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Kicked out of Memory Care Facility
Millennialcaregiver
Posted: Sunday, November 24, 2019 6:18 PM
Joined: 10/6/2019
Posts: 4


Hello, my dad Was diagnosed with Alzheimers 5 years ago (now 67) and is physically fit and very restless. 8 months ago he moved  into a memory care facility because he was constantly doing “bad” things and he would get aggressive with us. The memory care facility frequently sends him to the ER because of his difficult behaviors and they always think he might have a UTI but never does. The whole last month he was in a geriatric psych unit because he is getting increasingly agitated, aggressive and combative. He gets in peoples faces, grabs people’s arms, and he was once punched so he punched them back. So they talked to us about having him go to the geriatric psych unit for medication management and help getting him to sleep through the night.  There he was given harder medications and was discharged after being there a month. After one week back at the memory care center, he was sent to the ER again for behavior and medication management. Now, he is in back in the same psych unit (which is considered to be a good one). However, the ER doctor told the memory care center, it’s not safe for him to just be in a memory care facility. So they won’t take him back because of doctors orders. No one from the hospital or memory care facility can recommend a place for him to go after his stay in the psych unit. We have talked to the social worker and staff but everyone is “not sure.” We live in South Jersey, but we are willing to move him into a facility that’s farther away if that’s what is needed. But I am not sure where to even begin looking. Once you tell a facility he is being hospitalized and kicked out due to behavioral issues, then they don’t want him. Please help!
abc123
Posted: Sunday, November 24, 2019 6:47 PM
Joined: 6/12/2016
Posts: 670


Others will come along with some excellent advice for you. Whatever happens, please Do Not take him back home. It’s not safe for any of you.

I’m sorry this is happening. Hopefully they will increase his meds.


jfkoc
Posted: Sunday, November 24, 2019 6:52 PM
Joined: 12/4/2011
Posts: 17547


I can certainly understand your frustration and fear and anger but what to do?
I know I would find out exactly what drugs were given the first time. Then I would like to see the nurses notes of exactly what happened in the facility. I would then find out what drugs are being given this visit to the psych ward.

You want to know that the problem does not stem from under trained staff or from reaction to a drug or an interaction between drugs. 


LicketyGlitz
Posted: Sunday, November 24, 2019 8:58 PM
Joined: 2/3/2018
Posts: 541


Wow, Millenial, what a nightmare for you and your Dad. I don't have personal experience with this issue, but I would put a call into the Alz Association, see if they have any recommendations on how to find an MC that specializes in difficult behaviors.

So sorry this is where your journey has taken you all.


Bakelite1
Posted: Monday, November 25, 2019 12:52 AM
Joined: 12/26/2018
Posts: 18


I'm so sorry that you are facing this issue. 

My father was also kicked out of his first memory care facility which was not at all equipped to handle his agitation level.  We switched him to another care facility which was considered better equipped to deal with cases of higher level agitation.  In our area, there were 2 choices that were suggested by the care facility and his medical team.  He was not placed in a GeriPsych ward, though I tried to make that happen.   Eventually, he was also 5150ed out of the 2nd facility because of hitting people/agitation and sent to the ER.  I'll never forget the sight of my then 84 year-old father with his own security guard in the ER.  What we did was to hire a private social worker who came from an elder care services group.  She acted as an advocate for my father between (in the 2nd case) the hospital and the facility to create the conditions for him to be re-admitted to the 2nd memory care facility.   I believe that if you contract with a Social Worker who is not on the payroll of the hospital, you can get input from someone who will know the facilities in the area intimately and will be able to let you know what might work.  This person will also take on the negotiating role for you, which is so incredibly difficult to do on your own.  As a result of these episodes, my Dad was first placed on an anti-psychotic and then, after the ER visit, on an anti-convulsant.  He became less aggressive and the disease took its toll eventually in other ways.   I hope that things start to settle out for you.   This is such a difficult experience, and not one that we are prepared for when we are introduced to the idea of memory care. 

MN Chickadee
Posted: Monday, November 25, 2019 9:32 AM
Joined: 9/7/2014
Posts: 900


Bakelite's suggestion of hiring your own social worker might be a good idea. Google geriatric care managers in your area. They would likely have experience in navigating this. Make it clear to the psych unit that you cannot take him home. They will have to help find placement for him.

I would also request documents from the original facility to make sure they were giving him the meds as prescribed. When we moved my mom to MC, one med didn't make it on the med list that was faxed from her doctor, and we discovered 2 weeks later she wasn't getting it. Make sure there was no error there. 

