Carers giving medication

[TheLazyPanda]

6 weeks ago, after years of refusing point blank to have any outside help, my parents (89 & 96) started having visiting care twice a day from a private company. One of the main needs/concerns was their medication because they had become very confused with it. The breakfast time carer gives them their morning tablets. We asked for the lunchtime carer to put their night time tablets in little pots that we provided (like hospitals use) and leave for them to take at bed time. This has been working fine until the company rang me yesterday and said they can't do this, it's against their medication policy because they can't leave tablets out for later. They said it's called "secondary dispensing" and I googled it and it is a Thing. They presented me with 2 solutions: 1) the family does it - not practical as my sister and I don't live locally; 2) they have an evening visit. This is mad, paying for another minimum half hour visit just to hand out some tablets. It increases the weekly cost by 50% (they are fully self funding). My parents can't be left to do it themselves because my mum's arthritic fingers can't handle the boxes and my dad tends to mess them up. Has anyone encountered anything like this and found another solution? Thanks

Could the carer do something else useful with the spare 20mins?
Eg washing up, lay breakfast, put away laundry etc?

Could your parents have Meals on Wheels to provide a hot cooked meal lunch times and then the carer could visit in the evening instead to give medication? That is what Adult Social Services would recommend.
Edited to correct spelling

Is there a pharmacist at your parents' GP surgery? If so, ask if they can have structured medication review. It may be possible to stop some medication, or swap to once a day alternatives.
You could also discuss this with the pharmacist who dispenses their meds.

This might not be possible though, and moving the lunchtime visit to evening might be a better option.

We've had this issue with FiL with dementia. Had to move him to assisted living and now pay for twice a day visits. Before he moved his doctor's surgery arranged for someone to come and dispense the meds everyday. Where he is now we pay for them to come in and administer from his locked meds box. He was forgetful and either not taking it or forgetting he'd took it and overdosing. If they can't remember then the boxes and dispensed meds won't work.

As others have said, we are not allowed to leave medication in a pot for later, we also are not able to assist with the filling of compliance aids
It's not that we don't want to assist, CQC regulations say we can't.

It sounds as if they need a 3rd visit....possibly from another company who will do a 15 min call

I prefer not to say, but they can't be taken earlier in the day because they cause drowsiness. That would be considered a fall risk.

Thanks for the suggestion, we've already had that review and the meds are as rearranged as they can be. We need a lunchtime visit to make their lunch so it can't be a swap, it has to be an extra.

That's an interesting idea - thank you, I'll look into it!

Thanks. I hadn't thought of getting a different company, will think about it

Are your parents in the UK OP? Any reason they haven't been assessed by adult social services and getting visits via them? You could then top up with private visits in addition if needed.

You could ask their GP for an IBC medication only request. Only the GP can request this as it is literally someone calling in to give them their tablets. You do have to pay, unless they are unable to do it themselves due to being incapacitated, a disability or condition preventing them from taking it themselves, or there is a mental health need.

Don’t let the GP fob you off and tell you it doesn’t exist! Social Services told me about it last year and I have had to fight to get it for my ddad when he eventually comes home, and that’s on the grounds of mental health.

Maybe try meals on wheels for lunch as they will come in and deliver the hot food, so that you can have the medication visit in the evening.

I've been a GP for 20 years and never heard of this. If it's something that you pay for, then you can just contact a carer agency and sort it out yourself - or ask social services - doesn't need a GP.

What about something like this?

https://pilltime.co.uk/

Speak to your pharmacy about options for their medications. They're very good at knowing systems and tools that can help.

PillTime dispense in labelled pouches.

They would open the morning pouches and give to them and leave the sealed evening pouches out for them to take themselves? Would that meet the rules?

My father used PillTime and the only issues he had was the monthly roll came undone like a plastic eel and he started the wrong end so dates got mixed up but when they were in my custody it was fine. And the plastic pouches don't always open if you don't pull at the right place, so have some scissors available to use if they find it difficult.

Can you please use the quote function so it's clear who you are responding to.

Does DM get confused too or is it just the physical opening of the packaging she can't do? Would something like this tool work to help her pop them out of the blister packs?

https://www.amazon.co.uk/Portable-Blister-Remover-Puncher-Splitter/dp/B0CFDK4HGZ?source=ps-sl-shoppingads-lpcontext&ref_=fplfs&psc=1&smid=A364VWXA8AQ3L&gQT=1

Thanks but it's not blister packs, the tablets are in nomad boxes AKA pill boxes AKA dosette boxes. It's not just the arthritic fingers, she's worried she'd forget too.

It is a thing but some local authorities are better at enforcing it with the GPs and local NHS than others.

If a visit is JUST for essential meds at that time and isnt meeting any other need at the same time then that is a health need not a social care need and should be funded by the NHS. Social care happily pay for meds to be administered alongside other social care tasks but they/individuals shouldn't be paying for meds only visits (in theory - what the NHS should/shouldn't fund is a whole other debate, the current state of play is healthcare is free at the point of access)

In my local authority the District Nurses and GPs apply for the NHS funded visits and asked social care arrange them and it was billed back to the ICB. In a previous local authority the local authority identified if meds only visits were part of the package and applied to the ICB/CCG for funding for them.

We find some surgeries are really good at recognising when their patients need support taking meds and applying for that to be put in place and some literally have no idea the option for them to do it even exists. Sounds like you/your surgery falls into the latter camp.

With my parents we just had to suck it up and pay £200 a week just to make sure they were taking their medications properly. At the time I thought it was extortionate but now dad has died and mum is self funding in a care home £200 a week seems very reasonable.

This should not be a GP role. Maybe the DNs do it in my area. We have enough calls on our time. Also it would likely be the ICB's choice to fund or not fund it

IBC....not something I've ever heard of...
I have had one client (in 12 years) who used to have a DN visit every morning re oral meds, so maybe it is a (rare) thing

I think that poster meant ICB (what used to to be the CCG and before that the PCT).

My mum used nomad boxes, but the carers had enough visits to cope with that.

My late husband didn't have the manual dexterity to get into them, so the OT and social work eventually gave us a Pivotell box which allowed me to set the timing and alarm. A light would flash and an alarm would go off. The box would turn round and DH could empty the tablets onto the table using only one hand. It worked well.