Will a Care Home Give Elderly Mother Access to Better Drugs?

[IAmNotALoon]

My mother is 86, has mental capacity and is suffering from a mental and a physical health crisis at the moment. She is in pain from a neuropathic condition, severely depressed and not sleeping well. I am caring for her 24/7 at the moment.
She has said that she wants to die. She thinks that if she goes in to a care home the staff will be able to give her strong sedatives that will take away the pain, knock her out and hasten her death. Is she right?
She has had a few similar crises in the past couple of years but with the right treatment she has bounced back, so I think we should pursue correct medical treatment first. However she will need more care in the future so I am looking at different options.
Do you think the staff in a care home would be able to medicate my mother to make her more comfortable any more than her GP can?

No. Staff cannot give anything that isn't prescribed by a GP. We're not even allowed to give paracetamol if they aren't written up on the MAR chart.

No absolutely not. As above, medication is GP prescribed. She will have less access tbh, not more as she will be at the hands of the staff whereas now she has ‘free’ rein as to when she takes her meds within regulations. My Nanna waited 2.5 hours for bloody paracetamol after a fall on her care home one day, it was only after I arrived and chased them up it was given. At home I could have done that straight away.

ITA! When MIL was admitted to a NHS pay bed in a care home, they refused to give her paracetamol, when she had flu, as she wasn’t written up for it. SS sent her to another care home, rated inadequate. She got a UTI and the GP prescribed antibiotics. The staff didn’t get the prescription for 2 days, even though we could see the pharmacy across the road, from her bedroom.

GP in my family complains about how care homes don’t get the prescriptions, he’s prescribed.

Ordinary care home care staff are not trained in palliative care, if that is what she is hoping for.

Thank you. I didn't think my mother was right. She hasn't exhausted all the treatment options yet and I think there are medications that could be given without doping her up or hastening the end of life! She has never been suicidal before and I'm not sure how to handle it.

I am sorry to hear about your poor nanna, averychoc. Falls are the biggest fear.

That’s very difficult for you - do you live with her normally? Is she mobile?

No, they can’t but if you’re caring for her 24/7 how sustainable is your current joint situation?

My Mum told everyone that would listen that Dad was finished off by the MacMillan nurses! To be fair she had dementia at the time so I follow her reasoning.

He had terminal prostate cancer that had metasized to his bones. He had a syringe driver and later that night Mum called them back out as Dad was very poorly, in a lot of pain and was very agitated (actively dying).

He would have died anyway, maybe the injection did speed things up but only because he was already on the very edge of life/death. So no they won't 'put your Mum to sleep'. However, if I had been a vet I can honestly say I probably would have done so for my poor Dad and suffered the consequences later.

No I don't normally live with her, but move in when she gets unwell. She has survived breast cancer but has severe "restless legs syndrome" which is causing severe pain and is proving very difficult to treat. Everything goes to pot when she gets low sodium but they won't take it seriously. She eventually gets such low sodium that she goes totally doolally and needs a sodium drip which reverses it.

Clutterbug if my mum doesn't improve ( or deteriorates) then we will have to get help. My preference is to have carers coming in for overnights etc to give respite care, even if I am in the house. I need to sleep! My mother's preference for a home seems to be that she thinks they will knock her out. If she was going for the company and bustle and activity it would be a different thing though. But at the moment she doesn't want anyone around but me.

No. They administer medications with consent and PNR prescribed medications are offered, with explanation, and given if the person wants them (i.e would you like paractemol for any pain today?)

Having said that, the care home my father is in seems to have an excellent system of working with the local GP and DNs, so requests for assessment is done quickly. Our surgery never listened to me (so much so he ended up with sepsis!) My father is on two new medications since going into the home, one which our surgery wouldnt prescribe as they said theres no good evidence it works, but the new surgery feels it is appropriate. So, its possible if the home is linked to a different surgery that the GP will take a different view.

But in answer to your question, the staff wont give anything not prescribed by a GP. My father is very hard work at night but no medication is given for it because he has dementia and is a falls risk - any medication for sleep would make that worse. So, the home take care of him overnight as he is and that is resource heavy.

