Observation of Assisted Living Resident Who Stops Taking Psychotropic Medication

If psychotropic medication is to be taken by a resident of an assisted living facility, the resident’s care team has what might be called a heightened responsibility in the matter of medication management. A resident’s determination to stop taking a psychotropic medication on his or her own volition can have serious consequence. These include serious consequences for the resident, his or her family, other residents in an assisted living community, and the staff of the facility. 

In this regard to this type of situation involving psychotropic medication and a resident of an assisted living community, there are particular medication management and observation duties and tasks that come into play if a resident refuses to take his or her psychotropic medication. These tasks and duties are discussed in this article.

Description and Definition of Psychotropic Medications

The state of California defines psychotropic medication as drugs “that affect the central nervous system in the treatment of certain psychiatric disorders.” Psychotropic medications include, but are not limited to:

  • Anti-anxiety agents
  • Antidepressants
  • Mood stabilizers
  • Antipsychotic medications
  • Anti-Parkinson agents
  • Hypnotics
  • Medications for dementia
  • Psycho-stimulants

In layperson’s terms, these are “heavy duty medications.” They can be invaluable in the treatment of residents of an assisted living community with a wide array of different types of conditions. With that said, summarily ceasing to take a psychotropic medication without medical approval and proper monitoring by a healthcare professional can have serious consequences.

Closer Observation of an Assisted Living Resident on a Psychotropic Medication

The state of California mandates that an assisted living community and its staff engage in closer medication management and observation of a resident taking some type of psychotropic drug. According to the state of California:

Particular caution is to be observed in the management of psychotropic medications due to their unique capacity to significantly alter one’s mood, perception, level of consciousness, cognitive processing, and behavior.

Resident Refuses Psychotropic Medication

One scenario involving an assisted living resident that takes a psychotropic medication is a situation when that individual refuses to take the drug. California law prohibits an assisted living facility from forcing a resident to take any medication.

A member of the resident’s care team should discuss with the resident why he or she is refusing to take the medication. The fact is that helpful information very well may be discerned from this discussion. For example, the resident might advise that he or she is experiencing adverse side effects. The resident might tell the care team that the medication does not appear to effectively treat symptoms of his or her condition. 

When refusal to take a prescribed psychotropic medication occurs, the resident’s medical record needs to be documented. In addition, the resident’s physician needs to be notified. California law also requires:

When changes in the physical, mental, emotional and social functioning of the resident are observed as the result of not taking the psychotropic medication, facility staff must document in the resident’s record and bring the information to the attention of the resident’s physician.

Staff Observes a Cognitive Decline, Confusion, or Decrease in Level of Consciousness of Resident Taking Psychotropic Medication

When a patient stops taking a psychotropic medication, assisted living community staff must be on the alert for:

  • Cognitive decline
  • Confusion
  • Decrease in level of consciousness

Staff must take a pair of immediate steps when these changes are noticed:

  • Log the resident’s observed changes and maintain it in the resident’s record
  • Document the efforts made by the facility to address noted changes and/or concerns in the resident’s record

The resident’s physician must be notified of the changes set forth a moment ago. A determination may need to be made for a facility reappraisal. In other words, a consideration of whether or not the assisted living community remains suitable to the resident under the circumstances at hand. 

Staff Observes Marked Change in a Resident’s Weight

If a resident experiences a marked change in weight in the aftermath of refusing to continue to take a psychotropic medication, the resident’s medical records must be documented. In addition, the resident’s physician needs to be notified. If this occurs, a facility reappraisal as discussed a moment ago may also be necessary. 

Changes in this category include:

  • Marked or unexplained weight gain
  • Market or unexplained weight loss
  • Refusal to eat
  • Refusal to drink
  • Abnormal lethargy

Other steps that need to be taken by assisted living staff include:

  • Log the resident’s daily weight and energy level in resident’s record
  • Document efforts made by facility to address feeding concerns in the resident’s record
  • Log the resident’s food and liquid intake in the resident’s record

Historically Agreeable Resident Becomes Aggressive or Combative

The refusal of an assisted living resident to take a prescribed psychotropic medication can also result in that person experiencing significant behavioral changes. Specifically, a normally or historically agreeable resident may become aggressive of combative. 

If this change in behavior occurs, the resident’s medical records need to be documented. In addition, the resident’s physician needs to be contacted. Moreover, a facility reassessment or reappraisal is appropriate. This type of behavior change can prove to be in opposition to the best interests of other residents and the staff of an assisted living community.

Other steps that need to be taken by assisted living staff include:

  • Trying to talk to the client about why he or she has become aggressive or agitated
  • Moving the resident into an environment that is more soothing than the general population areas of the assisted living community

In the final analysis, odds are significant that when an assisted living resident stops taking a psychotropic medication, the stage is set for the very real prospect that the resident will face transfer to another type of long-term care facility. For example, if a resident has been taking psychotropic medication as a result of a dementia diagnosis. A facility reassessment and examination by the resident’s physician may reveal that the person’s dementia has progressed to the point that he or she needs to be transferred to a memory center.