Changing Client Meds for Staff Convenience
My son just was placed in his first group home since moving to another state 10 months ago. And I was out of state at a conference, hoping that the staff would get things right and squared away. Wrong. I learned (as I was 400 miles away) that instead of meds given four times a day, in a very carefully planned order, the medication staff set up his med log sheets with ganging all 14 pills together in the morning and then all 8 for the night at once. For his entire life he has had four med times and this was stressed in the staffing last week. He has difficult and precise pharmacology, such that one med is given upon wakeup and then a different form of it in a sustained release is given an hour later with breakfast. He has six different medications in the morning. It makes a big difference the order given and the combination at one time. Two involve a careful calculation of time for one form and then a later sustained release form. One anti-convulsant is also a stimulant, so it must be given at supper, with food. Then at bedtime (10 pm) the other two anti-convulsants and a tranquillizing-form of medication is given. I learned by phone from the new staff that all were ganged into two times daily, only, because "that is how we do it". After two days of phone calls back to the administration of the group home, no calls were returned. I specifically asked that it be resolved by Friday so he would not have to go the weekend with continued pharmacological stress. Guess what, I arrived in the middle of the night on my way home from my conference and had to pick him up to bring him back to my own home until this can be resolved. Of course, Monday will be the earliest opportunity to talk to the doctors and the medication staff responsible for this travesty. I could just scream. My son was knocked out tonight by all the meds given at 8 pm, all the meds which were for 6 pm and for 10 pm. We may have to go to the ER just to get new orders written AGAIN by doctors in three specialty areas so that I can return him to the group home.

The larger issue: how can care givers ignore what is best for the client and boldly decree how the meds will be administered and for their convenience? 25 years of careful pharmacological management, down the tubes due to an agency that wants to do what is convenient for staff. Oh, this is going to be a gggreeeeeaaaaaatttt next few months of adjustment. Now, how do I decide to politically handle this and phrase my language "just so"? There must be a change in the "System" to meed the needs of clients - too bad it must be a forced issue. And now Mother Bear may immediately appear to be one of "those" parents/guardians.
- posted by BJ @ 6:03 AM |

 
Blast From the Past about Cereal Bowls
Recording this story into this blog because it is one I forgot happened until last night when my son was attacked in a group home by another client. He is fine, and the attacker is a fine young man who is not known at all for such behavior. Although he was hauled away to an overnight emergency respite and the police were called, it is something that happens to those in dependent care on a regular basis. It is thought that perhaps a recent med change caused this aggressive behavior, so that is being looked into. Yet these situations are not handled at all, not at all as would be with normal young adult men. Just think, normally men could get into a scuffle and they would work it out somehow. Yet if one is a dependent adult, everyone goes nuts and an "emergency call" is made. I think to the time that my own son may act out like his roomate. Yes, it "can" happen. But his life in dependent care makes everything so bizarre and under a microscope. We are truly repressive to people by the tendency to make everything criminal and legal means to sue.
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September 21, 2003

How a Cereal Bowl Leads to Psych Ward

Yesterday, my 24-year-old son argued with a young woman. He yelled at her, called her names and tipped his cereal bowl over at breakfast.

So, why the title?

He is in a dependent-care supported-living home where staff is present to assist him and two other disabled young adults. In this case, he argued with his staffer, a young woman who has worked there four months. Like many young men, he does not like to be "bossed around" and he was angry. So he called her a bitch and accentuated his frustration by tossing his cereal bowl over on the table.

What does she do? Calls her supervisor and says she is afraid of him and that he needs to go to a Psych ward.

So the supervisor came and took my son to the local emergency room, where the doctor present was incredulous as to why this incident required an ER trip. The supervisor said that his staff felt threatened, and insisted that my son be evaluated and placed in the Psychiatric unit.

The supervisor called to tell me that my son was going to be admitted. When he told me what happened, I said, "It is not acceptable to have him punished for something so small. This is part of his disabilities," as he has extreme ADD/HD and Organic Personality Syndrome with his major handicaps of hydrocephalus and a seizure disorder. "This would be punishing him for something he can't control. Was it so bad to warrant an ER trip, let alone an admission?"

I reminded the supervisor that this same staff member was responsible for a total of six admissions of the three residents in the four months she has worked at the home. Two for my son, two for a male roommate, and one for the female roommate.

And now she was requesting a sixth Psych ward admission since she "felt threatened" and my son was verbally abusive.

