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Takeaways

 

Understanding Medication Management in Dementia Care

 

From the moment of diagnosis onward, you become the eyes and ears on the ground. Healthcare providers rely on you to monitor daily medication effects and raise concerns about necessary adjustments. This responsibility requires continuous observation, thoughtful preparation, and gradual adaptation of strategies.

 

Here are four tips to help you support your care receiver with medication management.

 

Tip 1: Begin Medication Audits

 

When our care receiver receives their formal diagnosis, medication audits become crucial. The medical team needs a thorough understanding of all medications, supplements, and alternative treatments to prevent dangerous interactions and ensure effective care.

 

Key points:

– Create complete listings of all prescribed medications

– Include all supplements and alternative medicines

– Use one pharmacy whenever possible

– Share medication lists proactively with all doctors

– Make sure medical teams can share information

 

Tip 2: Be Their Advocate

 

Being their advocate involves both legal and practical aspects of medication management. This ensures you can effectively participate in their medical care and decision-making.

 

Key points:

– Obtain Medical Power of Attorney specific to your state

– Secure HIPAA rights at each medical provider

– Consider Advanced Healthcare Directives

– Remember financial and medical powers of attorney are separate

– Make decisions through the lens of “what would I want?”

 

Tip 3: Take Over Medication Distribution

 

Begin monitoring medication distribution as soon as your care receiver has a diagnosis. Don’t wait for problems to arise.

 

Key points:

– Monitor when medications are running low

– Check how medications are organized

– Consider modern solutions like:

  – Pill dispensers with alarms

  – Phone alerts for caregivers

  – Pharmacy-prepared pill packs

– Watch the actual taking of medication

 

Tip 4: Adapt Medication Delivery Methods

 

As our loved one’s journey progresses, we may need to change how they receive their medication. Many care receivers forget how to swallow pills or resist taking them.

 

Key points:

– Consider pill crushers when needed

– Test different food options for mixing medication

– Try alternative medication forms:

  – Liquid versions

  – Creams

  – Other delivery methods

– Always verify food preferences before adding medication

 

Special Considerations for Independent Living

 

When your loved one lives independently, medication management requires extra vigilance and creative solutions.

 

Key points:

– Monitor medication supplies closely

– Consider camera placement to observe medication taking

– Watch for unusual patterns or behaviors

– Be prepared to adjust strategies as needed

 

Final Thoughts

 

Medication management is a continuous journey that evolves with your care receiver’s needs. While it may seem overwhelming at first, remember that small steps toward better organization and monitoring can make a significant difference in your loved one’s care and safety.

 

Key takeaways:

– Start medication monitoring early

– Secure legal advocacy rights

– Adapt delivery methods as needed

– Monitor consistently

– Stay in communication with healthcare providers

– Give yourself and your care receiver grace as you navigate changes

Full Episode Transcript

Nancy Treaster 

I wish I had started monitoring my husband’s medication sooner than I did. You’ll hear more about that in tip three. In today’s episode, we’re talking about supporting your care receiver with medication management. We have four tips. Sue, you ready to get started?

 

Sue Ryan 

I sure am.

 

Nancy Treaster 

Before we begin, it’s important that we share this disclaimer. Neither Sue nor I are a doctor. We’re not giving medical advice. We’re not lawyers. We’re not giving legal advice.

 

Sue Ryan 

We are not.

 

Sue Ryan 

We are definitely not. We are, however, caregivers and we are giving caregiving advice.

 

Nancy Treaster 

Medication management is something you’re gonna be focused on throughout your caregiving journey. From as soon as your care receiver is diagnosed onward, you are gonna be the eyes and the ears of what’s going on on the ground every day.

 

The doctor is going to be relying on you to observe and to raise up any adjustments that might be needed to medication. So let’s start with tip one. Sue, you want to start?

 

Sue Ryan 

All right. Yes, ma’am. Tip one is to begin medication audits. When our care receiver has received their formal diagnosis, one of the first things that we’re going to be asked is what medications are they taking? And we want to be able to provide a very thorough listing of all of their prescribed medications, all of their supplements, and any alternative medications they’re taking so that the medical team has a complete picture of everything our loved one is currently taking. Second thing that’s really helpful is as much as possible. Yes, there are going to be multiple doctors. Let’s have one pharmacy where all of the medications are coming from, if at all possible, because that’s part of what pharmacies do. They know about interactions, they can raise the flag right away if there’s a potential interaction. And then the next part of it is when we’re doing these audits, we’re proactively sharing every single time we go in to see the doctor, we are taking the current audit information, whatever doctor it is. Now we’re asking them, you know, where do we stand with this medication?

