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Need to find place for physically combative Mom
lyy
Posted: Sunday, February 19, 2017 10:29 AM
Joined: 2/15/2012
Posts: 15


My Mom has episodes of physical agression.  This is her 3rd time in Geri Psych.  The medicines work until they don't.  The assisted living places are not really set up to handle this. 

I need to find a place where they can still treat her like a human, but know and deal with the fact that she might be aggressive.  Sometimes her aggression is tied to the physical care she needs with toileting, dressing, bathing and approach can somewhat mitigate that, but really no guarantees on that.  But she has had a few times where she got physical with other residents.  Much of the time she goes along sweet as she can be.

We live in South MS.  IF we can really find an appropriate place we will travel in the state, to south Louisiana, south Alabama.  Does anyone know a good place for someone like my mom.  I am getting desperate as she only lasted 6 days at the most recent Memory Care assisted living place where put her.  We do have financial resources.  I just want her and others to be safe and cared for.

Thanks for any help.


Stephanie Z
Posted: Sunday, February 19, 2017 11:46 AM
Joined: 12/15/2011
Posts: 3979


Hi,  Have you tried calling the local Alzheimer's Associations and asking for their list of facilities that have good MC units. I'm thinking a nursing home with a unit might be a better choice than assisted living since the staffing levels and quality of caregivers vary greatly between the two.

You can also call the national Alzheimer's Assoc. at 800-2723900 but most likely they will refer you back to the local associations anyway.

You might also ask about a support group in your area and if you can attend, ask the people there about there experiences with facilities in your area.

One other thought, was your Mom diagnosed by a neurologist?  If not, it's possible that she may not have Alzheimer's but may have frontal temporal dementia. People with FTD seem to be more aggressive. The treatment may be different for FTD, so if she has not been seen by a neurologist, think about it as a second opinion.

Hope this helps,

Stephanie Z


bela
Posted: Sunday, February 19, 2017 1:42 PM
Joined: 12/15/2011
Posts: 3962


I agree  check out FTD.

Also, a NH might be more appropriate as there are nurses on staff that can administer meds regularly.  Furthermore, you can keep your own MD (neurologist) so if there is a need to increase or decrease dosages the MD can communicate with nursing staff on site and get the matter resolved rather quickly...

In some cases I have read about howver, a NH will send the person off to geri psyc-  Seems to me, but I am no expert that the right therapeutic dose or mixture of medications should be helpful....Just a thought.


lyy
Posted: Sunday, February 19, 2017 5:25 PM
Joined: 2/15/2012
Posts: 15


Mom was diagnosed by 2 separate neurologists as having alzheimer's in 2011. She is in the 6th year since diagnosis and did not become aggressive until last year.   We haven't had a lot of luck with the getting the right mixtures of medicines.  She has been on some combination of Seroquel, Zyprexa, Klonopin, Depa-kote, Xanax, Atavan, Zoloft, Celexa,Haldol, Risperdal, etc, for over a year not counting the Namenda and Aricept. She had severely bad reactions to some of those medicines; others seemed to give relief for a little while.  They are now trying Geodon.   The neurologists don't seem to be able to handle the problem behaviors with medicine.  The aggression is sporadic, but severe enough to be a problem when it occurs.

If you know of a nursing home that takes people with these issues in the geographic area I spoke of, that would be helpful.  I have been calling numbers and visiting for several days straight and I'm not having much luck, probably because there just aren't many places in a rural state that do this when they can focus on easier residents to care for.

Thanks,

Lisa


Mimi S.
Posted: Sunday, February 19, 2017 6:27 PM
Joined: 11/29/2011
Posts: 6040


Welcome to our world IYY.  

I am sorry, but not surprised that you ave having difficulty getting a good placement.

 

The National Hotline has the same lists the local organization has.  If you call local, only call during normal office hours and then make sure you are speaking with the local.  Most offices have an arrangement where National picks up after a certain number of rings. 

 

It is my opinion that not enough research and training is going into changing behavior through non pharmaceutical means.  I am, in particular, thinking of Naomi Feil's, Validation Method.  Do get one of her books from your librarian.  Her ideas are different from the usual, so more thought is necessary to understand where she is coming from.  If you are convinced, begin using the method and then get the staff of the residence to also get trained.  Teepa Snow is also a good source of videos.  The entire staff needs to be on board.  

