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geri-psych eval
Abuela
Posted: Thursday, April 11, 2019 6:26 AM
Joined: 6/24/2012
Posts: 330


I am looking for advice about sending mom for a geri psych eval.  She is on Seroquel and trazodone.  It's not working that well lately.  Seemed to be doing well initially.  I know that this is not an exact science as to the dosing.  I am fine with getting the dosing tweaked in the geri-psych unit but the issue is that she will freak out by the whole hospital experience and I don't want to put her through that.  

She was in the hospital in March and it was a nightmare.  She freaked out and had to have a one to one aid for the whole time she was there.  I mean she bit the nurse, yanked out her IV, ripped off the EKG wires.... threw stuff at the staff started to take her gown off in front of the nurses station while demanding her clothes from them.  They had to call security and sedate her.  I just don't want to put her through this.  Is geri-psych ward different?  It's in a different hospital.  I would have to get her there by ambulance because she would never go into the building willingly.  

Anyone who has experience with this I would appreciate some input.  The good news is that she will come home from the hospital this time to a new room in the MC unit.  


MN Chickadee
Posted: Thursday, April 11, 2019 9:34 AM
Joined: 9/7/2014
Posts: 767


What kinds of things of changes or behavior are going on right now? Do you think moving to the MC with more trained staff would be enough without the geri-psych stay?
Mimi S.
Posted: Thursday, April 11, 2019 9:58 AM
Joined: 11/29/2011
Posts: 7036


And those who know me will recognize a familiar plea. From your library ask for a opy of any book by Naomi Feil with the word Validation in the title. It's not an easy read but worth every minute. It's proper use can cut down on the need for the meds you are discussing and make life more pleasant for all. Do ask if MC staff have been trained in its use and if not, would they check it out.
citydock2000
Posted: Thursday, April 11, 2019 2:47 PM
Joined: 9/7/2017
Posts: 788


So where would she be going :  hospital --> geri psych --> memory care? 

Our experiences in both MC --> geri psych and MC--> hospital --> geri psych --> MC were positive.  For us (san diego, UCSD) geri psych was calm, quiet, and a good environment for my FIL to get stabilized/medication stabilized before going back to MC.  When he was hospitalized, he went into a tailspin and we couldn't send him back to MC like that - he would have been bounced in a second - so back to geri psych he went.  They are mostly left alone, and the environment was very calming, with the added benefit of less of a rigorous dress/shower/eat schedule than in MC.  They didn't release him until they knew he could be released into MC (usual stay is about 1 to 2 weeks from what I can tell). 

We lived on the edge in MC - I would STRONGLY recommend doing everything you can to get her in as good a shape as possible before sending her to MC.   The transition period/staff getting to know her can be tough - so if you feel like she needs time to calm down post-hospital, geri psych is a more forgiving environment than MC, where if she hits someone, etc, they will send her to geri psych in a second. 

 

 

 


jfkoc
Posted: Thursday, April 11, 2019 6:59 PM
Joined: 12/4/2011
Posts: 16900


In my opinion it would be better to stay away from the hospital and do some tweaking with your neurologist acting in conjunction with the psychiatrist they work with. 

I agree with Mimi that it is essential to get as much education as you can in how to care for a PWD. You may not need additional drugs at all.


Abuela
Posted: Friday, April 12, 2019 12:20 PM
Joined: 6/24/2012
Posts: 330


Thank you all for your input.  Mom was in hospital for pneumonia a month ago.  She flipped out and had to be sedated and security called and had a one on one for the rest of her time.  I took her home and stayed two days with her at her place to make sure that she was back to 'normal'.  She seemed to be doing well on the new meds, Seroquel. But now it has been about six weeks and she is having issues again.  She is not changing her clothes all week.  She is not leaving her room.  She is not eating.  So the staff have recommended a visit to geri psych before we move her to the new unit which will be memory unit.  The hope is that the geri psych will be able to stabilize her meds issue.  I know that this is a work in progress and the meds situation will continue to fluctuate.    My issue is the hospitalization part of it.  But perhaps because it is a psych hospital they will be better able to handle the bizarre behaviors she will have from the stress of being there.  I'm torn.

