What do I do now?

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What do I do now?

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Mom agreed to assisted living. Everything was paid for and set up. Furniture moved. Even Pictures hung on the wall. An hour before she was to go there, the nurse of the facility told her she would meet with her in the morning to discuss her medication management. At that moment mom called it off. She refuses to go now because her medications will be managed. I'm quite aware my mom has an addiction problem ...Thats why we chose to go to assisted living. Now I'm out over $6000. I live overseas. Friends did the moving. I can't ask them to move it back. I don't want to ...because the same stuff of repeated hospital visits for "anxiety," falls, and depression are going to continue. I'm at a loss. I don't know what to do. Is it time to step back and let her go it alone?

She blames us all for pushing her, even though she was excited for the last weeks until it came up about the meds. She is now living in her condo which has no bed, an uncomfortable pull out sofa and no clothes (all at the facility) not even a coffee pot. But she said she prefers this to having her meds managed.

I'm at a loss... Any thoughts welcome.

Only child...no other family

Addiction Assisted Living Care Decisions

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I told my mother when she pulled this, that she could not get her money back, there is no choice. I Live states apart. The difference for you is that you weren’t able to be there, I flew in for three weeks to make the move. And sell the home. But it was pulling teeth. My suggestion to you is to be firm don’t go back, don’t give in. Maybe your friend can step in , Be firm with her and move her in. Just don’t give her a choice.

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Oh , and eventually she will get tired of her current accommodations

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You may have to wait for another hospital visit and make sure that discharge is to AL and not home. Who owns the condo? Is it paid for or still a mortgage? Do you handle her finances? Stop paying for anything having to do with the condo. Also contact Protective Services and report her unsafe living conditions.

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She owns the condo. The plan was to rent it to help pay costs...There is still a mortgage. When she agreed to go , she agreed I could handle finances but Im guessing shes gonna take me off her account again.
The last time she left the hospital , she left against medical advice. They reported her to protective service. By the time they followed up a few weeks later I told them she agreed to go to ALF. So Im not sure if they kept the case open. Ill have to check

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You should not be using YOUR money to pay for your mother's care. Her funds pay for her care.

Step back, call APS (or have a friend do it). Do not sign as "responsible party" for any of her care, unless you are signing for her her POA.

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Thanks for your answer ... I did sign as her POA. We have Long term insurance but it wont kick in for 90 days so we used our private money for the up front costs. Móm has none. Only SS and credit card debt.

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What meds are she 'abusing'? Or is she just afraid of losing her power to live as she wants.

Can't she forgo the medication management is it's for chronic pain? If she's on a lot of other stuff, maybe all they'll 'manage' is that and let her get her other meds on her own.

As a chronic pain patient myself, I would hate to have someone standing over me, telling me what I can and can't have, and when.

One of my clients in ElderCare had Parkinsons's. Her meds for Parkinson's were very carefully metered out. Her pain pills were on her nightstand and used as she needed them.

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Its an opioid pain med for chronic pain. and prescription sleeping pills and an occasional xanax or prosac in the mix.
Shes supposed to have 1 a day of the pain med...she takes up to 3 that I know of and runs out ahead of the prescription and ends up in the hospital going through withdrawl which she translates as Im dying. Multiple times. Its a circle that continuously happens and is happening more and more often.

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Only child here! My mom is an alcoholic and is dependent upon/addicted to Benzo's (Klonopin). After the same cycle you indicate - anxiety, falls, medication mis-management, for years, the doctors suggested I place her in an ALF. I loved, loved, loved having her "contained" as I chose to describe it :) She, however, hated it and moved herself back to her home after 5 months. I had no way to make her stay there, legally, and she was insistent she was coming home even though she uses a walker, has fallen and broken many bones, and has no friends or support except me. Sigh. Ultimately we are placed in the position of waiting for a serious fall or other such thing. Living at home alone, drinking, popping pills and wobbling around, my mom will eventually reach a point where assisted living will look wonderful because she will be going straight to skilled nursing or something like that. She's only 78, I fear I've got a long road ahead.

