Mom (and Dad's) primary care MD which we are looking to change is not really in the picture based on his inattentiveness when needed to refer mom to hospice a few weeks back, along with some other issues...I had hoped mom's neurologist would oversee her care as she began hospice. For the immediate needs she was officially referred by an ER doc having been in the ER for a day; and then we basically were assigned a hospice staff MD. We met her for the first time in the past week and based on knowledge and a brief observation, she suggested mom be put on a 12.5 mg dose of SEroquel 2x a day. Even one of the nurses thought her more agitated behavior was appropriate considering strangers etc. and didn't think it was so bad...I did not do my homework and did not realize until speaking to a nurse today that Seroquel is an antipsychotic and has a black box warning and is of more concern in use with elderly. (mom is 98). Knowing this made my decision far easier (NO!) I think it is a huge leap, especially when the behavior is agitated, to go directly to an antipsychotic before even trying something like an anxiety medication.
In addition, today another stranger was in: the podiatrist we'd never met prior who tended to mom's terrible toe nails and feet. They were a massive improvement by time she left, and in spite of her wiping her feet and clipping and dremeling, mom did not carry on or get agitated and all went as well as it could. SO taking that into consideration, I especially feel it is inappropriate to medicate her with an antipsychotic for very sporadic behavior. In fact, I have to wonder if it isn't the attitude, and less respectful behavior of the aides that set her off compared to someone genuinely caring and kinder. Although some effort was put forth by the aides after I spoke to their nurse supervisor to keep mom covered when not bathing a particular area, it would appear they have slipped back again, in less than a week or so. I have made connections with both competing hospital systems this afternoon and and both seem to offer hospice /palliative care programs so I may consider other options....
My mother (92) now has extremely thin skin that is prone to tears at the slightest contact, and she was trying to hit the caregivers whenever they were dealing with her. She was literally tearing herself up just by gently bonking the caregivers, or the table or her wheelchair. (She can't hit hard, so a gentle bonk is the best she can do.) The Seroquel calmed her agitation enough to stop her from trying to hit them quite as much.
She has had no ill effects from the medication, and the doctor felt the warnings of using it on elderly patients is overblown.
As far as the doctor goes, hospice comes with its own doctors, so your mother's neurologist isn't likely going to be her doctor now. Her PCP also is no longer her doctor, so that's why you aren't in contact in with him either. All of this should have been explained to you when Mom was signed up for hospice. If it isn't clear to you, call the hospice company and ask how it works.
Maybe a benefit analysis is in order. He does not enjoy the delusions that he is having, they are frightening and his reality. It the med helps then it is worth the risk as it is improving quality of life for everyone.