Sandy

 

[Tas_Bhatti]

Covert Medication and the right to refuse

Hi Sue

Sorry to hear about the problems with your mum.
There are two issues at stake here - the right to refuse medication and the ability to covertly administer medication.

The starting point is that everyone has the right to refuse to take medication. This extends to people in care homes as well as the general public living in their own homes.

However in cases where an individual lacks the mental capacity for whatever reason to make a sound judgement as to what is in their own best interest, then the law allows for a "multi-disiplinary" team to meet to discuss and decide if covert or forced administation of medication is in the patients best interest. This team usually comprises of the GP or consultant, the responsible person in the care home, often including the carer who actually looks after the individual, the pharmacist and relatives of the individual.
These people need to firstly decide if the indivdual is incapable of making a decision and then decide if the covert or forced adminstration of medication is in the best interests of the individual.

Before it comes to this however, alternative avenues need to have been explored such as liquid formulations or changes to formulation or indeed a different person adminsitering the medication. Only then should covert medication be considered and only if the formulation is suitable to be adminsitered covertly.

as regards to cost, whilst some liquid medication can be more expensive to the NHS, this is not always the case, and often the medication can be changes to one that is available without having to resort to "specials manufacture" which is often pricey.

However I must say that cost is not usually a driving factor in the decision making process as GPs and Pharmacists are obliged to act in the best interests of patients above anything else.

On a final point, you can absolutely ask to be involved in any meetings which are convened to discuss your mothers health. Care homes and GPs take the "diginity in care" agenda seriously and are usually very happy to involve close relatives.

 

[Margaret W]

Hi Sue

I am trying to take a more relaxed view from others, I might be wrong. Has your mum actually indicated that she doesn't want the medications or is it just that she can't swallow them? I ask this cos I had a stroke myself 3 weeks ago, and am taking a whole barrage of medications (including statins) and despite being reasonably young and fit, I find some of them hard to swallow. The huge Asasantin takes at least four gulps, and even then I often gag at it. It cannot be chewed, it has to swallowed whole, and the idea is it seeps into the bloodstream bit by bit, if it is chewed, it goes to the blood stream at once. The tiny Levothyroxine chokes me as it has no smooth coating and sticks in my throat. I don't envy any person with a quantity of tablets to take. Maybe if mum was given them over the morning, rather than all at once? It won't really matter. Two at 9 a.m. two at 10 a.m., two at 11 a.m. I must admit it is rather unpleasant trying to get down 7 tablets all at once. And once you have struggled with a tablet, it is psychological that you will struggle with the remainder.

I applaud the idea of someone who said take it with yoghurt, that provides lubrication as well. I will try it! Even milk might be easier than water. I can agree that cost might be an issue, but a liquid drug gets into the system very rapidly and that might not be appropriate for some slow-realease drugs, such as Asantasin.

Hope you get your mum to take the drugs. Eating a banana might help, soft and smooth.

Good luck

Margaret