 

The other thing that we’re doing is we’re making sure each of them is specifically connected so that they know who our entire medical team is from all of the different types of doctors. So they’re able to share about medications. They know dosages. They have all the information that is valuable. We’re proactively taking that list in to whatever doctor it is every single time. So they’re able to stay right on top of what that is.

 

This is a really important area for me to focus on because I didn’t used to do that and we almost found out the hard way. Three, two, one. I prioritize this because I didn’t always do this and it almost caused us a pretty significant issue and here’s what it was.

 

Even before my husband was diagnosed, we had talked about the medications he was taking, we had talked about the supplements he was taking, and that was fine, we had the information. When he was diagnosed, we did the full audit. When we reviewed it with our doctor, he began asking questions about the different medications and the different supplements. And he came to two different supplements, and he asked my husband why he was taking them.

 

And he said, well, one of my buddies was taking them. And he said, they sounded like they were good. So I just started taking them. Well, they interacted with a medication he was currently taking. And that was a huge red flag for me. And I vowed that from that point in time on, I would make sure that every doctor knew any medication or supplement or anything else and were able to be proactive in making sure that none of them interfered with each other.

 

Sue Ryan

This is part of the reason this is so important is we’re really their advocate. I mean, we’re advocating for them with this because they don’t know. And that actually, Nancy, leads us into tip two.

 

Nancy Treaster 

Yes, and tip two is to be their advocate. Now, by default, you’re already naturally doing that probably, but let’s first talk about being their legal advocate, which means taking ownership legally of their medical decisions. If you’re in the United States, you do this through a medical power of attorney. Now, the medical power of attorneys are different state by state, so you need to understand which, you need to get a medical power of attorney that’s correct for your state.

 

And if you’re not living in the United States, understand in your country what’s required to get legal responsibility for their medical decisions. You want to get legal responsibility while they’re still capable of signing and making these decisions. This is the time to get out there and have these conversations with your loved ones so that they can actually sign over legal responsibility to you.

 

Sue Ryan 

This is that’s huge. That’s absolutely huge is do it early while they can still sign. I promise you from stories I’ve heard in support meetings from people who haven’t done it. You just really don’t want that to be your experience.

 

Nancy Treaster 

And here’s the time that medical power of attorney is not the same as financial power of attorney. Financial, and I found that out the hard way. I took the financial power of attorney to a doctor’s appointment with my father-in-law and they’re like, you don’t have the right to sit here and have this conversation and make this decision for him. Now, thank goodness they gave me the correct form and I did go get a medical power of attorney, but you need both. So that’s something to know. Then there’s in the U.S. you need to have HIPAA rights. HIPAA is healthcare privacy and your care receiver needs to sign off at each individual doctor the right for you to have access to their medical records. So those are HIPAA rights. HIPAA rights and medical power of attorney are not the same thing. They’re two different things. So you need to have HIPAA rights at every doctor, a medical power of attorney that’s appropriate for your state or for your country that you live in.

 

All right, let me think where we’re going to go back to. A medical power of attorney, a medical power of attorney, while you’re getting the medical power of attorney, this is a great chance to have the difficult conversation around other things. Financial power of attorney, it’s a great chance to talk about getting your name put on their bank accounts, possibly becoming their social security representative. There are other things that now that they have the chance to sign and you have the time to have those conversations this is your chance to sort of go through the laundry list of things to discuss.

 

Sue Ryan 

Okay, Nancy, this is also a really good time to discuss the advanced healthcare directive. Some people may still call it a do not resuscitate order. When you’re doing the rest of these, this is a really, really valuable component to add.

 

Nancy Treaster 

We talked about being your legal, we talked about being your care receiver’s legal medical advocate, but you’re also their just on the ground day-to-day medical advocate with their doctor. The doctor is counting on you to observe what’s happening every day and make recommendations or have discussions around any potential medication adjustments that need to happen. Couple of examples, very common with people living with dementia are sleep challenges or even behavior challenges. And there’s lots of medication options that go with those two things. It’s not always easy to decide what to do. So the lens I look through when I think about how to make medication choices for my care receivers is if the roles were reversed, what would I want them to decide? And that’s been a real guidepost for me. How would I want them to, what would I want them to do if they were making this decision for me? And that’s given me a lot of peace of mind when I’ve had to make difficult decisions around medication.