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Oh Geez.. Mine is 85. Im sorry . Im thinking this is the case. Just wait for the next crisis. I however am doing this from 6000 miles away. No visits...especially not now with Covid I cant even travel. Ugh.

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Is your mother competent? If so you can’t make her go anywhere. My mother is turning 96 next month and is competent and still lives alone in her house. I can’t make her leave. She said she is going to die on her home. I tried everything to get her out of her hoarded house. I was told there is nothing I can do unless something happens. If she falls, if she has a stroke. So in the meantime I wait for a crises to happen. I go visit my mother once a week and my son goes to her house 2 or 3 times a week.

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Yes, I would step away and tell her she is on her own for all care, for moving back home, and for any incidents that occur in future. You are overseas? This is pretty much impossible and I would tell her so. She is very unlikely to give up her addiction. As they say, for the addict, the drugs come FIRST. So let her negotiate her own world, and tell her once she takes a fall or becomes helpless, someone a good deal less understanding will manage her addiction. I do not know if you are POA or guardian? I hope not. POA is a tough job; I did it, and that was for a quite with it man who was honestly the best man who ever lived in my book. So you have my sympathy.

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Five years ago you would not be labeling mom as an 'addict'....the war on drugs has taken a nasty toll on people who NEED pain relief on a daily basis.

ONE pain pill at some point in the day is probably not covering her pain well. Prozac is taken everyday, or it's pointless. An occasional Xanax is not a problem. A LOT of people take something to help them sleep. Without good sleep, chronic pain becomes the overarching theme in your life.

What she NEEDS is a pain management dr. who will listen and compassionately treat her. Then, when she feels she can ask for and receive the meds she NEEDS to keep comfortable--I bet she sings a different tune about moving.

Until you have lived with chronic pain-- the kind that NEVER goes away, but is simply managed so you have a semblance of QOL, she isn't going to be amenable to letting someone else handle her meds.

There are MANY different 'cocktails' of meds mom can take to relieve her aches and pains. Just labeling her a drug addict doesn't help and is super offensive to those of us who DO have to take something daily to manage pain.

Just my opinion. And personal experience.

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Midkid58, my mom mis-manages Klonopin (a Benzo like Xanax). Sadly, she was put on it decades ago for sleep & anxiety. She takes it like candy, morning and evening, and sometimes in-between. There is always an excuse, a reason, a drama, why another pill is needed. It's a controlled substance, so when she doubles & triples up on her pills, then she runs out and, guess what, no refill for days/weeks. Withdrawl symptoms begin within 48 hours and they can become quite severe. A few days ago she informed me that she's run out of pills (again) and now she has to wait 5 more days for refill. She called 911 yesterday and was transported to the hospital. They told her it was just anxiety and turned her out almost immediately. This is a constant cycle we are on and it's rung me out. The doctors recommended assisted living last December due to her medication mis-management, but she moved herself out and back to her house in May (over my objections). Her life revolves around the pills. I refuse to let mine revolve around the pills any longer. I don't call her an "addict", but she is dependent upon the drugs, and her dependency causes significant life disruptions.

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Amy, who manages your mom's pain meds? How often does she see that doctor?

We have a poster here, Dorker, whose dad has chronic pain and is in end stage cancer. His demented wife INSISTED that he was abusing Oxycontin. Dorker believed her.

It comes to pass that dad is hospitalized and in rehab and Dorker mentions this "addiction" to the staff at all of the places. The medical professionals see NO issue with the number of pills that this elderly man is taking.

Pain is a frightful thing. I know that you are far away and that that makes this whole situation terribly fraught. If you have a label of "addict" from a qualified medical professional, then so be it. But taking 3 pain pills a day does not an addict make.

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She is/was a recovered alcoholic..The adiction symptoms are there and have been for a while. I ignored it and thought no...its fine for a long time.

She has decided to stay in her home now.

She was reported to the authorities after the last time she was in the hospital that she should not live alone. They called me and I told them we organised assisted living. Now I need to call them to update.
In home care is not an option financially. We have a Long term care insurance that she chose but only covers ALF or nursing.