 

Yes, it will take time to learn.  But less drugged patients and happier patients and staff are a huge reward.
lyy
Posted: Monday, February 20, 2017 7:37 AM
Joined: 2/15/2012
Posts: 15


I appreciate that you are trying to help, but I did not find staff all that receptive to changes because someone else will come along and fill your slot.  Also mom has delusions where she has attacked residents in the memory care place where she has been.  Sporadic but there. I have two middle-school aged children.  I work full-time.  My time off is getting really low. My father died last summer after a year of physical (not mental) deterioration where I took care of both him and my Mom because we tried to keep her at home as long as possible.    I am literally losing my mind after all this time.  .  Mom is falling a lot now.  I need a safe place for her.   I have worked so hard to do what is best for them and I just want to rest so bad.

Help is sparse where I live.  I have reached out. I have tried.  I have read everything I could get my hands on. It has taken over my life. My children get so little of me. I get up every day and do the best I can.  I love my Mother.  I want what's best for her.  I can't make her well.  I can't keep her happy.  I try as hard as I can and I still fail to keep her safe.  I am sorry so sorry. I know I must be strong.  There's something wrong with me that I am having problems.  I am sorry that people can't help me with a few words.  I am so sorry.j I don't deserve help I kknow itijust don't know what to do anymore.


BW daughter
Posted: Monday, September 11, 2017 12:20 PM
Joined: 8/28/2017
Posts: 13


I know how you feel tyy and I feel the same way.  My mom lived alone in NY, and had 10 hours of care 7 days a week. She recently took a turn for the worse and her aggressive behavior is unpredictable.  I live in CA.  This is the third time she's in the hospital and I'm trying to find answers to what is best for her.  She tried to strangle me this morning and she kicked, scratched, and punched me, thinking I'm some who is trying to hurt her.  I tried to calm her down but it took all my strength and I was so afraid she would get worse.  When she finally calmed down, she was fine.  But the nurse services said I had to call 911 and get her to the hospital because she is unsafe, even with 10 hours of care.  What can I do?  It seems like a nursing home would be the only place she would be able to stay long term that would keep her safe.  But she is still going to be so far from me.  It is heartbreaking, and I have no words.  I know I should try to do what's best for her, and she's no longer in the frame of mind to assess and understand what is going on, but it is so painful.
Pearzee
Posted: Monday, September 11, 2017 1:08 PM
Joined: 4/13/2016
Posts: 21


I am going through the same issue with my father, lyy, and I feel for you.  Is there a social worker at the hospital who can help you find a place?  Do you have an elder law attorney you can consult who might know of some places?  Also try the state ombudsman's office for nursing home care.  They might have some ideas.
GemsWinner12
Posted: Monday, September 11, 2017 2:45 PM
Joined: 7/17/2017
Posts: 76


Hi, 

I really can at least partially sympathize with you; my Mom was nearly kicked out of her memory care facility for hitting caregivers and other residents .  It made me feel so helpless!  

Luckily, medication adjustments and some caregiver training about her fear of showers helped greatly. 

 Have you considered setting her up in a two bedroom apartment so that she and a live-in caregiver can co-habitate?  partial payment for the caregiver would come from giving the caregiver a place to live and utilities.  Just an idea if you haven't come up with any other options yet other than having her live with you and pushing you beyond the brink.  I've considered taking my mom into my home when her. long term care insurance money runs out ( about a year and a half left, and Mom just mumbles but can still walk a bit so she may live another 2-3 years or more .  


ghostdog
Posted: Monday, September 11, 2017 4:18 PM
Joined: 2/9/2015
Posts: 712


I've been on both sides of this kind of issue -- my mom was kicked out of her first facility, the final straw was physical aggression.  She then moved to a facility that specializes in dementia and tolerates a pretty wide range of behaviors while meds are adjusted. This facility's tolerance and expertise is known throughout the region.   It turned out my mom's issue on her side mostly a med reaction and a staff experience issue, and she adjusted.  If she hadn't adjusted so well we might have been asked to provide private one on one in addition.