 

Nancy Treaster

Ready to go on to tip three? All right, tip three is taking over medication distribution. Back where we started, which is don’t wait as long as I did to start monitoring medication distribution.

 

As soon as your care receiver has a diagnosis, start inserting yourself into what’s happening with the medication. Here’s how I learned that lesson the hard way. All of a sudden, a few months after my husband’s diagnosis, he started acting more confused, a lot more confused than normal, or than he had been. And I thought, what has happened? He has really taken a turn for the worst. So I called the neurologist, we got an appointment for like the next day and I walked by his office and he’s got his pill box in front of him and he says, hey, come in here for just a second. You see this medication right here? I said, yeah. He said, I haven’t, I’ve been out of that for a couple of weeks so I haven’t been taking that. Well, it was his dementia medication. Well, okay, no wonder he’s confused, right?

 

I just thank goodness that it was a medication that showed symptoms. What if it was his heart medication or something that was critical to his survival? fortunately for me, it was something that was symptomatic and I could see that there was a medication challenge. But don’t let, this was only a few months after his diagnosis. So don’t even wait that long. Just insert yourself in. You can do it very lovingly and very casually.

 

check when the medications are becoming, when they’re getting low on their medication, check how they’re putting their medication together. Is it going in the right pill containers? If they don’t use a pill box or some sort of pill distribution method, now’s the time to introduce one. Today, we use just the old pill boxes back then, but today you can get pill dispensers that have alarms.

 

They can send alerts to your phone, not just the phone of the person who needs to take the pill, but to a caregiver as well. They can send alert when the container’s been opened. So there’s lots of great ways, there’s pill packs that your pharmacy can put together, lots of great ways to help maintain that independence. But stand over them and watch and make sure that it’s actually happening correctly.

 

And that includes actually the taking of the medication because there was a time a day, both for my father and for my husband, where my husband took two days of medication at once and my father did the exact same thing. And this wasn’t long into our diagnosis. So start monitoring the medication pretty early in the process. And that’s just really all the way through to taking the medication as well.

 

Sue Ryan 

And when you talk about independence, when we’re talking about the medication on maintaining independence, let’s see what independence means for them in that. Let’s have conversations with them. Let’s try to help, you know, can we support you with that? Can we organize it? It gets kind of cumbersome. What can we do to help? And part of the reason is that we may think that they’re going to have more of an issue than they did because share the story about your husband when you decided after all of this that maybe you should.

 

Nancy Treaster

I did, I just said, well, know, would you like for me to put your medication in the pill box for you? He’s like, that’d be awesome. So, I mean, he was struggling. He was happy to have me take it over. Might not be as big a deal as you think it is. Now, especially if you’re, there is, and it’s worth injecting, inserting yourself into the process and figuring out what the you know, combination of you taking it over is at what point. Also, if your loved one is living independently,

 

Sue Ryan 

So there is that possibility.

 

Nancy Treaster

you’re going to leverage a lot of these pill dispensers and pill packs and things to try to help support their independence as long as possible because if they can’t take their medication, they can’t live independently. So this is a good example of supporting someone who lives independently as long as possible, but medication management has got to be working in order for that to happen.

 

Sue Ryan

However, there is more than just the medication management when they’re living alone, because part of what we need to make sure of is that all of those fancy dispensers or pill packs or whatever are actually being used in the correct way and the medications are being taken. And I have a variety of stories. This didn’t happen to me. I have a variety of stories of other people who’ve shared that the importance of cameras for their loved ones who are living alone to help them maintain their independence is especially important when it comes to medication. And the cameras need to be positioned so that there, where you can see that your loved one is actually taking the medication. And here are a couple of examples of why that’s important. One of the young ladies in a support meeting said that she went over to help her mom clean up.

 

And she was getting ready to throw some things in the trash and she saw something shiny and she looked down and here were all these pills in the trash. She’s like, mom, what did you throw your pills out for? She said, I didn’t, I was just cleaning up the kitchen. I was getting all these crumbs off the counter. Part of the diagnosis is changes in depth perception, changes in vision. The mom had apparently gotten the medication out and put it all on the counter and then did something else, got distracted. And then when she came back to it, she couldn’t see them clearly and she thought they were crumbs.

