Violent behavior or scared?

Salsam

I was traumatized last night.  I got a call at 2AM and they told me my dad was violent.  He has been there 3 months in MC.  I said I would come in 15 minutes and the nurse said that wasn't soon enough.  When I arrived the police were in the lobby and the head nurse was telling them he was violent. 

What came out of my mouth was "He is not violent."  So I went in to the MC unit and he was so scared...he saw me and said, "Oh my darling daughter, you are all I have left in this world."  I hugged him, and two of the lower level caregivers were touched...one of them was extremely helpful in helping de-escalate...and I told her...and put a sticky note complimenting her on the caring board.  She has only been there one month. 

He has a lot of anxiety and does NOT want to be left alone, which is why he is there in the first place.  I could not handle him and my mom here in the house anymore.  They are both there.

I could not sleep. he paces at night.  I stayed there from 2 am until 10:30 AM.  I am an essential caregiver, and the place is great about allowing me to come any time. I thanked the nurse for calling me, but I was also upset, and my husband was very upset because I have described several smaller incidents with this same nurse, who is the one with the credentials. 

He is under Hospice Care, so they ask Hospice  to give another med--psychotropic they call it...and he is already on Trazedone and they upped the dosage recently.  I gave him a Lorazepam last night but it did not help him sleep. 

He was scared of locked doors and thought people were trying to kill him.  This nurse has only done night shift twice, she was filling in because they were short staffed. 

My husband  spoke  to the manager...and the manager told me this would be "dealt with" and they were a community.  

I am not sure what that means.  Partly, sadly, it means they are a business.    Luckily I got two good reports this evening, from the daughter of his roommate and the Hospice social worker that he was happy and polite and talkative. 

My dad has never been violent...he had a UTI before he went to Memory Care and he threw chairs on the floor and screamed in pain...and it took awhile to figure out what it was. We did not know if it was escalating Dimentia or pain...and he got better, but never regained too much control over going to the bathroom. 

The nurse did talk to me before she left...but she did not listen.  I think she is a person with knowledge but not compassion.  Or maybe she is overworked and underpaid, as are all of them.

Have others experienced this?  I do not like to blame people.  It is not an easy job.  This nurse was already telling me  they are not a behavior management facility, and she had to be concerned about the safety of her other residents.  

I really do not know what happened.  The nurse told me she was concerned for her other residents' safety and that he had  grabbed her and called her a ******.  

I live in a small area and there are not other facilities...I have been very impressed with the staff for the most part....

Any ideas please advise...thank you.  

star26

His paranoia (fear of locked doors and thinking that people are trying to kill him) is psychosis caused by the damage that dementia does to the brain. I recently listened to a podcast where a person who experienced psychosis and paranoia due to a brain illness was able to describe the experience. It sounded absolutely awful and he was terrified. The most ordinary and harmless things in his environment triggered intense fear and felt like threats to him. This is what leads to various behaviors such as violence - it’s caused by the psychosis and how it makes him feel. Hopefully others will chime in about a hospice nurse treating this. Usually the MD that is best at this is a geriatric psychiatrist.  

I love the way you and your husband handled this. Your relationship with your Dad sounds so precious. It’s true that you are the best thing he has in his life. I think you are absolutely right about the nurse. Yes, it’s true that she has to protect other patients but some people naturally have a way with people who are scared/suffering/have dementia and some do not. It can make all the difference. 

jfkoc

I would chalk it up to fear and lack of training. I would ask just what the initial and ongoing training is for all staff.

