Hi Kateia,
I moved the 2 discussion threads that you started about state department visits and changing medications into one discussion. Furthermore, I took your original question to a pharmacist here at Mayo Clinic. Here is her response:

"Medication reviews are usually required in institutional settings to ensure that treatment regimens are periodically re-evaluated for efficacy. In some cases patients and caregivers are involved in the changes and in other cases they are not. There are recommendations for periodic consideration of a trial taper and even withdrawal of antipsychotics in dementia patients. This is not always possible based on patient-specific factors. You mentioned there is a warning about Haldol use in dementia patients. The warning you mentioned includes all antipsychotic drugs used dementia patients. The findings that led to the warning were not clear on the extent to which the risks are attributed to the antipsychotic as opposed to patient-specific factors. From what you describe it seems like this was a natural progression of dementia. Unfortunately, dementia is a terminal disease. This TIME article "Redefining Dementia as a Terminal Illness" (http://content.time.com/time/health/article/0,8599,1930278,00.html) refers to a more accurate description of dementia as “fatal brain failure…like cancer…”. We need more research to establish the best way to manage dementia symptoms.

You wonder if the med changes had an effect on how quickly she faded. It is so hard to let go and we wonder what we could have done to change things. This is part of the grieving process. If you had more involvement in the decision to alter her antipsychotic regimen, do you think that would have made this process easier or harder?"

The decision to put mom in Hospice was a very difficult one. We chose no IV or tube feeding as mom had gone through so much the past year and one/half. She had been in a pretty steady decline for the past six months. Sleeping more and having a very difficult time walking and not being able to communicate verbally. She understood every word we said, she could read out loud, and we played three games of "domino's" less than a week before she became bedridden. She knew her numbers and where to put them but she could not form a sentence that was understandable to us. Many people say that a dementia patient rallies before their death and I truly believe that is what she did that day. After becoming bedridden she was offered food and drink and refused by pushing away the offer or shaking her head. She died from a urinary tract infection that went septic. Antibiotics were given but diagnosed too late. The warning on the Haldol stated that it could make an infection increase. This is what I was questioning. I think her brain shut down and her organs along with it. Her last words to me were "I love You". Words I'll cherish forever. I truly feel that God was taking charge and was taking her into his comforting arms and removing this horrible disease from her.

I do feel that families need to be informed that the State Health Department will come in an review medications. To order that they be changed without doctor approval (this was done several times) was a little much for us. Of course as a family we consulted her doctor and worked with him on the changes. He visited her every two months and we were notified of any med changes. We had family members in the memory care unit daily visiting her and consulting with the staff. My concern is for all of the patients that do not have the support and medications are being changed without anyone knowing not knowing if it's doing more harm than good.