DH was declined admittance to the psych hospital due to his acuity level

LadyTexan

DH was declined admittance to several psych hospitals. I was hopeful (as was the local hospital) for a place in Austin. We all thought it was a done deal until I learned this morning that DH was declined due to his acuity level. I am at a loss of what to do now. 

DH has been in the ER since Sunday. He is not receiving psychiatric care. His meds are not being administered or managed. As a reminder, he refused his meds for approximately a week before he went to the ER. He was given Ativan in the ER as needed for agitation. DH is watched by a large muscular patient aid all the time. Basically, he is being warehoused until a psych bed opens up.

The Mental Health Authority is considering sending him to a locked unit in a nursing facility. That would sound okay, but the place she suggested was a COVID hot spot in our town.

I know now is the time to think with my head. I want to do what is best for DH and me. Its hard not to be fuming angry.

I welcome any and all suggestions for actions that I can take to get him the care he needs now.

Doityourselfer

Lady Texan,  

If I was in this situation, the locked unit in a nursing facility would be the choice - COVID or no COVID.    It must be very difficult to be in the ER for an extended period of time.

M1

Has he been vaccinated LT? If so, he should be okay. If not, I'd ask the ER to give him the first shot now or the Johnson and Johnson, one and done.

Quilting brings calm

I agree- get him vaccinated.  Also-  you write ‘was the Covid hotspot’.   That’s the past.   Covid germs, virus, etc only last on surfaces for a short time, especially in the heat.  Covid patients are only contagious for 14 days or so. He will probably have limited contact with patients  for  that long. Covid numbers are falling nationwide.  Chances are patients in that facility have been vaccinated already.  Safety protocol has been expanded. Take the bed, the risk is  probably lower  than  being in the ER where a current Covid patient might come thru the doors. 

Get him started in psych treatment wherever you can find it, get him medicated.... then see what happens.  I think you have come to terms with the fact that he’s going to be in a facility.  That doesn’t mean he will be in this one longterm.  

LadyTexan

DH and I received both shots of the Moderna vaccine.

dayn2nite2

Take the locked unit.  Do not take him home.

jfkoc

I did not go back and read all of your posts so please excuse if this has been covered; what does his neurologist say?

Ed1937

OMG, Lady! How much can you take? I know you're tough as nails, but......

Being vaccinated, he should be OK regardless where he goes.

A few years ago, one of our sons tried to commit suicide by going into a sports shop, loading a rifle, and tried to shoot himself in the head. The bullet missed, and went into the ceiling. Police were called, and he was taken to a local hospital, where he stayed for about 6 months, waiting for a bed to come open at a state hospital. He made the almost 300 mile trip in a police car. Then after 13 months there, he was finally released, and in much better shape. The ride home was also in a police car. I hope your DH can find help very soon. I don't think you should be concerned with Covid. You both need any help you can get.

M1

Absolutely, take the locked unit as a place to start. He should be protected regarding Covid.

M1

And btw I would say you're entitled to some anger. Doesn't have to be at him personally, but at the situation for sure. At the disease. At being put in this situation.  Very scary.

Stuck in the middle

There is no reason to bring him home.  It wouldn't make either of you happy, and it wouldn't make either of you safe.  I suggest you refuse to admit him to your home.  That will force the community to deal with the problem.

The locked wing of a NH is the option I would choose.  He will receive better care there than in the unlocked wing, because the staff/patient ratio is higher.  Actually, I agree that hospital admission is not the best option.  A hospital is for treatment, with the goal of healing and returning to semblance of normality.  In a progressive disease such as AD, that goal is not feasible.  

I would let him go to the NH, visit from time to time, and take some time to heal.

You can do this.  I have to go help DW now.  bye

LadyTexan

jfkoc wrote:

I did not go back and read all of your posts so please excuse if this has been covered; what does his neurologist say?

LadyTexan response:

DH has not seen the neurologist since he was diagnosed in February 2019. Since that time DH was seen regularly by the geriatric psychiatrist, until we relocated to Kerrville in August 2020. The PCP then took over managing his meds.

abc123

I’m thinking of you this morning and praying.

harshedbuzz

LadyTexan wrote:

jfkoc wrote:

I did not go back and read all of your posts so please excuse if this has been covered; what does his neurologist say?

LadyTexan response:

DH has not seen the neurologist since he was diagnosed in February 2019. Since that time DH was seen regularly by the geriatric psychiatrist, until we relocated to Kerrville in August 2020. The PCP then took over managing his meds.

Would it be possible to reach out to the geripsych he used to see? S/he may be able to facilitate a bed in a geripsych unit near them.

LadyTexan

The geri-psychiatrist DH used to see has been looped in since Monday. Her practice is with the medcenter that has the Psych Hospital in Austin that declined to admit him due to his acuity level. That is why I am feeling especially defeated. A separate doctor at the facility led the local hospital to believe that the transfer was a done deal.