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What are this facility's rules about medications management?

I think your mother might have jumped the gun, here. The nurse told her they would meet to discuss meds, not for the nurse to confiscate every tablet in her possession.

I don't know if this is true for this particular facility and your mother's particular meds, but I would remind her that "medications management" simply means, literally, how the medications are managed. It doesn't necessarily mean that somebody else will be doing it for her. If the facility is satisfied that she is able to identify her medications, understand her px, and remember to take her medications at the correct times, there's no reason that your mother can't be her own "manager."

Don't forget that a competent adult is entitled to refuse medications if she so chooses, to take them with whisky if it pleases her, and to do all sorts of other ill-advised things that drive me up the wall daily.

[Yesterday evening: my instructions were to ensure that the lady's "pivotal" (a type of pill dispenser with a timer on it, that releases the right meds at the right time and sounds an alarm) was at her bedside. Sweet lady watched me place it carefully there, then pointed out that the pivotal was empty. So it was. Her daughter refills it for her (but, I didn't snarl, only when she can be bothered). Oh dear, I said, how will you take your bed-time meds? Long story and a hurried conversation with my Shift Leader later - this lady had a strip cut off from an old blister pack which contained unidentified pills from goodness knows when which goodness knows who had left for her. That's what she was planning to take. My hair stood on end - but it was "up to her...").

Now for your mother, her taking more than the prescribed dose and running out before refills, and the possibility of addiction, muddy the waters rather. But it's still a matter of *discussion* in which she, the consenting adult, will be the decision-maker; and the primary conversation should be between your mother and her prescribing practitioner.

So it all depends on The Rules - what are they? It may not be too late to reassure your mother about what will happen.

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The facility was super nice and was willing to discuss it with her doctor that ordered the management on the ALF ...even offered to go to the new doctor she chose to reevaluate, She wont discuss it anymore. Its off the table she wont go.

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So when did this all blow up?

I should ask the facility to put everything on hold for - say - 48 hours. Let the dust settle. Hold your peace. Keep talking to your mother but not about that. How often do you normally speak to her?

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In some situations it's more like "when doesn't it blow up." It can be dominant / control / power issues too.

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Amy, I think you need to tell mom, as kindly as possible, that if APS is notified, the State is going to swoop in and appoint her a guardian. There won't be any choices for her to make. I say this because the groundwork is there; medication management was ordered by her doctor, not you. The hospital saw that she could no longer live alone, reported her to APS and APS was only put off because you made arrangement for her to go to AL.

If she has dementia or other cognitive issues, she may not be able to understand the severity of the results that her actions will bring, but I think you might try to explain it. Or might it be better for her doctor to do so?

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Amy, I am an only child and my mom developed late-in-life alcoholism (I did not grow up with an alcoholic mom). On top of the drinking she mis-manages Klonopin, on which she is totally dependent. Sadly she has lived down the street from me for years. It's been an awful experience and it's taken a toll on me. Every time I think I've done something to make a difference and things will be "OK", she slips back into her old habits (or worse). I've just had to back away, self-protect, and let her run her course. She's determined to drink & die in her house (she's told me that many times). I would love to be far, far away and let this unfold from a distance, but for many reasons I am not able to sell our house & move far enough away to put the distance between us & my mom. There's not much you can do for a determined elder but wait for things to fall apart and then just hope for the best (for yourself).

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I imagine a move to Texas, or Europe, anywhere.

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Amyped, is your mother competent? Would she pass a competency test? If yes, then there is nothing you can do. You can’t make her do anything. If she’s not competent, call APS and then stay out of it. Let APS handle it. It all comes down to one thing. Is she competent? They set the bar really really low. It all hinges on her brain. She can be an addict and still be competent. My 96 year old mother is living proof of how to stay out of assisted living. She can barely walk, but by golly she has her mind.

