Medication Support
Suspected Issue Potential Intervention
Difficulty Swallowing Pills
Inquire with the doctor whether the medication comes in other forms (for instance, a liquid or gel that can be pre-poured, or ask if it can be cut in half or quartered
In extreme cases, a compounding pharmacy may be able to support with a pill swallowing gel or coating
Suspected Side Effects
Implement a symptom journal with the client and show follow-through to address side effects
Inquire with the doctor about the timing and dose of medication
Explore whether a medication is intended to be taken with food or on an empty stomach
Explore treatment of side effects (ex. If constipation, is the client actively exercising/hydrating well?)
Request a med review
If the side effect is temporary, create a template/script explaining the expected length of time, how far into the process the client is, and what the hoped for outcome will be (relating it to their goals)
Difficulty picking up individual pills
Overwhelmed by the Number of Pills
Concern About a Change in the Number of Pills
Difficulty Initiating Taking Pills
Encourage the responsible party to purchase pill cups. A companion can support the client to pour pills into a bright-colored, visible cup
Explore with the doctor whether the timing can be staggered or whether any of the medications can be stopped/combined/omitted safely from time-to-time (ex. multivitamin)
Explore with the doctor whether pills are available in other forms that can be pre-poured
Consider implementing a template introducing the new pill (color, size, name) and what it is designed to treat (explain the pill in terms of how it will help a client with what matters to them - for instance, this will help with your knee pain). Ensure the template is from a trusted figure.
Leverage the environment using an auditory and/or visual cue
Some possibilities:
Create a Ritual (potentially include humor, song, or rhythm)
Set up a Montessori-inspired station with all necessary items present (pitcher of fluid, clean glass, pill pouch (with contrast), tracker, posted medication times, etc.)
Integrate a reminder from Alexa or an alarm (if the client’s hearing is good and he/she can demonstrate follow through with turning the alarm off)
Consider involving a speech or occupational therapist to support carryover.
Difficulty Tracking Accurate Medication
Taking
Intervention depends on the level of orientation and can be done with the support of a speech or occupational therapist.
Ensure pill bottles/pouches are secure
Implement a templated chart and DayClox with a Weekly Medication Box (leave one day at a time out for use)
Implement a chart and DayClox with Pill Pouches
Implement a DayClox and/or auditory prompt with a secure Medication System (ex. Hero or Medminder)
In all cases, implement daily checks to ensure medications are being taken
If systems require supervision for implementation, consider an increase in care hours for
Distrust of Care-partner or Physician
Desire for Control
prompting and assistance
Actively listen to the client’s emotion surrounding the care-partner or physician Some examples:
-”These make me sick ”
-”These make me foggy”
-”I don’t like how this pill makes me feel.”
What is the client’s perception? Some examples:
-”I don’t need medications.”
-”I’m not getting any better with these.”
-”He gives me these pills to control me.”
-”They’re poisoning me.”
Investigate whether there is truth to the client’s perception. Investigate any history of trauma (ex. Holocaust, challenges with the healthcare system, etc.)
Implement Validation-based approaches (ex. Validate emotion, ask coping questions, opposite questions - is there ever a time when you do feel . . . has your best interest at heart? Is there anyone you do feel very comfortable with? Is there ever a time when you do feel they help? Do you feel that you’ve gotten worse?”)
Utilize information gathered to guide intervention (often, providing education or leveraging an existing trusting relationship can help; this may involve switching a provider)
Evaluate how much is being done on behalf of the client rather than with the client
Evaluate whether the client needs to feel heard and have a choice of companion or physician
Be sure to ask “May I?” about specific tasks for which you hope to provide support when managing and supporting medications as well as with other activities
Emphasize how the medications may empower the client to have more independence in day-to-day life
Identify areas of mastery for engagement. For instance, when you are planning options for how to spend the day together, emphasize programs that support the client to have an active role and a sense of self-efficacy over tasks. Express genuine admiration for the client’s skill and independence.
Desire for Normalcy
Normalize pill-taking
Explore language: ex. “Vitamins” versus Meds/Medications/Pills
Take “meds” together (whether you take real meds or tic-tacs side-by-side)
Emphasize how the medications may empower the client to have more normalcy in the day-to-day
Identify areas of routine for engagement. For instance, when you are planning options for how to spend the day together, emphasize programs that support the client to feel “normal” - for instance, if they were involved in household tasks previously, bring that back.
Desire for Respect
Do not attempt to force or argue when a client declines medications
Validate the client’s feelings surrounding agency over their care and knowledge of their body
Reapproach after time has passed (it is important to have an understanding of the window of time allotted for the medication to be taken safely). For instance, some medications must be taken within one to two hours of the prescribed time; others can be taken at any point in the day.
Use formal address if needed (for instance, rather than calling the client by their first name, you may use “Dr. Smith” or “Mrs. Jones” as a sign of respect). Culture plays an important role here as well.
Communicate genuine admiration for areas about which the client has pride. Clients are more likely to accept support when they feel a sense of rapport and trust.