Think ahead to some of the ramifications of group home agency's having such a policy, where the clients must be perfectly docile or they are threatened with being sent to the Psych Ward. Come on!

I immediately called that ER. The doctor evaluating my son said that my son was fine and he did not consider it an emergency. Did I? He said, "Maybe I have to admit him, because the agency says they will not take him home."
"Is he a danger to himself or others?"
No, he was quietly coloring pictures.

The doctor also said that the agency "routinely tries to dump clients here."

I thought it was an abusive situation for one adult to have the power to punish a client so severely for having an argument. He agreed, and he said he would talk with other doctors and recruit a social worker for help because he did not want to admit my son to a Psych Ward.

The ER social worker told me my son was fine, agreeable and still coloring. She did not feel this warranted a trip to ER or an admission.
My son's assigned county social worker also felt it was ridiculous to have brought my son there. He was most disgusted and told her it was most certainly not an emergency and the agency should not attempt to dump his client. It was ludicrous.

She said they most definitely would not admit my son, and further the doctors in the discharge notes would instruct that the agency was no longer to bring my son to ER there for such a thing. Yeah!

Three hours later, I received an irate phone message demanded that I call the agency office within the hour, to discuss their deep disturbance that I hindered their admission of my son to a Psych Ward when it was "only to prevent harm for their staff that they determined he needed to be admitted."

Last night I called my son and casually asked how his day was.
"Not so good," he had a bad headache and felt sick.
"How was work today?"
He didn't go.
"Why not?"
"J. took me to the hospital so I couldn't go."
"Why?"
He didn't know or have any idea!

"Did you get up and have breakfast OK?
My son said "I think so," but a staff person came in his room this morning to wake him up and the staff would not leave his room so he could get out of bed and get dressed."
"Who was the staffer? Was it J or T, K or L?"
"No."
"Then who was it?"
"Oh yeah, it was S".

What happened then? My son could not remember. But he did say that "she would not leave my room so I could get dressed!" and he was really bothered by this.

I am just glad I decided to follow up with him and discuss the incident with him on his level. As I predicted to the doctor and social worker, he did not remember it at all.
So we talked a bit more, and I urged him to inform his night staff of his headache so he could take some medicine. He did this while I waited, since he told me that he hadn't told his night staff about his headache.

When the night staff came to the phone, she said, "Well, maybe that is why he's been in bed since 7 PM tonight!"
It was now 9:30 PM and if I had not called my son, he would have continued suffering all night.
I learned today that shortly after my call he had had a 45 second seizure.

My son is 5'4" and weighs about 85 pounds. The only staffer with whom he has problems with is the same one with whom the other residents have problems -- 22, 5'7" and 250 pounds.
Yet, the agency is up in arms because she "feels threatened" by my son. She'd now done this same thing six times in four months.
Wouldn't a reasonable person think that she is perhaps unsuited to her job?

I am concerned about the larger harm to him and to so many dependent people being abused by an agency that is supposed to be able to care for them and obviously is not doing the jobs.
Is this a horror story just for this particular agency? No -- this is one of the best direct care placements I can see for my son and his needed routines. When the ER doctor told me that the agency does this same thing frequently "because they can't handle client behavior," I realized how much harm is being done.

People in supported-living are often on Medicaid or Medicare. Think of the costs to our government and our society for such neglect and trivia. I would guess that each ER trip is about $500 and a typical three day "observation stay" in a Psych Ward may be about $4,000.
Now do the numbers. Are you mad, too?

I will keep up with this accounting. It's time to record faithfully for my own peace of mind, as well as to record what sadly may be needed for documentation.

I received a call from the agency management today: In the future, they will continue to bring my son to the ER for admission and no other agency is going to dictate to them how to take care of their clients. "We will not drive him to [my son's lifelong hospital center 30 miles away] as the local ER tells us to do if we really think he needs an emergency admission. In the future we will continue to take him to the local ER, and if they refuse to admit him we will call the police every time."

If any of my friends wonders why I decided to move back to the state and locality where my son lives, this account pretty much explains some of the urgency I felt to move back here. And remember, this is one of the better care situations out there.

I've taught Special Ed Behavior Disorder, worked in two residential treatment centers, and worked five years in group homes in another state. I do not make my comments or decisions lightly, for I have been on both sides of care issues from staff to parent.

Signing off for now,
Mother Bear

- posted by BJ @ 10:07 AM |