by Flora Bessey, Pharm.D., BCGP

Concealing medications, a pharmacist’s response….

As a consultant pharmacist, facilities depend on us to show them the way with regards to medications.  One issue as described in a vignette by Dr. Luxenberg last month deals with hiding of important psychotherapeutic medications in the resident’s food to ensure consumption.  The short and simple answer to this is we can’t do it. Period.  No matter how vital the medications are, no matter how sick the resident is, they retain their right to refuse.  This appears in the law and across regulations. (42 CFR §483.10(f)(2)

The only exception may be if the resident is conserved.  Conservatorship is vastly different from authorization granted by the responsible party or family.  With conservatorship, the patient has been deemed incapable of making their own decisions and the court has appointed a conservator.  This person may be a family member, but it is someone who has been appointed by the court.

by Patricia Bach, PsyD, RN

As one of the most innovative state chapters in the country, CALTCM has once again taken the lead to support the next step in AMDA—The Society for Post-Acute and Long-Term Care Medicine's membership expansion efforts.

Many will recall 2013 as a banner year for AMDA, with expansion of full general membership offered for the first time in the history of the organization to nurse practitioners (NPs) and physician assistants (PAs), in what was previously a physician-only category. In addition to voting rights and membership in the House of Delegates, a seat on the AMDA Board of Directors was made available to NP/PA member candidates elected to this position, thus affording an opportunity for collaboration in governance at the highest levels of AMDA leadership. Given its role as a supporting state chapter and House of Delegates Resolution co-sponsor, CALTCM played a critical role in facilitating what was clearly a major paradigm shift and culture change in our national organization.

Provided by Jay Luxenberg, MD

A 78-year-old nursing home resident with mild dementia and a long history of schizophrenia controlled with an oral antipsychotic was given a trial of antipsychotic tapering and discontinuation by her primary care physician. Several months later she began demonstrating increasing paranoia and delusions. The physician reordered the antipsychotic, but she had begun refusing to take medication due to her suspicions about the healthcare system and medication in general. This included her medication for co-existing medical conditions such as hypertension.

by Timothy Gieseke, MD, CMD

As a senior physician, I have cared for many 80+ y/o’s with Shingles (HSV).  In this age group it’s common to become severely depressed and lose > 10% of their weight.  In addition, if the feared post herpetic neuralgia (PNH) develops, many of their lives are forever altered despite applying current therapies to mitigate the pain.  For this reason, I highly recommended the Zostavax live vaccine when it became available in 2006.  Unfortunately, this vaccine has not been very effective in 70+ y/o’s (18%) and immunity starts to wane after 3 years.  In addition, as a live vaccine, it couldn’t be used in immunocompromised hosts, the very patients who are at greatest risk for Shingles.