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My mom's place used to have an LVN and new ownership took over and now there's just a med tech on staff. My mom has long term care insurance and I would have thought if they're paying there would be a requirement of a nurse on staff. There was recently a medication mistake with my mom who has advanced dementia. Caregivers gave mom milk of magnesia for a week daily, instead of as needed for constipation. She had gushing diarrhea for a week and didn't tell me until the week was over. They told me about her bleeding rectally, but come to find out, it was caused by the gushing diarrhea and she had to be double diapered for a week, and diarrhea, etc was spilling out of that. I told them to stop the milk of magnesia and she was better the next day (no more diarrhea or bleeding). I complained to the owner, but I was told there is only a med tech on staff. I recommended having at least an LVN on premises. There is only an off-site RN to talk with over the phone in cases like this.
Is a med tech only on staff normal? Obviously the med tech did not dispense the medication properly.

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Roseformom: Something seems to be amiss with the med tech.
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Rose, I’d suggest that you tread cautiously on all this. You definitely have reasons to be concerned but be careful as to how you bring these concerns up to the new owners. I’d be way waaaaaay more concerned that as her MC has new ownership that they will want your mom gone & moved to a higher level of care facility even without yiur pointing out their shortcomings.

I went through some of your old postings & your mom has a healthcare plan that is pretty involved….. dementia is kinda at a 5, incontinent, cannot transfer on her own for toilet or bathing, has fallen, has a pessary (which you take her to an outside MD appointment for it), and on the Purewick system. Socially your mom had “happy hands” (taking things from others) and that was dealt with by her being in a private room…. but realize this is in her chart which new owners can review.

Payment wise she’s 2K for life via a LTC insurance policy plus $ from annuities, house sale $ and the usual SSA income. Right? So the MC knows she can move to a NH/SNF and has $ to pay for it. And they also know there is a son who came in-state to visit who took her and paid caregivers out to a $$$ Airbnb in the desert for a “outing”. There’s $ & resources, so MC can safely tell you she needs a higher level of care of her staying there becomes bothersome for them.

The only issue - which I imagine they don’t know about - that could happen would be if she ever ran out of nonLTc insurance $ so would need to file for LTC Medicaid, is might be gifting issues with $ mom gave to out of state son if the time period is in the lookback period.

Any MC who uses an internal telemed approach to staffing for basic nursing oversight is going to want to do things and provide all services as low cost as legally feasible and have residents who are as easy care as possible. That is not your mom. And she now does not have owners who have known her and you for years and gone through Covid times together to want to do best for her.

You might want to proactively quietly be looking for a SNF for her.
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Med techs are perfectly capable of knowing MOM is a laxative, and not to give it when there is "gushing diarrhea". Something is wrong here. Communication I suspect. Time to speak with the admins about all of this. MOM should never be given consistently in any case, so something wrong with the MD who ordered such a thing. This is simple all around bad care and has little to do with whether a med tech is giving meds or an RN.
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igloo572 Mar 4, 2024
May not have been dispensed as per physician orders. Old posts kinda read that there isn’t much of a MD oversight. Sounds like it’s an AL that is designed with locked / limited access so technically it can be a MC. So if that’s its structure, it does not have to have MD affiliated as its no skilled anything. OMFgawd!!

Back couple years ago, when the mom appeared to be quite ill, the OP took her it seems to an UrgiCare where she was dx’d with pneumonia, got RXs which then the staff administered to her mom. Seems to be outside doctors for care. It’s not coming from an on staff MD or even a PA or NP at the place who does bedsides. (No shade meant to PAs & NPs).
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I agree, my State an RN has to be on duty and when not on call. An LPN cannot be the main nurse. You need to check your State laws. A doctor is suppose to be affilated too. No meds can be introduced unless your doctor or the ALs doctor orders them. A Medtech is not a trained Medical personnel. Its a CNA with a certification to give out meds. Who gave the order for Milk of Magnesia? Thats a laxative not a binder.

An AL is not skilled nursing. A nurse can recommend but a doctor gives the order. Even then, your mother should not have been allowed to have gushing diarrhea for a week. If she did not replace the water lost, she could have dehydrated herself. You had the right to take her to her own PCP.

I would hope that if my mother had gushing diarrhea for over two days the RN would recommend she be taken to her doctor.
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Igloocar Mar 7, 2024
JoAnn29, I believe you have this distinction backward. A CNA cannot administer meds, only tell the patient it's time for her meds and possibly (not sure about the legality) hand the patient the meds. A med tech, though, IS certified to dispense meds to patients. Med techs have additional training for this responsibility. I'm famliar with this distinction not only from reading and discussion but also from my own medical care.
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Not normal in the several ALs and Memory Care Assisted Living facilities I've been associated with in the Denver area since 2014. All of them have had an RN and an LPN on staff at all times. I'd move my mom out of this place if it were me because who does the staff rely on for questions or issues they cannot handle? A med tech is certainly not a nurse! In fact, at moms MC, only a nurse could hand out pain meds of any kind,
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igloo572 Mar 4, 2024
Absolutely Spot on!!!
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Yes. It is. They often have an LVN or RN on call, but med techs are quite common in ALF.
This is for discussion now with the admin of your loved one's facility of course, as we cannot be privy to the details.
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You can report the mistake to the state DPH. Since states have different scope of practice, this is the department to ask this question. You can further ask if an LPN is also on duty with a med tech
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yes, some can be staffed without a nurse on site.
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