[NPInfo] Another Alzheimer's question

Thu Jan 4 05:18:39 PST 2007

Hi Diane,
An FL-2 is a document that is basically a set of physician orders which will 
admit a person to an extended care facility.  This is all based on a work 
background in the state of N. Carolina.  The physician must sign the orders, 
an NP cannot do it, at least not in this supervisory state I work in.  And, 
since a specialist is not going to follow her in a SNF, the neurologist 
probably won't provide you with orders, so a family doc would have to do it. 
Or someone else can actually sign the admission orders and the facility MD, 
perhaps the medical director will admit and follow her. The social worker 
and/or admissions director at the facility you're interested in will be able 
to tell you these things.

Some assisted living facilities don't require an FL-2, some will accept them 
as admitting orders.
BTW, a SNF has someone licensed providing care, an assisted living usually 
has someone licensed as a director, but actual care is given by medication 
aides; they can't administer IM injection there, they have to be followed by 
home health nurses if they need skilled care.

I don't think FL-2s are peculiar to NC; I believe I remember seeing them in 
Texas, but can't be sure.  But regardless the actual number of the form, I'm 
sure your state has requirements to get a set of physician orders for 
admission to an ECF / ALF.

Here in NC, there are several counties in western NC which have a variety of 
assisted living facilities; one gorgeous one (where I want to go when the 
time comes) has a locked unit for the dementia patients that stays full all 
the time.  It just depends on their admission criteria and if they will 
accept her, have a bed, etc.  It may be a good idea to find a ALF with a 
locked unit, get her admitted to the "regular" part of the facility, and 
then when the time came, she could go to the locked unit as her disease 
progressed.  Less stress on her and you when it comes time to change.

Joy
----- Original Message ----- 
From: "David or Diane Dito" <dddito at charter.net>
To: "'NP Info'" <npinfo at nurse.net>
Sent: Wednesday, January 03, 2007 11:40 PM
Subject: RE: [NPInfo] Another Alzheimer's question

> Joy,
>
> Thank you for your suggestions. We are trying to get her back to her
> neurologist, and if appropriate to a neuropsychologist to re-evaluate her
> and her meds again. That was my feeling, that she might need a mood
> stabilizer, but since I don't work in this area wasn't sure if it would be
> beneficial in dementia.
>
> What is an FL-2? Is that a document declaring her incompetent?
>
> She is completely ambulatory and--besides the Alzheimer's and psych 
> issues--
> otherwise healthy. I think the question is whether to try to place her in 
> an
> Alzheimer's or dementia specialty unit/facility or assisted living at this
> point. She's in sort of a "twilight" zone of sometimes acting 
> appropriately,
> but increasingly is showing lack of judgment, reasoning and the paranoia.
> Most of the residents in the Alzheimer's unit we toured seemed further
> "gone" than she....
>
> Diane Dito, NP
> St. Louis
>
> -----Original Message-----
> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
> Of Joy C
> Sent: Wednesday, January 03, 2007 9:46 PM
> To: NP Info
> Subject: Re: [NPInfo] Another Alzheimer's question
>
> Sorry Diane,  I hit the send button prematurely.  Anyways, if she needs to
> be placed somewhere in the near future, get her family doctor to sign an
> FL-2 sooner, rather than later, and have the sons go and visit facilities.
> You probably won't get on a waiting list for a bed in a dementia unit
> without the FL-2. This is assuming your state requires a document of this
> type.  They may be a Medicare regulation, I'm not sure.
>
> If she's completely ambulatory and early Alzheimer's, she might do well in
> an assisted living for a while.
> It sounds like, from her behaviors, she could use either one of the
> anti-convulsants like Depakote or an atypical antipsychotic to stabilize 
> her
>
> mood.  Paranoia is very typical for dementia.
>
> Joy
> North Carolina
> ----- Original Message ----- 
> From: "David or Diane Dito" <dddito at charter.net>
> To: "'NP Info'" <npinfo at nurse.net>
> Sent: Wednesday, January 03, 2007 8:56 PM
> Subject: RE: [NPInfo] Another Alzheimer's question
>
>
>> Speaking of Alzheimer's, we're currently trying to figure out how best to
>> care for my mother-in-law who lost her husband earlier this year and is 
>> in
>> the early- to mid-stages of Alzheimer's. I bought a book, Alzheimer's
>> Disease: Everything You Need to Know (revised edition), by Dr. William
>> Molloy and Dr. Paul Caldwell, that is helpful (especially for her sons),
>> but....
>>
>> She has some underlying psych issues (personality d/o and depression) on
>> top
>> of the Alzheimer's, and is getting into a more paranoid and
>> argumentative/verbally aggressive state lately. She has a caregiver in 
>> her
>> own home 24/7, but will not allow them to monitor her meds...and has
>> admitted essentially that she is not taking them as directed (Lexapro,
>> Namenda and Aricept). In fact, she wants to send the caregivers away, but
>> has been told by her sons that this is not option.
>>
>> She will need placement in the near future. For those of you with
>> experience
>> in dealing with this disease, what type of environment seems to work 
>> best?
>> We're trying to give her some input into the process, but she seems
>> incapable of making a decision, although she agrees she doesn't want to
>> stay
>> in her own home much longer. How is the medication issue best handled to
>> ensure she takes her meds while maintaining her dignity and giving her a
>> sense of some control over her care and environment?
>>
>> Any suggestions or input anyone can offer will be much-appreciated.
>>
>> TIA,
>> Diane Dito, NP
>> St. Louis
>>
>> -----Original Message-----
>> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On 
>> Behalf
>> Of Priscilla Merrill
>> Sent: Wednesday, January 03, 2007 7:39 PM
>> To: 'NP Info'
>> Subject: [NPInfo] Question
>>
>> Anyone heard of a Dr. Blaylock?  My dad was asking.  His site looks like 
>> a
>> scam but told him I'd poll the group.  He supposedly helps Alzheimer's
>> patients.
>> Thanks for any info,
>>
>> Priscilla Merrill FNP
>>
>> -- 
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