Part of why I am so MAD - People with dementia related diseases deserve psychiatric treatment. I can appreciate that DH is not a good candidate for Cognitive Behavioral Therapy (CBT) because of his memory issues. DH is an excellent candidate for intervention, oversight, and medication adjustment to stabilize and/or modify his behaviors. IMHO, people with a terminal illness may have a higher propensity to find themselves in crisis due to what they perceive as awful and hopeless. I am just sick at what I see as an exclusion of DH receiving the care he needs.

abc123

I understand your anger. The situation is ridiculous. Please forgive me if this sounds stupid but have you tried calling the psych hospital in Austin? Ask for information and guidance? Explain that DH is in a hospital getting NO help with his meds. Ask them “How will he get stabilized WITHOUT their help. What would they do if it were their LO? Lady, I’m grabbing at straws here. I wish I could help you.

LadyTexan

On a very positive note - the geri-psychiatrist reached out to a social worker that was part of our health care team when we were in Austin. The social worker will Zoom with me this afternoon to help me process this situation.

I am grateful that we have a network of people that care about DH and me. I wish it would transform into actual tangible care for DH right now.

This just in......

On another ESPECIALLY positive note - the geri-psychiatrist expedited adding DH to her schedule. They have a telehealth appointment set up for Tuesday June 8th at 8am.

M1

That's good news LT.  I hope s/he is helpful.  Some of the psych social workers are very knowledgeable, she may be familiar with the different facilities.  But an unlocked ward could be dangerous, to him and others.   This is still very early in what's likely to be a long process to stabilize---I would suspect a matter of months, not weeks.

jfkoc

A nightmare! Why? Why is there no adequate care?! Please keep us in the loop.

Jo C.

What monumental set of disappointments; once again, I am truly sorry for what is happening.

What you are finding out is that GeriPsych and in fact, regular Psych Units are different from one another in what and who they will accept as an inpatient.   This also has been experienced by other Members here. 

Your husband is on the younger side of the spectrum, he is quite a strong fellow with violent tendencies which he has acted upon several times; he is a definite danger to others, and in all probability to himself.  He refuses medications and is severely delusion driven to the violent end of the spectrum . . . . some units will refuse such a patient due to risk to staff or other patients and some are ill equipped to handle such a patient.  ( I have even suspected a bit of "cherry picking" with some units.)

You have a locked unit prepared to take him. If this was my husband, and I absolutely adore my husband, I would choose to have him admitted to the locked facility no matter it would be painful to me.  He actually needs a specialized locked unit fully capable of managing a patient with his behaviors and potential behaviors - he would be more apt to wander off a fairly open unit as the spirit moves him, and the locked unit by acceptance of him hopefully appears to be able to handle the challenges he may present.

As far as the past COVID concern; by now most all patients in facilities have been vaccinated and also the larger number of staff in most facilities.  You and your husband have been vaccinated with the Moderna Vaccine.  That sounds as though he is in good stead on that front.

Whatever you do, I agree with the others; he should not be going home at this point.   Our dear Ed has shared with us the severity and heartbreaking angst of his son's experience; it is so hard, but needs must and the most important thing is to get your DH into a facility where his care can be adequately managed; it does no good to admit to a lesser capable unit and have the end result be far less a good outcome.

It is also now a point at which a primary care MD would probably no longer be the best at managing medications for your husband.  He is far into the realm of absolute necessity for a dementia specialist to oversee and manage his treatment and medications.

So hope that this will have an answer soon and that it is the best one for your husband as well as for yourself.  Time will tell whether he will be able to ever return home again; a Plan B for unwanted custodial placement would be a good cautionary idea to screen for once he has been transferred to a psych unit.   Preparation in advance to anticipate possibility of need and prevent future overwhelming issues would be helpful to you.  Of course, as discussed in the Post above, the psychiatric social worker should be seen asap after admission for input to possible post discharge needs.

NOTE: Under no circumstanaces can you be forced to take him home if it is not safe to do so or if his acuity level is so high that you cannot manage without becoming ill yourself, so do not let this be a simple shortcut for the social worker- you cannot be forced to do so..  

We will wait to hear from you while hoping for the best,

J.

banpaeng

Ms Lady Texan, I am sorry you are going thru this.  I am fast behind you.

A short tale.  When my Dad was in the hospital at 80, they wanted to discharge him home Because Medicare rules said it.  I met Doctor in the hall and told him he could not discharge him to home as my mother was unable to handle him, as she was barely able to walk.  He said he had to due to Medicare.  I told him he was able to write something in the record that extends his stay. ( I had to go to work).  Doc kinda stomps off but returns about 10 minutes later to tell my Mom, dad will stay in hospital.  My point, sometimes you need to tell them instead of listening.

Also Ms Jo C had some very good advice, especially the note part.  You need to take care of yourself and do what is best for you, not your loved one.  If you don't the next caretaker will.  Please take care of yourself.