Today I am going to get a check of her urine at urgent care and make sure that she is not festering a UTI.  But to be honest, I don't know if she will leave her room with me or not.  


citydock2000
Posted: Friday, April 12, 2019 2:09 PM
Joined: 9/7/2017
Posts: 788


To clarify, in my experience, geri psych is more like memory care than like a hospital or ER setting.  

In a traditional hospital setting, whatever the patient is hospitalized for is primary - and the medical professionals intend to "heal" the patient and get them out as quickly as possible. In this environment, professionals are not trained or staffed to handle dementia behaviors, and their goal is compliance, hence restraints, lack of supervision.   To the extent that dementia gets in the way, they will "deal with it" but there is no specialized approach or awareness, and often medical professionals will do things to heal the primary ailment that unintentionally impacts the patient's secondary ailment (dementia). 

We called hospice during a pnuemonia hospitalization, after realizing we NEVER wanted to do this ever again.  We were prepared to have him die in memory care, if the alternative was going back to the hospital.  The hospital was great, staff was awesome - and it was a brutal experience. 

I told a nurse one day  - "to you, his pneumonia is primary and dementia secondary.  To us, the dementia is ALWAYS primary, and anything else is secondary." We saw him deteriorating day after day in the hospital - and couldn't do anything about it because the problem was... the hospital. 

In geri psych, the behaviors and the treatment is focused on the primary ailment.  If they are good, their goal is to get her stable - behaviors, medications - and move her into the right level of care seamlessly and without needing to return her to geri psych. 

 


jfkoc
Posted: Friday, April 12, 2019 8:54 PM
Joined: 12/4/2011
Posts: 16900


That would mean two moves. One to hospital and one to MC. The moves themselves are going to take a toll.

MC should have the training to handle the behavior displayed.


Abuela
Posted: Saturday, April 13, 2019 9:13 AM
Joined: 6/24/2012
Posts: 330


Citydock... thanks.  I feel better about the whole thing now.   The nurses want mom to do the best that she can so I think that they feel she would do better if she got the meds under control first.  And they don't want her to upset the memory unit by displaying this behavior.  Mom will know that she is not in her old place.   I am heading out today to sit around in MC for the afternoon so I know what she is facing when she moves.  I actually do realize that she will benefit from it more than where she is now.  It's just been me not wanting to make these life decisions on her behalf.   Some days I feel stronger than others about it all.  And yes, I don't ever want her to go to the acute care hospital again.  Good suggestion on the hospice.  I have friend who used that also.  Thanks again.
citydock2000
Posted: Saturday, April 13, 2019 12:24 PM
Joined: 9/7/2017
Posts: 788


jfkoc brings up a good point, too - its important to be very honest about the capabilities of your MC staff.  Two moves can be rough.  We all have the right to expect MC staff who are capable, agile, and able to handle our LOs needs.  You have to weigh where your LO is, her needs, the capabilities of the MC, the impact of multiple moves, and so on. And the ability to see the difference between how things should be, how you want them to be,  and how things really are. 

We worked with a pretty good MC that met many of our needs - location (we work full time and were 100% responsible with no backup so having LO close to us was most important), caring staff, management willing to work with a pretty tough PWD, and we had spent ourselves with a cross country move, emptying and selling their house, and dealing with extensive financial elder abuse  - but weren't the best handling aggressive behaviors consistently cross all shifts.  We didn't think LO was going to make it that long, and another move would have been rough - so we rode it it out.  Was it perfect?  It wasn't.  Would we have made other choices?  Maybe but who knows?  What's the point of second guessing?  

This can be tough when you feel like you have no idea what the right choice is.  Sometimes you make the choice between a number of not great choices. You make the best decision you can with the information you have, and you move forward.  No regrets.  


jfkoc
Posted: Saturday, April 13, 2019 1:14 PM
Joined: 12/4/2011
Posts: 16900


I so agree with citydock. The odds of  making the right choice are about 50%. In others words and educated guess.

Please keep us in the loop.....


