Nobody want will take LO

mom2asb

I'm at my wit's end! My MIL is in the later stages of Alzheimer’s, she is 84 and was still living at home with her husband of 64 years. She kept getting worse as far as combativeness, making everyone including herself miserable. She doesn't sleep and won't let her 85-year-old husband sleep. He was EXHAUSTED and would just fall asleep every time he sat down in his chair. It was all getting to be too much for him. My husband, their son and myself decided we were going to have to move in to help take care of them. After 2 weeks, we realized that me being there was making her upset. She accused me of sleeping with her husband and I couldn’t do anything right. So, we decided to stay in our camper in their yard, so we could be close if they needed anything. That worked for a while, but after 3 months we realized that we needed to go back home. We only live about 5 miles from them, so we could still jump in the car anytime he would need us. She had been leaving home, but she always ended up at a neighbor’s house up the street. We live in a rural area with planted pines and woods everywhere, but she always went to the neighbor’s house, and she knew her and the situation and would bring her back home. The final straw came when she left home early in the morning, no shoes in her pajamas and turned the other way instead of going to the neighbors. She made it to the end of the street and was standing in someone’s yard. He called the police and thankfully she was able to tell him her name and they brought her home. Unfortunately, my FIL was so sound asleep he didn’t hear the police knocking on the door. My husband was going over that morning to check on them and saw the police. So, we got that straight. The whole family decided it was time to do something. Obviously, having someone move in with them would not work. So, we started the process of finding a place for her. The closest town is ½ hour from here. We visited 3 facilities with memory care. So, we begin the process.

We chose an ALF memory care facility ½ hour from home and thought this would be a great place for her. They are in the process of converting over to full memory care. She was NOT happy when she realized we were taking her there, and from the start, there was a lot of confusion about what she needed. It’s way too long to explain, but the admission process was not very well organized, so things fell between the crack.

2 days later we get a call she fell and was on the way to the ER. She was on blood thinners, so they were concerned about a brain bleed. She had CAT Scan, no brain bleeds or broken bones, just looked like she was in a prize fight, a LOT of bruising. WE neve got a straight story on how exactly it happened. Because of the confusion when she was admitted at the memory care, she wasn’t placed in the right wing. So, they moved her to the “Keepsake” wing. More CNAs to resident ratio. When she got back from the hospital after the first fall, she was not stable on her feet and could not walk unassisted. She was placed in a nice room by herself at the other end of the hall. She fell 2 more times. The last time she ended up in ICU an hour from home for a week, with a brain bleed. The call was made, does she have a DNR. They were able to stop it, but she is not able to walk unassisted at all and her combativeness is worse. It was decided that she would need skilled nursing care and the search for someone to take her began. Nobody wanted her, but we finally found a place that would take her for rehab. They wouldn’t let us see her for a couple of days, I guess so she could adjust. We get there, and she is sleeping. The administrator asked us what are the long-term plans for her and said for her to stay with them. He informed us that they wouldn’t be able to place her in this facility because of her combativeness. She was hitting the CNA’s and scratching them, and that was unacceptable. As long as she was participating in the physical therapy they would keep her there for rehab, but if she refuses, then we were going to have to take her somewhere….

Sorry, this is so long, so much has happened since May 14th when she was placed in memory care. She went from being able to walk, and taking care of her personal hygiene, to not being able to walk with out assistance, wearing depends and basically sleeping all the time. So, where do we go from here? The administrator said that we were going to have to find somewhere as soon as possible. We needed to find a memory care. Is she the first patient with Alzheimer’s that is combative? Any suggestions of where we go from here?

King Boo

Your post does not mention if she has had a Geriatric Psychiatrist MD see her.  Prescription medication can make her quality of life better, and make caregiving possible, thus opening up care options.

This class of meds is their wheelhouse.  Neurologists and PCPs prescribe, but don't have the comprehensive expertise.

LaurenB

have you contacted your area council on aging?