I had a long talk with my son yesterday.  He gave me the same advice as above.  The outcome for my wife is the same no matter what I do.  Mine can be the same as hers or I can do for myself.  Does that mean I don't care what happens.  No, however I am trying to listen.  I hope I can do as he says and not come back on here in a few months repeating you.

Thanks for reading and I wish you all the best,

dayn2nite2

jfkoc wrote:

A nightmare! Why? Why is there no adequate care?! Please keep us in the loop.

Because he is young (in terms of dementia), strong, male and violent.  If he were more advanced/bedridden there would be no problem.  He can hurt staff and other patients/residents.

Most states dismantled the system of "state mental hospitals" years ago so those places (where people used to be put if they couldn't be handled at home) no longer exist.

That's why we are all advising if there is any place willing to accept him that has a locked unit, have him go there.  Because there is really no other place.

LadyTexan

This day has been both awful and unbelievable and exhausting.

The care coordinator (social worker at the local hospital) and the woman from the local Mental Health Authority who was working on finding my DH a psych bed since Sunday, "collaborated" and finally found a psych hospital that would accept my husband.

Frankly, I don't know what they did, because they rarely communicated with me. Around 4 pm, I learned a psych hospital agreed to accept my husband. DH will be going to a place in Waco which is about 200 miles from here. 

I am too tired to relay the multiplicity of disappointments and frustrations of the day. I hope tomorrow is a better day. 

I want DH to receive the best possible care. I accept that DH is suicidal. I accept that DH has Alzheimer's. My DH deserves quality health care. I wish it was not such an effort to get him the care he needs.

Thank you all for your kind words and support. I am a wound up ball of emotions, mostly sadness and anger and frustration. I also have gratitude for all of you. Thank you for your thoughts, prayers and kindness. Thank you for your thoughtful suggestions. Thank you for listening. God bless you all.

Quilting brings calm

LT - I have found that getting info out of hospital staff is next to impossible. However, like you, I have  found that they really are working behind the scenes during that period of little information.

 I’m sorry this hospital is so far away.  However it will allow you justification to limit your visit to weekly until they get him straightened out. That will allow you some time to check into suitable long term facilities.  It will allow you some time to sleep and just rest.  You need and deserve that.  

ButterflyWings

Dear LT - thank goodness! It is progress at least. I have been saying a few 4-letter words (well, thinking them at least) on your behalf today. The system appeared to be utterly failing you and your DH,  Take some well-deserved  rest and self-care if you can. Just do nothing. You must be exhausted on every level.

We are lifting you up, and sending you endless love and light.

ladyzetta

((((((((((((Lady Texan ))))))))))))

Mint

Many facilities for those with severe mental illness were closed some years back.  Many of those people are now living homeless, often addicted.  Many others are in prison.  Prisons sort of became the new treatment facility for mental illness sadly.   Makes you wonder were those people truly advocating for the mentally ill?  Let’s hope they thought they were.

So many families now find themselves in your shoes. Very few facilities for those suffering from very severe forms of mental illness.  A facility may be miles away and shortage of openings.  These types of facilities have a lot of patients who need long term care, there is usually no quick fix, so guessing they don’t frequently discharge patients so why there are not a lot of openings.

When your husband does get placed, would definitely talk with someone there on a regular basis.  IMHO you do not need to go visit on any regular basis.  You did your very best to care for him and keep him safe.  Due to his illness, this triggered him to have much anger toward you.  May be best to stay away a long while.  Would talk with those at the facility where he ends up at about this.  Also, if that long trip is stressful to you, don’t do it. ((( Put on your oxygen mask and take care of yourself.  )))You have went without your oxygen  mask long enough.  You have done the best you knew how, that is all you can do.  You are now caring just as well for him, by turning his care over to others.

Take care

Joe C.

LT, I am relieved that they found a hospital that would accept him. I cannot image how you are dealing with all this stress. Please take care of yourself!

abc123

Sending good wishes and hope, that today will be a day of blessings for your husband. May he get the treatment that he needs. You are an inspiration to us.

June45

LT...quite honestly, I am not sure if would survive what you have been through.  Thank you for keeping us posted...there are many here who care about you.

LadyTexan

A gift from God - This morning I took the dog out in the yard so he could take care of business. A purple flower caught my eye. I think it was a weed actually that had grown through a crack in the patio tiles. Its a beautiful flower. Its a reminder that even though life can be challenging and frustrating and exhausting, there is still newness and beauty. As you know, I am a woman of faith. I am grateful that I saw the beautiful flower as a reminder of newness and beauty. It refreshed me and reminded me of something I truly believe: God is with me and he strengthens me. 

Here's an update:

• DH is safely at the Psych Hospital.
• I am coming to terms with the fact DH may not ever come back to our home. Placement is likely and I am preparing to take steps to put that into action. My heart is breaking.
• I am angry and sad. This disease is so cruel and so unfair.
• I feel so broken.

Thank you all for carrying me and holding me in your prayers.