"not a behavior management facility" ???????   Ludicrous!!!!!!  That is exactly a big part of what they are.

abc123

What a terrible thing to happen. I am sorry for you, your husband and your Dad. IMO that nurse should find a different line of work. I think compassion is a must for anyone in the medical field. Reading your story reminds me of my husbands oncologist in Houston. She started each visit by reminding my husband he was terminal. As if we had forgotten that fact. She had the bed side manners of a cow and that’s an insult to cows. I’m very sorry this happened to you.

melynnG

Hi All, Am feeling sad and tired today. Constantly doing for both parents, stayed over last nite because nighttime caregiver couldn't come. Changing mom's Depends, feeding her, etc. Back and forth all day today because we never have daytime help on weekends (we have 4 hours on the weekdays). And I know how lucky I am to have the help that I do. I still feel like I live at my parents' house.  And God help me, I leave as much as I can between Depends changes and feedings because staying at their house all day feels like being forced to live in a nursing home and socialize only with the residents.  No one else comes over besides me, our paid caregivers, and occasionally my brother and sister, because of Covid and the fact that my introverted father can't tolerate the intrusion.  I know it's because I'm tired today, but I get irritated when my siblings call my parents but don't call me. My sister lives 6 hours away so she can't help at all on a daily basis. She freezes casseroles for them and brings them when she does come and will be here in a flash if mom is really sick (and of course so am I). She is a paralegal who supervises other paralegals in a large law firm in South Carolina and basically works all the time.  My brother is 1.5 hrs away with 3 kids ages 13, 10, and 8 and is an attorney so he's busy. He does what he can but is not here with any frequency.  I retired early at 53 from the public library system, so live mainly on a pension.  I would be working somewhere if not for mom and dad.  So as my sister is cheerily talking to my dad, I am once again changing a wet Depends and slathering diaper rash cream on mom's backside. I don't call my siblings much, I think because I feel really negative and depressing and don't want to release that energy on them. But I know I am also resentful that they aren't here and don't know what this is like (but I would be mortified if they ever knew I said this).

Cynbar

I agree that it sounds like the nurse handled it poorly ----but I still would take it seriously. His behavior could escalate. alarming other staff and residents. Other families could complain. And, it can't be pleasant for your dad to be that upset. You say that there aren't other alternatives in your area, so you want this to work out. Some posters here have had LOs asked to leave their MC for difficult behavior. I would start by talking to his hospice RN case manager and communicate your concerns. She can advocate for either a geripsych exam or a change in medication. A number of people on these boards have had good luck with an anti-psychotic like Seroquel or Zyprexa for extreme agitation and combative behavior. I'm not a doctor, but doesn't sound like he takes anything like that now (trazodone is an antidepressant I believe.) It's at least worth considering, before more incidents occur that upset more people.

Stellad

What a horrible night and I’m sorry your dad and your family went through such an awful time.  My dad suffered a lot with fears and extreme terror of people coming to kill him and my mom.  He would be absolutely terrified.  It was terrible for him.  He ended up in a Geri psych unit and was put on seroquel.  It’s made a world of difference.  He’s doing so much better and has been able to get a measure of peace again.   Hopefully there will be another med that could help your dad as well.

Salsam

Thanks to everyone who posted.  I did talk to hospice and they will try Seroquel.  And I saw my dad today and my mom (they are divorced so don't room together, but they have another whole story here!)  

Sunday there are no RN's...just med techs and AC staff...(Assistant Caregiver)

And my favorite med tech was there...and she told me my dad did push his walker into her...but she was so calm...and we discussed medicine...and changing it...all of this stuff takes time.

My dad was calm when I arrived, and I was told my mom had been  crying today..but my husband visited with her and soon she was smiling. 

My dad said he was so glad to see me and my husband and he had a bad dream that we were in a horrible storm...he was calm and ate well. He was very relieved we were not in a storm, and we were OK.  

My theory on this one is that we WERE in a horrible storm with that RN.  We have requested she not have interaction with my dad.  And that is not that difficult, because she was subbing, and does not usually work with the residents, but since she is higher up she works with paperwork.  

My mom's tears were another loop...she was sure my dad had a new wife and she was going to have to adjust and he was through with her....funny thing is 2 days ago I witnessed him crying and hugging her and telling her that they had been married for 44 years (actually married 30, divorced 39, but who is counting?) So this time she was REALLY THROUGH with him!

I distracted her with another resident who loves to walk ...and they walked off together....well uh I guess I won't say Happily Ever after. Dimentia Soap operas. 

Thanks again to everyone who posted...I really really appreciate.