  Nonetheless it doesn't work for everyone.  18 months after her move, my mom was seriously injured when a newish resident at the tolerant facility assaulted her and then assualted her a second time in front of many witnesses when we brought mom back from the ER (the line staff and private caregiver were scared of this resident and there had been many complaints from family members observing verbal aggression).

I would put serious pressure on the geri psych facility to assist you with discharge planning.


Mimi S.
Posted: Monday, September 11, 2017 6:33 PM
Joined: 11/29/2011
Posts: 6040


I wonder if you put Naomi Feil in your browser, Hopefully there is a phone or e-mail contact. 
Ask what institutions in the area in which you are looking have been trained by them.

 

One of the posters mentioned that a Nursing Home might be a better placement. Do be frank in your discussion with the intake people. They should be forthcoming in how they can meet her needs.  
And this has to be so frightening for her.

Iamnumberfour
Posted: Monday, September 11, 2017 6:48 PM
Joined: 2/29/2016
Posts: 563


There is NOTHING wrong with you. You are a good person in an impossible situation. Caring about your mom shows what a kind and decent person you are. Please call the Alz helpline 800-272-3900 and ask to speak with a social worker. You are in crisis and need and deserve help.
militaryman
Posted: Monday, September 11, 2017 6:55 PM
Joined: 4/22/2017
Posts: 39


Have you check her for a UTI?  My father had one and he was very aggressive but much better after treatment.
Mroark628
Posted: Tuesday, September 12, 2017 9:30 AM
Joined: 9/12/2017
Posts: 9


Hi Christie,

Can you give me more info on your dad and his UTI?  My mom had a very scary violent episode on Sat. Against my father, her caretaker. She believes he is leaving her and taking all the money. She did attack him. I live in SC and they in WV. Ems was called and my mom was taken to a geriatric psych hospital. I came on Sunday. She is diagnosed with a UTI. We visited yesterday and as soon as she saw my father she immediately started the behavior all over again. 

The psych doctor says he wants to keep her there until she gets over the UTI to see if this is the cause. 


DianaMccly
Posted: Tuesday, September 12, 2017 1:19 PM
Joined: 3/7/2016
Posts: 107


Mroark628  This happened to my Dad. He was living with us and became convinced that my husband had stolen his car (we had taken it away because he wasn't safe driving and had actually driven across the state at one point to return to a different state he hasn't lived in for years). He became increasingly verbally abusive and was on the verge of becoming physically abusive. We called the police and had an emergency custody order put in place and while he was in hospital we found he had a sever UTI. He was involuntarily committed at a geriatric psych hospital as well. They treated the UTI and adjusted his meds. He ended up going into a facility after this episode and improved significantly as far as the aggression, but his dementia had gotten worse and never really recovered back to his previous levels.

Just a few thoughts,

1) I discovered that the geriatric psych hospital had placed him on zyprexa for his delusions and it is considered a "black box drug". My neurologist was very concerned about the side effects and weaned him off of it. The thought was that the delusions were caused by the UTI and so the med was no longer necessary once he was treated for it. You may want to double check everything given and decide if it is truly necessary.

2) if you have previously had cognitive testing done you may want to repeat them after the UTI is treated and see if the decline has stayed. LO may also need to be tested for PT and OT. My Dad's physical condition declined as well...

Hope this helps and that it is just a UTI and your LO is right as rain once it is treated!


Mroark628
Posted: Tuesday, September 12, 2017 9:45 PM
Joined: 9/12/2017
Posts: 9


Hi Diana,

Thank you so much for your reply. I posted that story and then saw your reply. I apologize for not having good message board etiquette yet. First time posting. They are not giving my mother anything but an antibiotic. She is worse now than ever. We went for our visit tonight and dad waited in the holding area before trying to see her. We would go get him if it was safe....it wasn't. I'm wondering if she will ever be able to stay with him again?   


agreen24
Posted: Wednesday, September 13, 2017 10:03 AM
Joined: 4/20/2016
Posts: 35