Abuela
Posted: Sunday, April 14, 2019 6:53 AM
Joined: 6/24/2012
Posts: 330


So the facility where mom is living now in the AL unit has two MC units.  The one that I visited yesterday has residents that are higher functioning than the other one.  It felt really like a good fit for what mom needs.  It is small and intimate.  Right now there are six residents, two full time aids and an activity aid.  All of them do everything.  The nurses administer the meds on rounds.  They eat family style and everything is right there so they are always in contact with staff.  They re approach all the time to get the residents to participate.  They are well trained (at least who I saw yesterday).   They take them outside to a courtyard every day for sunshine and fresh air. Activities outside like planting and such.  After the initial shock I think mom will do better.  Her room is exact floor plan as to where she is now. Exact same view out the window.  She is literally moving down the hall behind the locked doors.  And that will be hard for her but eventually she will be okay.  

Also I had the geri psych eval explained to me.  I think they are doing the right thing about this.  I asked if mom could go by ambulance.  They agree it would be better for her.   She would listen to the EMTs better than me and I can't imagine getting her to agree to being admitted via the hospital lobby.... I imagine a scene.  She likes being 'sick' and being taken special care of by doctors. She has gone by ambulance twice now with no issues.  These guys are really well trained as we live in an area full of elder facilities.   But once inside the hospital she will get upset and want to leave.  She will have a one on one 24/7 and they will keep her at least a week. 

Questions:   How long is the stay usually?  I am expecting 2-3 weeks??  Am I off base?  

Do you visit or stay away?   

She will be wearing her own clothes.  How much should I pack?  Or just bring fresh items as it goes.  

Anything else I need to know?  


citydock2000
Posted: Sunday, April 14, 2019 11:51 AM
Joined: 9/7/2017
Posts: 788


oh my gosh, yes, an ambulance, absolutely.  

Based on our experience (which was a good one): 

1. The stays can be lengthy because they will want to give her time to settle in (the first few days she may be agitated etc), maybe make medication changes, give THAT time to settle in, make some more changes.  At UCSD, the goal was to make sure he was settled and stable, under doctors supervision.  That was the problem with fiddling w medication changes in MC if there is no doctor - the communication from MC staff --> MC nursing -->offsite geri psych was not always great.  

Our LO really liked QUIET and being left alone.  For this reason, geri psych was great for him, and it gave us a chance to figure this out, so it's not just medication.  We left geri psych feeling like the issue was NOT medication (he did best with a VERY light hand on calming medication) and was how MC staff were dealing with him (waking him up at night, aggressively energetic and cheerful, getting him dressed too early, pushing him to breakfast).  

2. For this reason, I do suggest visiting as much as you can, if its not disruptive to her, and talking to staff, learning as much as you can from them.  This is where, unfortunately, geri psych can be MORE like a hospital.  Doctors come and go on erratic schedules, you might not hear from them for a few days, etc.  I did not like this approach at all. 

Connect w the social worker immediately, and check in w her either in person or by phone every few days.  Ask the best way to be there when the doctor is there, "how does this work, when should i expect to hear from the doctor, how frequently, please inform me when medication changes are made."  Ask alot of questions about how communication will work, when the first care meeting will be and so on. If you are frustrated by lack of communication, share that and talk to the social worker about it. 

3.  Clothes - we kept it pretty simple, pajama pants and tshirts, slip on shoes.  We didn't want the staff to have to deal with anything very complicated.  I can't remember, but I think they washed?   We went over most days, or every other day, so would check on clothing supplies, and bring some extras in case we wanted to switch anything out.  

The days are pretty loungy there from what I remember and the staff don't have alot of time or inclination to deal with extensive dressing regimens.  

In regards so communication, etc - remember that you will be the conduit between geri psych and memory care, and regular doctors.  Its nice when they communicate but... don't expect too much.  The healthcare system is just not set up that way. That's why I say, keep track of what medications and dosages, and keep track of how she's doing on those different medications - keep your own log and your own notes.  This was very helpful for us when our LO was admitted to the hospital (another hospital because emergency) and we were able to say "No, not that... he did not react well to the medication at all".   Not everyone will have access to everything as time goes by and .. well, hospital staff (not geri psych) with limited knowledge of dementia often prescribe behavioral medications that have unintended effects. This sadly includes staff in MC.  

 


Abuela
Posted: Sunday, April 14, 2019 12:19 PM
Joined: 6/24/2012
Posts: 330


Thanks Citydock.   Sounds like good practical advice.  I'll let you all know how this progresses.
 
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