Last week a daughter of a resident asked to have her mother’s medication reviewed by the house doctor, to insure all medications were necessary. The MD was a bit annoyed by my request, unsure why he needed to review meds he, himself, had prescribed for her.
I called the daughter quickly as the doctor saw other residents.
” Hey Susan, the doctor is here today. I asked him to review your mom’s medicines….he wants to know what he is looking to adjust? ( I thought if I made it sound a bit more comprehensive and concise,her reply would be specific.)
” It’s simple, mama can not afford to pay for all those medicines. He needs to pick which ones she really needs and get rid of the rest. Matter of fact, tell him to get rid of the most expensive ones and and maybe we can afford the rest. We will just have to see.”
I knew that this news would annoy the doctor even further. But what could I really do? The daughter was fully empowered to carry out her mother’s Power of Attorney and Advance Directives. I was simply the messenger.
” Dr. Smith, the daughter stated that her mother can’t afford all of the meds, and would like to have her taken off of the unnecessary ones.” I braced for his reply.
” What is this? What do you mean? Unnecessary? What is this? If the medications she is on, have been prescribed by me, they are needed, necessary and are to be given.” His thick accent became more difficult to understand as the volume increased.
” I understand what you are saying Doctor. However, the daughter who holds her Medical Power of Attorney has told me she can not afford to pay the pharmacy bill, so she needs you to discontinue the most expensive ones.” Brace for impact number 2.
” Price? This is about price? What is this? Her mother needs the medications to stay in health. What does she want me to do? Stop them? What is the point to her being on any if she can not afford all? There is no point to this. What is it you want me to do, you tell me, Ms. Steele. I am here to make sure all the patients are healthy, not harm them. What is it you want me to do?” Whoa, hold the phone. This is NOT my decision to make…..nor should it be. I can not advise the MD of what he ” should ” do; but rather I can only convey the message to him, and back to the daughter.
Thinking quickly on me feet, I offered; ” I think it would be appropriate for the daughter to bring her mother to your office and discuss with you options….generic or samples….”
Before I could finish, he shut the chart and stood up. ” You tell daughter to bring mother to my office. I will tell her what I have told you. If she wants to stop medications, we will stop. My services will then terminate and the Hospice physician can assume her care.”
I knew the phone call back to the daughter would be just as thrilling. Brace for impact number 3.
“Hey Diane, Jessi Steele. I spoke to the doctor and he would like you to bring your mother to his office to discuss her plan of care and medications….”
” Jessi, if we could afford to pay his office co-pays, we would not even be worried about medications. Why can’t he just stop the medications? What is his problem? All these pharmacies and doctors want is money. Money, money, money. My mother lives off of her pension, social security and interest from her investments. When she is dead and gone, I know she will want to have something to give to her grandkids. But these people want money, money money, money. I pay you every month, pay them, pay for her diapers, pay for this and that and by the time I am done, she doesn’t have a dime left. So what am I supposed to do? Sell off her investments, that she worked hard for all her life to pay for medications and your place when she has no quality of life? She doesn’t know us from the man in the moon. I will call him myself and handle this.”
With that, she slammed the phone so hard it vibrated my ear. Wow.
Investments. Annuities. Afford. Grandkids. Hmmmm. My mind raced. I went to the nurses station and decided to see for myself what medications we were talking about. The list was relatively short. Hmmm. I decided to take it one step further. I called the pharmacy and priced out the meds. The total per month?? Brace for impact number 4. $51.00. Fifty-one bucks. Hmmmm.
“Mama can’t afford it or the daughter doesn’t want to pay it Which is it?”, I asked myself. I may never know the answer but I do know as time pushes forward, I expect to see more people not electing medication administration, but rather, hospice care. I know firsthand, how difficult and frustrating it is to watch a loved one slip under the control of dementia; losing the ability to recognize family and friends. But how do we make decisions that could potentially have adverse effects all because of an inheritance? Now, this would be a totally different question if indeed, mama could not afford medications or services.
It is certainly not my place to judge anyone for the choices/ decisions they make in regards to their loved ones. I know my siblings and I did the best we could for both of our parents, even chipping in money to make ends meet. We stood by as our mother forgot who we were. We visited, supplied her with her favorite junk food and her often sought-after Mello Yellow. We made the tough decisions, always doing what we thought was the right choice….not driven by any other motivation.
Brace for impact number 5. We are all getting older, and one day…..we too, will be at the mercy of our children, grandchildren….