I am so sorry you're going through this with your mother, IYY. We have been dealing with my now 88 year old MIL's dementia for almost two years now (of course there were obvious signs that something was happening, many years prior to her mixed dementia diagnosis by a geriatric specialist who has been treating patients with Alzheimer's and other dementias for over 30 years). My MIL's sudden decline and diagnosis came after extreme delirium brought on by a shoulder injury; her dementia then worsened to the point of her being extremely violent, physically and verbally. It continued, even after treatment for her shoulder pain from arthritis, and her doctor at the rehab facility where they were keeping her, said her only option was Risperdal. She had stopped eating completely due to extreme paranoia, believing her food was being poisoned (this actually had started happening while she was living at her condo, with home health care aids helping her); she didn't want to wear any clothing (that was being poisoned), and she was having 24/7 visual and auditory hallucinations (which also had begun while living at her condo, but we were so ill-informed, we thought she was having nightmares, and believed her when she said a neighbor was "playing a radio with old fashioned music," all night and sometimes during the day. We knew something was terribly wrong when she stated that now she was seeing a woman appear in a business suit in her living room, and a nice man was now singing a very personal song to just her on the neighbor's radio. She also believed neighbors were trying to steal her artwork. Things began unraveling VERY quickly after that!) She was having dementia with psychosis. She is a tiny woman, but was violently swinging at and kicking nurses and doctors at the rehab facility. After putting her on a low dose of Risperdal, she started settling down almost immediately. It took a month for the full effects to kick in; no catatonic effect, just calming and allowing her to have some quality of life again, begin eating, and reducing the horrific aggression, paranoia and hallucinations. She has been in memory care for almost two years now, still maintaining on Risperdal. It has been a life saver. Wishing you the best outcome for your own mom. We found the right medication, thank god. Remember, with the psychotropic drugs comes serious side effects, but thankfully my MIL experienced none of them. And again, it did take over a month for it to really take effect!
Armondo
Posted: Wednesday, September 13, 2017 11:10 AM
Joined: 12/18/2015
Posts: 90


We had to place our mom when her behavior at our home became too much for us to handle on our own.  She was combative, verbally and physically aggressive and uncooperative with others--including doctor visits and home-health professionals.  She was a wandering risk and fought often to get out of the house.  A loving NH has been the answer for our mom.  She was very combative in the beginning and resisted interacting and care from the staff.  They were very patient with her and eventually found that monthly Haldol injections and Xanax worked for her aggression and anxiety. They were able to settle her down and gain her cooperation within the first month or so.

 

It's been 10 months and she is still doing well.  The atmosphere of the NH seems to be more agreeable for her.  She can feel more independent--as she can pace all she wants and pretty-much do what she wants (or not).  The staff is very patient with her and "supports" her while helping her to feel like she is helping them. She cooperates now with help for toileting, dressing and showers  She has periods--particularly toward the end of the month when she is less cooperative and more anxious.  Again, the staff is patient with her and we work as a team during difficult times.

 

Be prepared to allow her time to bond with the staff and to get used to her new home.  You will also need to be patient with your own emotions while you adjust to her being there.  This adjustment was not without incident by all parties--but it has been worth it for the final outcome.  We hope that things work out favorably for you, your mom and family.

 

 


dayn2nite2
Posted: Wednesday, September 13, 2017 11:45 AM
Joined: 6/20/2016
Posts: 1168


Mroark628 wrote:

Hi Diana,

Thank you so much for your reply. I posted that story and then saw your reply. I apologize for not having good message board etiquette yet. First time posting. They are not giving my mother anything but an antibiotic. She is worse now than ever. We went for our visit tonight and dad waited in the holding area before trying to see her. We would go get him if it was safe....it wasn't. I'm wondering if she will ever be able to stay with him again?   

Depends on how she recovers from the infection.  Using only an antibiotic is fine if she has a documented UTI.  After that clears, you'll be able to see how she is with your father.  If she continues to be aggressive, then no, she may not be able to be with him anymore and she will need placement.

You should be proactive at this time and start scouting for a facility just in case.  Go without your father right now, but be ready to pull 2 or 3 facilities out of your pocket if it's determined that allowing them to be together is dangerous for one or both.