 

And so she threw them out. So they wouldn’t have known it. And so it’s really helpful to make sure that our care receiver is actually taking the medications that these wonderful resources can be providing.

 

Nancy Treaster

That’s so true. Okay, ready for tip four?

 

Sue Ryan 

Let’s go to tip four. As our loved one is transitioning, we may need to change how they actually receive their medication. Many of the medications that are prescribed are pills. some care receivers forget how to actually swallow the pills, so that can become a challenge.

 

I know with my grandmother, one of the medications they prescribed, she was quite petite. And we used to say, well, this medication’s about as big as she is. It was this huge pill. And like she can’t even swallow that. And so we were looking for alternative ways. At any rate, with my dad, he was struggling to be able to swallow them. He really did have some challenges swallowing. So we got a pill crusher.

 

And they’re really great. So by the way, also a side thing with that, if you’re having a frustrating day, it’s really great to crush the pills. But you crush the pills and then you serve them in something that they like. My dad, whole journey loved applesauce. He loved applesauce his whole life. So that was not an issue. However, my husband who loved chocolate, anything, I used to put his in chocolate pudding. And then one day he’s like, nah, no more chocolate pudding. He would not eat the chocolate pudding. So what I learned is that

 

When I was going to give my loved one the medication in whatever it was, yogurt, pudding, both my dad and my husband liked ice cream, so periodically it went in the ice cream. But when I was giving them their medication, I would give them a bite without the medication first to make sure this was a day they liked that. Then I would give them the medication and put a little bit of it in and put it in a bite and then give them another bite without it. And Nancy, you have a great tip on the way that you put the medication in whatever they’re going to be getting it in.

 

Nancy Treaster 

Yes, because I also have made this mistake. I crush the medication and we give my husband his medication, which we call dessert, by the way. We don’t call it medication. We call it dessert. We give it to him after dinner and in a little small yogurt and we would mix it all in there. And after about two bites, he was done having this yogurt. And yet I’d be freaked out because the whole medication, it was all in the yogurt, the medication was. So we’ve learned to crush the pills on top of the yogurt.

 

Sue Ryan 

And that’s a great tip.

 

Nancy Treaster 

give him a spoonful with the medication in it. And then if he wants to eat the rest of the yogurt, that’s great for dessert, which often he does. But really bad problem when I put it all in there, mixed it up, and I was committed to him finishing the entire cup of yogurt. And that was a problem more than once.

 

Sue Ryan

That’s a problem. So there are variety of different options for that. And then another option is that when we are having these medication audits with our doctors is let’s talk about alternative ways for the medication to be distributed. So at the time they’re being prescribed a medicine, ask what different ways can this medication be received? Because if they’re already taking five or six pills, there’s a way to not have them.

 

another pill being added and there’s something that there’s a cream or there’s a liquid or something else that can kind of change it up. Let’s do that. So from the very beginning, let’s look at it. If they start having challenges with swallowing the pill or they can’t remember, know, my dad would put the pill in his mouth, drink water and you think this is great. And then he would take the pill out. And so, you know, so there are alternative ways. So this is where, again, when we go back to being their advocate, where they’re advocate for the ways to receive the medication throughout their journey as well as how to make sure that it’s all getting in there.

 

Nancy Treaster

That is so true. All right, we’re ready to summarize. All right, today we talked about how to support your loved one with medication management. We had four tips. The first tip was…

 

The first tip was to begin performing medication audits. The second tip was to be your care receiver’s advocate, both legally and just day to day. The third tip was to begin taking over medication distribution. And the fourth tip was around understanding all the different ways you can deliver the medication. Now, if you have tips around medication management that you think would help people, please go to our Facebook page or our Instagram page and share those tips. The links are in the show notes. If you like this podcast, please follow or subscribe as well as rate and review this podcast and please share it with your friends or other people that you think would get some advantage out of this podcast. Now, today we talked about medication management and we mentioned that this is going to be a continuous focus throughout your journey.

 

Nancy Treaster 

But hopefully with these tips, you can, I’m not gonna say hopefully. Today we talked about medication management and the fact that it will be a continuous part of your caregiving journey. With these tips, you can handle it.

 

Sue Ryan 

We’re all on this journey together.

 

Nancy Treaster

Yes, we are.