Good! Maybe She’ll Wake Up!

This is a true story told to me many months ago by a woman I’ll call Sylvia. Sylvia got a call from the nursing home where a long-time friend of hers was living. Sylvia was not power of attorney for this nursing home resident, but the nursing home knew she was a close and long-time friend and that she was planning an out-of-town trip. Staff called to tell Sylvia that her friend was being put on hospice care.

In a sense it was not a surprise to Sylvia. Through the course of her faithful visits, her friend had “deteriorated” cognitively. She did not always recognize Sylvia; often she could not engage in meaningful conversation or call Sylvia by name. On more than one occasion Sylvia could not rouse her friend. “Dementia” the nursing home said.

“I’m going to be out of town for four days,” Sylvia said with some anxiety. “It’s okay”, she heard the voice reply. “She’s stable now. We are enlisting hospice and we will be taking her off her routine meds.”

To her later amazement, Sylvia heard her say to the staff person, “Good. Maybe she’ll wake up.”

She did!

The nursing home resident is no longer on hospice. She is alert, always recognizes Sylvia and calls her by name; she shares stories of earlier days when they lived on the same block in a tight-knit neighborhood. She laughs. She asks about this one and that one as if -- as if -- she is actually engaged with life again!!

Such is the tragedy of over-medication, or possibly drug interactions resulting from what is called polypharmacy. The topic of over medication has been addressed in the blog many times. It is a major concern to governmental regulatory agencies that have strict guidelines about the use of “Unnecessary Drugs”.

It is a concern for those long-term care practitioners who sincerely want to execute that part of the nursing home reform statute (commonly called OBRA ’87) that mandates that their organization “must” provide the necessary care and services to enable the resident “to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”

A resident cannot attain or maintain her highest practicable level of functioning when she is medicated to the point of obvious sedation, or sometimes even to the point of being so sedated that she cannot be roused, cannot open her eyes or even lift her head which is at a 90 degree angle to her body as she sits in her wheelchair.

It’s not right. It's that simple. I hope that anyone reading this blog who has some responsibility for or bond with a nursing home resident will be on the lookout for such obvious markers of over medication. The response should be that of an advocate. A strong, loving advocate.

If one would hire a person as an attorney who has no knowledge of the law, how smart would that be? The answer is obvious. The same is true when we are called to advocate for another. If it is a resident in a nursing home, then the advocate must know what the standards of care are before an issue can be adequately addressed.

Where does one go to learn what the minimum standards of care are? And do these minimum standards matter if the person in the nursing home is not in a licensed nursing home? Tune in tomorrow!