Expert: Ivan Goldberg, M.D. - 1/25/2010

Question
Hello,
My mother is in an Assisted Living facility in Kennesaw, GA.  She is a geriatric psychiatry patient.  She is having difficulty (refuses) to take her medication. Once she stops taking them, she gets aggressive and this results in a hospitalization and a resulting loss of placement due to her behaviors prior to hospitalization. She does not acknowledge anything is wrong with her, and the placements get frightened if we tell them she has a mental illness.  Hence her primary diagnosis is vascular dementia but she also has bi-polar with paranoid features.

The doctor has prescribed a longer acting medication (injection).  She requires restraints to administer it.  Usually, once she is stabilized, we can move to administering medication through a crush order.  The problem begins when a new staff member uses the word “medication”.  We have found a wonderful placement and do not want to lose it.

Besides the dementia and paranoia, she is healthy, ambulatory, and active. It would be cruel to place her in a nursing home.

Do you know of any resource that would come to the Assisted Living and administer these shots with restraints?

Again, this is usually only needed during times of agitation until she is again stabilized on medication.

I'd like to avoid the revolving door hospitalizations which will be happening again today.  Usually these are followed by a loss of placement, which is difficult for her.

Thank you,
Carol


Answer
Carol . . .

I can thik of only 2 possibilities:

Have an outside physician come to the Asssited Living facility and administer the injections;

2. See if there is a Visit Nurses agency that will send a visiting nurse to give the injections ordered by a physician.

I'm sorry I cannot be more useful.

Best regards . . .

Ivan
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