Thursday, October 24, 2013

The Rules of Skilled Nursing

So, I was worried about having to learn about MediCal now that Dad will be moving to a nursing facility.  What I should have been focusing on was the difference between Assisted Living/Alzheimer's homes vs. a Skilled Nursing Facility.  There are a lot more rules in these types of facilities...

For example, we just recently found out that Dad is not allowed to be on an anti-psychotic drug.  Since these drugs are really meant for patients with mental disorders like Schizophrenia or Bipolar Disorder, the skilled nursing homes cannot administer these drugs to Alzheimer's patients.  I don't know for sure if the problem is with anti-psychotic drugs or with drugs that have the federal black box warning on them, but it's basically the same thing.  (I understand the origin of these rules... the government is trying to stop the over-medicating of patients in nursing homes, which is a good thing.  But what about when someone really needs the drug?)

So our problem is that Dad is on Olanzapine (Zyprexa) which seems to be curbing his aggression really well.  The skilled nursing home that I toured the other day said they would just take him off the drug.  But, again... we have a problem.  Patients on these drugs need to be slowly weaned off in a controlled environment and then once that happens, doesn't that mean Dad would just become aggressive again?  And I think we know what will happen next.  He will be kicked out of the Nursing Home because they won't be able to handle him.

When I shared my revelations with the Doctor and Social Worker at the VA, they seemed surprised.  Needless to say, Dad isn't moving anywhere until we can get the medication figured out.  And the Social Worker assured me that if he was kicked out of the new home that they would just return him back to the psych ward.  So much flip-flopping around.  Poor Dad.

The only good news is, I really liked the home that I toured.  It's called Del Rio in the city of Bell Gardens and the facility has big outdoor spaces, wide hallways, and a clean appearance.  I kind of like that it backs up to the LA River too.  It seems appropriate since Dad is a genuine Angeleno.


  1. An elderly person without cognitive impairment may have trouble remembering his medication schedule, and the assisted living facility provides assistance with administering medications. most of the assisted living facilities have rehabilitation programs designed to slow progression of the disease and deal with the more problematic symptoms, such as agitation and aggression.

    So, assisted living is better.

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