The system also means things like paracetemol have to be prescribed even if PNRs. So, no buying them for 30p anymore. They will probably be free due to age but will be costing the NHS whatever it is!

I am sorry to hear about your dad, hangrybrick, I know they can give morphine to ease someone's passing. Ironically my mum's neurologist has prescribed morphine for her but it hasn't been the Panacea we had hoped. It made her groggy, didn't take away the pain and gave her confused thoughts. In fact the GP thinks it has made her worse mentally. She has been given an opiate now to try.
The problem with nerve pain drugs is that the effective ones can cause a lot of harm, particularly to the elderly.

Opioid, not opiate.

It is also worth being clear on the difference between a care home and a nursing home. The later has a qualified nurse on site at all times and this does make some drugs easier/more available as they can use professional judgement for painkillers etc and administer drugs that in a care home they would need to wait for a Disrict Nurse.

Much depends on the home. Do they have a good visiting GP?

In our experience, moving our elderly relative into an excellent nursing home was the only way to secure GP services and effective medical care. She was neglected in hospital gaining a bed sore and losing weight and when at home ( although the visiting carers were excellent) the local GPs and district nurses refused point blank to visit ( on the rare occasions we actually managed to get hold of them) and getting any prescription was like getting blood from a stone.

She died pain free and seemed to be comfortable.

Is she thinking of a hospice? Or even a nursing home can sometimes prescribe, although not usually certain drugs which are probably the ones she wants.

So it is possible that the visiting GP in a care home may be more open to try different treatments? One thing that my mother hasn't tried are the benzodiazepines, which can work well for restless legs ( but can also make them worse). GPs do not like to prescribe these, particularly for the elderly, as they are thought to cause mental decline. They are harder to get hold of than opioids for rls, apparently. I think this is what my mother is thinking about. One doctor was going to give my mother diazepine at one time but the prescription got changed to zopiclone (which made things worse).

Things may have changed, but a Nursing home used to have someone qualified to administer drugs, similar to a district nurse. A normal care/residential home would be reliant on a district nurse calling in on their rounds.
My relative was in a lovely care home which had a GP come regularly on Wednesdays to see whoever needed it so they probably can get GP care quicker than mere mortals.

You make a good point about having access to a visiting GP in a home. At the moment it is not that easy to get my mum to the doctor.

Has she tried pregabalin? I find them brilliant for nerve pain and can actually get to sleep on them.

Yes, ITA it’s easier to get GP services. DD1’s care has its own GP practice on site, but that is unusual.

The GP in my family visits care homes every week.

I’ve been prescribed amitriptiline for nerve pain, but as a pp has said, they may not want to prescribe it for an elderly person, as it can cause drowsiness, which could make falls more likely?

I know she had tried gabapentin but not sure about pregabalin. I think she has tried amitriptyline in the past ( I know someone in the family has) but can't remember the outcome. She may not have given it a good go. I shall raise both of those with the GP, thank you.

I think one issue is that GP practices vary as we all know. Some will give a better service to a care home than others. I've heard of some that just use physicians associates for the care home. So as well as finding a good care home you'd need to look at the local GP.

Has your mum considered an advance decision? This would give medics instructions on her wishes should she become incapable, different from LPA.
My mum never lost capacity even when very ill at the end and we found medical staff very keen to understand and respect her wishes.

I dont think its that a care home GP is more open to different treatments. Its that a different GP might be open to a different treatment. Some treatments are black and white. But if its a grey area, then a different GP might have a different view.

Assuming she moves GP, that is. My father was with a different practice to the surgery the care home uses, so he moved.

As for access - yes, I think a good care home that has built a trusted relationship with the surgery, gets scheduled access. So they have regular opportunities to list the issues they have with their residents.

When you think about it that makes sense. His home has up to 32 residents and at any one time will probably have one on end of life. They may as well have scheduled calls and visits as that keeps what could be organised chaos controlled and the home have staff that know their stuff so they arent going to be raising issues without thinking about the obvious first.

My Dad hasnt looked so well since we lost my Mum. I truly believe moving him into care was the very best thing for him. Having cared for him myself for 2 years here at home I can say, while its expensive, its worth every penny.