The psych unit should be able to get him to the point where he is safe at a MC unit. The ER doctor may not have experience with dementia. You might give the Alzheimers Association hotline a call. Ask to speak to a care consultant. They are social workers who specialize in dementia stuff. They may have advice and be able to direct you to local resources. The service is free. 1-800-272-3900. 


ghostdog
Posted: Monday, November 25, 2019 10:50 AM
Joined: 2/9/2015
Posts: 542


MillenialCaregiver -

I am in south jersey and have some experience with my own parent re south jersey MC and difficult to place individuals, getting kicked out of facilities,etc.   If you want to discuss places by name, or more frank detail send me a request to connect on private side of the board -- or I'll send you one if you're not sure how to do that.

There is one exclusively MC place in SJ that is known to take problematic MC residents and does pretty well with a geriatric psychiatrist who visits weekly but even that place does have limits. Last I knew you have to be able to pay privately for 2-3 years (not sure which) and sometimes they require a private duty attendant.

I agree with those who have suggested going beyond the hospital social worker to get private assistance help.  There are a few geriatric care coordinators in SJ as well as elder law firms with accomplished social worker as part of their staff.

ghostdog

 


MacyRose
Posted: Monday, November 25, 2019 11:09 AM
Joined: 12/15/2011
Posts: 3935


If you have an eldercare/family law attorney who helped you with the preparation of papers (wills, trusts, HIPPA, POA's) they should be able to direct you to which care facilities are an option.  Often they know the best facilities and which currently have beds available.  An outside social worker is another option.  However, if the hospital attempts to discharge your father to you, you must state that he cannot come to your home because it is unsafe for him, you and your family and they must have a place he can go.  They may try to argue with you about this, but they cannot legally dump a patient with a history of violence on you if you refuse to take him home.  So stand your ground until this problem is resolved.  

 


SunnyBeBe
Posted: Monday, November 25, 2019 12:09 PM
Joined: 10/9/2014
Posts: 784


There should be places near you that provide care for PWD who have severe behavioral issues. I know that there are several in my state.(NC). I'm not able to PM you directly, so, I'll just list them here. I don't know the application process or any details.  

Long Leaf Neuro-psychological Center, Wilson, NC

Black Mountain Neuro-psychological Center, Black Mountain, NC (Specifically for patients with violent behavior and dementia.)  These are state run facilities.  

There are others as well and they have websites that will provide you with more info. 


Asteria
Posted: Monday, November 25, 2019 6:51 PM
Joined: 3/22/2019
Posts: 8


I have experienced the terror of a loved one's aggression caused by Alzheimer's. There are some MC facilities that are not daunted by difficult behavior, like Arden Courts in Wayne, NJ. I would give them a call. Some places are far, far better than others in understanding that Alzheimer's sufferers cannot help their aggression and they find ways to deal with it without causing additional grief to the sufferer or the family.

I would also see if there's any way to get your dad admitted to the geri-psych unit at Ramapo Ridge in Wykoff, NJ, which is part of the Christian Health Care system. They are miracle workers. Your dad might have another underlying condition, like bipolar disorder or psychosis cause by dementia, which is exacerbating his problem.
Since you're not too far from Philadelphia, I would also look into your options there (call Penn Memory Center, at the University of Pennsylvania)
Finally, I would look into a geriatric care manager who can help you. Go to aginglifecare.org for a start, and there's a search option for geriatric care managers in your area.
Good luck. It's a nightmare ... I understand all too well.


Millennialcaregiver
Posted: Friday, November 29, 2019 4:35 PM
Joined: 10/6/2019
Posts: 4


Thank you so much! I would love to discuss this more with you. We do have an elder care lawyer (Rothkoff) but they don’t have many recommendations. We talked with Arden Courts because they do take people with difficult behavior. On Wednesday they did an assessment and called today (5 minutes ago) to say they can’t accept him after reviewing his documentation. The hospital recommended a state run behavioral nursing home, but in NJ their are 5. One is near us, but everyone says they would never consider sending someone there, unless they had no other choice. The other one I don’t know much about it but it is closer than the 3 in north Jersey. It was extremely hard and heart breaking when we decided to place him in MC. This is even harder because of the quality of the facilities.
Millennialcaregiver
Posted: Friday, November 29, 2019 4:38 PM
Joined: 10/6/2019
Posts: 4


Thank you! I’m not sure how to message people on here. What websites helped you find those places? Also how do you message people on here?
Teresa701
Posted: Friday, November 29, 2019 4:44 PM
Joined: 7/19/2018
Posts: 17


MC, I just sent you a connection invite.  Once you accept we can message each other.  

You can click on the person's screen name and invite to connect, then it should let you message each other.