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I expect she has a big case of cold feet. Imagine being in her shoes. Giving up independence and admitting irreversible decline. Going through doors that will close behind you, never to re-open. She also is afraid of the unknown. What seemed like a good idea, even exciting and looked forwards to, is now a fearful unknown looming closer. I am not surprised she gets cold feet at the last minute.
Have you tried showing her that you understand her reluctance, her fears, her grieving over loss of youth, health, vigour, independence? When we're young we have doors opening, paths to choose from, future possibilities that are exciting and almost unlimited. As we grow older our options narrow, and most of our lives are behind us.
When older people rudely rail against those who try to care for them, it is not you they are against, it is the hard things of life, and of getting older, that bug them. Of course in an ideal world they would not take it out on their carers. But some personalities do that.
We can fight their personality and resent them (easily done, hands up!) or we can figure out how best to help them manage their emotions and behaviour.
It sounds in this case like your mum has clearly stated exactly what she does not want - to have someone else control her medications. I understand that! It is likely that there are other areas where she fears that others will be increasingly controlling her life. Her choices are already limited by time and health.
1) Show her that you understand, and care about, her feelings about all the changes. Specifically mention the meds and ask what about it worries her.
2) Ask some questions to find out how she is feeing about other things.
3) Work through with her all the upcoming changes, and ensure she does not feel all control is being taken away. Work out some things she can have a say in and make it clear you will honour those.

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Such a great response and caring to what her mom is/might be going through.

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What is all this, “ she does not sound like an addict”? First of all, that was not the purpose of the poster’s question. Second, her mother is abusing prescribed medication by doubling and tripling the doses and running out weeks before a new prescription is due. She is of course addicted to the medication which is common with opioid and benzo abuse. She is not doubling up on vitamins. And she is refusing the AL because she does not want them to control her pill popping. Chronic pain does require management and usually it requires lots of different pills because that is what pain doctors do. This lady was given meds back when people were often just given meds to shut them up. And now she is a management problem. So how about instead of attacking the poster for calling her mothers behavior what it is, we have some sympathy for her trying to manage the mess her mother made of her life.

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Do you have any compassion fool you don't know chronic pain like I do it's the worst thing ever and you will take medicine to make it stop because it ruins your life you can't do any of the things you used to do you can't play with your kids you can't even enjoy activities with your grandson or granddaughters you can't even go out to the movies or do anything when you suffer from chronic pain until you know what chronic pain is shut up you don't know anything and I'm sorry that I'm being rude but I honestly dislike it when people think that the problems we suffer from are addiction and not that we actually really need that medicine because we suffer daily put yourself in this person situation if you broke your leg then you know that pain and how bad it is but imagine that pain continues to exist even after the fact how tempted would you be to take more than one pill because of how painful it is we don't need more pills and we don't need people calling us addicts we need someone who shows compassion and knows how to manage our pain successfully and safely

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Your mother has an addiction. You can have an involuntary admission to an inpatient psychiatric facility if she is a danger to herself or others. You might be able to admit her if you are her medical POA and mom is deemed mentally incompetent. If your mother is mentally competent, you can not force her to do anything. That being said, do NOT do anything to help her stay addicted. Do NOT spend your money to help her. Please consider attending a substance abuse support group for family and friends of addicts for ideas on coping with her problems.

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Well my mom had the same issue

I told her that no responsible doctor would prescribe her medication if it wasn’t controlled so she would have none at all
she said “I guess I”m in a pickle and I have to go” and so she went
she does not like it but she has her meds managed, it was either go or no medication
its a nice place, expensive but she has the care she needs
find out who is prescribing and report them if they are overdoing it

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if your Mother truly has chronic pain, why is she only prescribed one pain pill a day? That’s crazy! Call the doctor and explain the situation, see if he will increase it three a day.

Or perhaps there’s a reason he only prescribes one a day, because he doesnt think there is truly chronic pain there?

I would call the doctor to find out. If her meds can be increased by two pills, she should be happy.

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Sorry, it's crazy, yes, and its what the doctors are doing due to opioid crisis. It's all true. But, its also true you give too much of that to the elderly eventually the drugs do harm too. Just a tragedy for the patient and family.

