Concealing Medication: A Case Vignette

Provided by Jay Luxenberg, MD

A 78-year-old nursing home resident with mild dementia and a long history of schizophrenia controlled with an oral antipsychotic was given a trial of antipsychotic tapering and discontinuation by her primary care physician. Several months later she began demonstrating increasing paranoia and delusions. The physician reordered the antipsychotic, but she had begun refusing to take medication due to her suspicions about the healthcare system and medication in general. This included her medication for co-existing medical conditions such as hypertension.

New Shingles Vaccine Available

by Timothy Gieseke, MD, CMD

As a senior physician, I have cared for many 80+ y/o’s with Shingles (HSV).  In this age group it’s common to become severely depressed and lose > 10% of their weight.  In addition, if the feared post herpetic neuralgia (PNH) develops, many of their lives are forever altered despite applying current therapies to mitigate the pain.  For this reason, I highly recommended the Zostavax live vaccine when it became available in 2006.  Unfortunately, this vaccine has not been very effective in 70+ y/o’s (18%) and immunity starts to wane after 3 years.  In addition, as a live vaccine, it couldn’t be used in immunocompromised hosts, the very patients who are at greatest risk for Shingles.

Have you “Bookmarked” AMDA Webinars?

by Tim Gieseke MD, CMD

AMDA, The Society for Post-Acute and Long-Term Care Medicine, has been my professional home for many years.  I was privileged to be in one of the last class of physicians attending the 3- part certification course in Minneapolis chaired by Dr. James Pattee in 1995-96.  Since then, I have regularly attended AMDA’s annual meetings and found them to be extremely valuable for the work I do on behalf of my patients and homes.  At these meetings, I have been exposed to leaders in our field who are committed to sharing what they have learned in very practical ways.

Recreational Marijuana

by Jay Luxenberg, MD

Although it's been said many times, many ways, there are still going to be many questions from our residents about the implications of the looming implementation of California’s decriminalization of the recreational use of marijuana for adults. Under state law, adults will be allowed to possess and use up to an ounce of marijuana starting January 1st. Facilities that rely on federal dollars will have little choice - Section 1819(d)(4) of the Social Security Act (42 U.S.C. 1395i-e(d)(4)) provides that "[a] skilled nursing facility must operate and provide services in compliance with all applicable Federal, State, and local laws and regulations . . . ." Marijuana is a Schedule I controlled substance under the Controlled Substance Act (CSA), 21 U.S.C. 801, 812. The manufacture, distribution, or possession of marijuana a criminal offense, CSA sections 841(a)(1), 844(a). Clearly at this time a skilled nursing facility would not be in compliance with those federal laws if marijuana was stored or distributed to a resident. It will be interesting to see how facilities will handle requests from residents that purchase edible marijuana products, for example. Would they be allowed to store personally purchased products in their rooms like they currently store candy or other snacks? Will we be thinking about this possibility as we analyze falls or changes in cognitive function? We live in interesting times!

CMS Mega-Rule Phase 2: What to Expect From Your Pharmacist

by Flora Bessey, PharmD, BCGP

As many of you already know, on November 24th CMS put a moratorium on civil monetary penalties associated with Phase 2 implementation of some of the new Requirements of Participation for nursing homes.

Good news, right? Not so fast…There is still a real possibility of deficiencies and citations during the survey process, even with this moratorium. The main result of this moratorium is that the harshest penalties (i.e. withholding of payment and decertification) has been put on hold.

Returning to the main topic: What can you expect from your consultant pharmacist and your pharmacy at this point?

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