Millennialcaregiver
Posted: Friday, November 29, 2019 4:45 PM
Joined: 10/6/2019
Posts: 4


Thank you so much for the response. I’m sorry you had to go through this as well. We have a lawyer (Rothkoff) but they aren’t very helpful with this. On Wednesday I met with Arden courts and after they did an assessment on him. 20 minutes ago they called and said they can’t accept him after reviewing his documentation. I feel like he is on to many medications and that is why they won’t take him. I feel like the huge list of medications are making everything worse, but I’m not his doctor so what do I know? I was thinking of looking into penn memory care. And I will look at that Geri psych you recommended. I really appreciate your help.
Teresa701
Posted: Friday, November 29, 2019 4:56 PM
Joined: 7/19/2018
Posts: 17


MC, 

I sent you a message, just check your inbox.

While my mom did get sent out of her first nursing home to a geri psych unit, they social worker there helped me get her placed where she currently is.  I hope you can find some answers here that will help you.

 


SuzW
Posted: Friday, November 29, 2019 8:40 PM
Joined: 6/9/2016
Posts: 7


Sometimes there are very good reasons why someone with dementia is very agitated/combative.  It could be the drugs and/or it could be what is being done (or not done) to them at the facility they are in.  Yes, that nice looking, friendly place.  

It could be they haven't been shown the bathroom all day and they are wet/dirty -- constantly (THIS HAPPENS OFTEN).  Maybe they have "diaper rash" because of this, which can be painful.  Maybe they have a UTI because of not being shown the bathroom all day (VERY common).  

If you really want to verify what's going on, get someone to check if they have diaper rash.  You'll need to be there when this is done so that you are given correct info.  

Maybe the place is unbelievably boring.  

Has anyone spoken with a certified geriatric care manager for their thoughts/suggestions?
Has anyone spoken with the Alzheimer's Association for their thoughts/suggestions?

 


SuzW
Posted: Friday, November 29, 2019 8:50 PM
Joined: 6/9/2016
Posts: 7


I re-read the initial posting.  My previous reply (just above) isn't completely applicable.  Obviously, something goes on with the brain.  

But, I've seen the environment play a major role in causing agitation.  An environment filled with noise, confusion, activity, people, and sounds seems to overload the brain and create anger.  

Ditto if someone also feels pain in/on their body.  How do we even know if they have dental pain or vision/hearing issues.  Or a headache.  Or stomach ache.  

 

 


ghostdog
Posted: Saturday, November 30, 2019 8:55 AM
Joined: 2/9/2015
Posts: 542


MC

I sent you a message. Check your inbox.


Dreamer Lost
Posted: Tuesday, December 3, 2019 10:12 AM
Joined: 3/7/2019
Posts: 324


I have to second SuzW comments on agitation due to pain or inadequate attention.  I am 24/7 caregiver for my DH (age 61) and he often gets headaches (daily) which increase his agitation and/or anger.  A little tylenol or advil can go a long way to helping.  He also will get agitated when needing the bathroom so I try to keep him on a 2-3 hour schedule,  also if he is hungry.  He also gets agitated if dressed too warmly or gets overheated or to a lesser degree too cold. As you can see there are a lot of little things that can trigger agitation/anger.  Definitely meds are important, DH is on anti-depressant and anti-anxiety meds along with other meds (6 in total given at 4 different times during the day) and they have to be adjusted periodically. You mentioned you think your dad is on too many meds so definitely review all of them as some calm a person while others pick them up (should they be taken at the same time?) and some interact negatively with others.  Make sure your dad is taking them, my DH swallows his pills dry, sometimes refuses them and I have to be creative to get them in him. My DH also sleeps fairly well which is so important with the help of melatonin and enough activity (which I think is difficult with physically fit EOAD) and sunlight during the day along with a routine (some people use trazodone a Rx).  
I would also request to see records of medication given along with bathroom visits, meals (if he's eating enough), how does staff help at meal times (i have to cut up my DH's food along with providing a spoon and getting him started) some meals he eats well such as breakfast but not too well at dinner, (check for weight loss), showers (which can by a high trigger) and make frequent visits at various times, early morning, late at night, weekends,  to see how staff is handling these times.  

Good Luck.  I hope you have found a caring facility. 


Abuela
Posted: Tuesday, December 3, 2019 10:31 AM
Joined: 6/24/2012
Posts: 403


Wow.  sorry that this is happening to you.  Geri Psych should be able to help you to find a place since this is their field.  But also agree about the meds being given at MC.  More than once a pill was found on the floor by mom's chair or even on her shirt.  So the episodes could be happening because of a missed dose.   Also, see about hiring your own caregiver to help him out at the MC unit.  Someone to check in on him and get to know the staff for you. This can help alleviate a lot for him... he can't speak for himself about his history but this person can if given the details... Just a thought.  
And my experience seeing my 91 year old mother with a security guard is something that is hard to erase.  She bit a nurse and took her IV needle out and plunged it into the aid who was restraining her.  She won her own room in the ER with a security guard.  Hang in there.  

 
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