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The determining factor is whether she has chronic pain. I would call her doctor first and discuss this with him. Then if she has a need for the medication try to have a 4-way call with your mom, the doctor, and the medication nurse. Is there a family member or good friend that could be there in your place since you are out of town? With the fake opioid crisis going on, many doctors and nurses are convinced that anyone who takes any opioids is a drug addict. This is just not true. My mother had serious pain; she went into hospice in 2015. The hospice doctor immediately cut her off cold turkey. She died a year later a horrible, tortuous death. When I confronted the hospice doctor he said people with dementia don't feel pain (wrong again!). If that facility refuses to give her the proper dosages that her doctor recommends, when he recommends it, I would find another arrangement with someone who has some common sense. If the facility refuses to refund the upfront costs, I would contact a local ombudsman, or find a complaint with Medicare or take them to Small Claims court to get a refund. If your mom has a doctor's prescription, there is no reason to deny her pain medication. Period.

I now have a brother in the same situation in a nursing home. He has numerous spine and other issues that require pain medication but all I get is arguments that he is addicted. Dependency is not the same thing as addiction.

Additional comment: I just read in one of your posts that your mom takes 3 pain pills a day. I would venture to say, if she has significant pain, she is not addicted - just dependent. Three pills a day would be under-treating her pain. To reduce her medication or under-treat her pain is cruel and inhumane. Again, I would go back to the doctor who prescribed the 3/day or find a pain management specialist and discuss increasing the number of pills or the dosage of the pills, i.e., like an extended release. Do not switch her to NSAIDS. Not only do these damage the liver/kidneys, they can cause serious heart problems. No elderly person should have more than 2,000mg a day and no more than 1,200mg if they already have liver/kidney problems. Besides the fact that NSAIDS aren't as effective as opioids to begin with. More people die of NSAIDS every year than those who are in pain and legitimately take prescribed opioid pain medications. The rest of the statistics of overdoses are people who steal prescription pain pills or those who die of heroin or illegal fentanyl smuggled in from Mexico.

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Fabulous answer. I just gave a reply above to the OP. I've watched my parent cold turkey. She gets opiate medicine but runs out end of month. I can't imagine your mothers death. I am so sorry. There were times even decades ago when we rushed mom to er for morphine because she could not get her prescription.

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The "managing meds or Me" may be the trigger. Is some "home body" type of person talking to her? Also it sounds like mom was not ready for this and the change was scarry. A nurse is only getting her meds set up with a pill minder after she determines your mother can manage by herself. The nurse follows up in a few days and verifys mom's ability to "manage". You have a local "help" person, with a have to approach that has only one direction....move into the facility. You, verbally give her the same message. And no alternatives. "you have to go Mom". The addiction problem can be managed between the nurse and the Dr. Sounds like your Moms "self medicating" just needed managing.

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As long as she has prescriptios for her meds, she is going to get what the doctor ordered. They just dispense them to have the oversight of what she got and when. Tell her that.
Should she get ill and they had to send her to a doctor, they have to know all of her meds and when she last took them. Maybe that will ease her mind.

You might also want to make a visit to her primary doctor now and take all meds w/you for him to ensure he has them all listed as prescribed meds. He may well already know all these meds and is ok with what she takes. There are times you/I may think someone is over medicated, but the doctor dispenses things until some reason is pointed out to them of side effects/quantities/etc.

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Imho, if she is indeed addicted to her medications, sooner or later a few things will happen - #1 The doctor who doses these rx's will catch on and place limitations, #2 The meds may be controlled substances, #3 Insurance will only cover so many - and the list goes on.

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I've only just seen this, so hopefully some progress has been made.

Your profile mentions dementia, among other medical issues. This alone isn't enough to allow anyone to force her to move (per our EC atty, even with all the POAs previously done! others will say get POA and move her, but it isn't that simple.) However, if it has only been a few days since you paid for this place, it isn't lost yet. Just because she isn't living in the space doesn't mean you give it up!

If there is someone who is very persuasive in the facility or at the doctor's office, they may be able to coax her into moving. The doctor could refuse to refill her medication unless she agrees to move. As others have said, if they can convince her that they are just "protecting" her medication, so it doesn't get misplaced, lost, tossed or stolen, rather than making any restrictions, and encourage her to give it a try, at least for a few weeks... maybe?

Staff at mom's MC have told me that they can't force anyone to do anything or take anything despite them all having some form of cognitive issues. They have to coax the person into agreeing, somehow making it THEIR choice! This is what your mom needs - someone who can reason with her and help her understand they are not taking her meds away!

If none of that works (it may take a few tries!), someone else's suggestion about telling her that if some emergency happens, a fall, injury, illness, whatever, and the state steps in, then she will NOT have a choice where she lives and she will DEFINITELY have medication managed, if not discontinued! Makes the AL seem like a pleasure palace!!

If you have someone (friends?) who helped move her things, can they take her to "lunch" at the facility and excuse themselves to use the bathroom, leaving her with staff? Sometimes trickery can work... Prearrange this with the staff!!!

It is going to be difficult handling this remotely, so hopefully you have some good, helpful people on the other end! But remember, you paid for the month, so you have a month to work on her. If some headway is made, but still no move, pay for another month and continue working on her. With no real bed, clothes, etc, she can't continue long at her condo. What about food, toiletries, etc? Who supplies that? She isn't going to be able to keep this up for long.

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I'm am only child too. All I can give is empathy.

If it's opiates addiction it's very serious. It's not as simple as "managing medications" as some of our young experts in medicine suggest. It is very scary to watch an elderly person cold turkey because they do not have even minimal medication for pain. The blood pressure can be suddenly out of control even breaking through controlling medication. Not to mention shakes, anxiety, etc. Then there is of course the psychological addiction which is also very real.

So, of course, when someone with multiple illnesses is suddenly told they are losing control of their medicines, that's scary for them. It would be for me too as an asthmatic who took a long time to control.

It sounds like the nurse or whoever did a lousy job of making a new resident feel safe and empowered. Of course, these patients frequently have paranoia too. Don't know, but if she's falling, etc. it's not safe for her to live alone. The only thing I can think of is if a family member go with her to meet with the facility nurse as an advocate to actually find out what the nurse has in mind by "management." Maybe it's not at all what she thinks.

Sometimes even paranoid delusional seniors with dementia know what's best for them. God is merciful like that. I guess it is hope for us all. God bless you. These siruations create so much anguish.

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Hello AmyPed22 - I am sorry you and your Mom are going through this. Can the nursing home help by sending someone to visit your Mom and let her know they care about her safety and remind her she will make many new friends living in a facility? Sometimes the kindness of strangers could get my Mom to do things her children could not. My prayers are with you. You are not alone. Many of us have been placed in awkward positions, like you, because our elderly parents do crazy things. It can be maddening. It helped me to know I was never alone and many shared my same experiences.

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Get in touch with the Office on Aging and Adult Protective Services and your doctor for her. Somehow they must do whatever it takes to get her into a place of safety. Perhaps lie to her and tell her SHE will be responsible for taking care of HER needs while she is in there. But she must be moved - now.

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And one more thing, tell her she is l00% on her own. if she falls or is ill, that is too bad - you are not there and can do nothing. So, whatever happens to her, she is on her own.

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Oh, I feel for you!
Klonopin, the Benzo, is not for chronic pain. If she is running out of her monthly prescription of pills, she is abusing then. And that is not healthy.
Going through withdrawal of this med monthly is horrible, and she definitely needs some help. You have been given some good advice here, ignore the negative comments, you know what you are talking about as far as her prescriptions and needs go, she’s been taking these for years.
I hope you are able to find someone who lives near your mom to help with this. I can’t imagine having to figure this out 6000 miles away. Our daughter and her family lived 5000 miles from us for 9 years. I hope you find the help you need! Prayers and you are doing awesome. 😢💞

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Amy, how are things going?

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