Rescue mom

Ditto to what king boo said. Many do get combative, and there are meds to help with that. prescription drugs can calm her, which is good for her as well as others who have to deal with her. Otherwise, you will have a very hard time finding a place. Few will take the risk/danger of having a patient who may injure other patients and staff, as she has already done.

M1

So sorry for your dilemma.  Yes, she may need medication for combativeness, but she will probably need to stay in a skilled nursing facility and she probably needs Hospice, I would suggest you inquire about that.  The chances of getting her back to a point where she could live in a memory care facility are very small, unfortunately.  It would be unlikely that she will regain the ability to walk unassisted.

M1

Another suggestion:  I would think about not resuming the blood thinners.  There comes a point where the risks outweigh the benefits, and it sounds like you are probably at that point.

[Deleted User]

The user and all related content has been deleted.

mom2asb

I know that she is on Ativan, and something else. I can't remember off the top of my head. But it seems everytime I go up and see her, she is sleeping.

mom2asb

No, I haven't. We live in a very rural area in North Florida. I will have to google that. Thanks

mom2asb

Yes, she is off blood thinners. The doctor said the risk of her developing a clot is small compared to her developing a brain bleed when she falls.

mom2asb

King Boo wrote:

Your post does not mention if she has had a Geriatric Psychiatrist MD see her.  Prescription medication can make her quality of life better, and make caregiving possible, thus opening up care options.

This class of meds is their wheelhouse.  Neurologists and PCPs prescribe, but don't have the comprehensive expertise.

I know that she is on Ativan, and something else. I can't remember off the top of my head. But it seems everytime I go up and see her, she is sleeping.

mom2asb

LaurenB wrote:

have you contacted your area council on aging?

No, I haven't. We live in a very rural area in North Florida. I will have to google that. Thanks 

mom2asb

M1 wrote:

Another suggestion:  I would think about not resuming the blood thinners.  There comes a point where the risks outweigh the benefits, and it sounds like you are probably at that point.

Yes, she is off blood thinners. The doctor said the risk of her developing a clot is small compared to her developing a brain bleed when she falls.

mom2asb

M1 wrote:

So sorry for your dilemma.  Yes, she may need medication for combativeness, but she will probably need to stay in a skilled nursing facility and she probably needs Hospice, I would suggest you inquire about that.  The chances of getting her back to a point where she could live in a memory care facility are very small, unfortunately.  It would be unlikely that she will regain the ability to walk unassisted.

That's what we are trying to find out. The skilled nursing facility that she is now, said she needed memory care, not skilled nursing. She is a fall risk, she can not walk unassisted right now. She is refusing physical therapy, so that is the facility's excuse for not keeping her. I don't know anything about Hospice care. How do  you go about finding if she can get that care. Also, where do they provide that kind of care? 

M1

I would start by asking the staff at the current facility whether they provide Hospice care and/or work with local Hospice providers.  You can also call yourself for a Hospice evaluation:  you don't need a doctor's referral.  You can call more than one, even.  Medicare covers it.  And for dementia patients, the criteria for Hospice acceptance are a different than for other illnesses:  for cancer, etc. there is typically a guideline for using Hopsice in the last six months of life, but that doesn't necessarily apply here.  You have absolutely nothing to lose by asking and perhaps a lot of support to gain.

mom2asb

M1 wrote:

I would start by asking the staff at the current facility whether they provide Hospice care and/or work with local Hospice providers.  You can also call yourself for a Hospice evaluation:  you don't need a doctor's referral.  You can call more than one, even.  Medicare covers it.  And for dementia patients, the criteria for Hospice acceptance are a different than for other illnesses:  for cancer, etc. there is typically a guideline for using Hopsice in the last six months of life, but that doesn't necessarily apply here.  You have absolutely nothing to lose by asking and perhaps a lot of support to gain.

Thanks! I'll look into that!

aod326

Possibly the MC would take her back if you provided a private aide. My DH had a very similar trajectory (including a brain bleed) and his situation was further complicated by him being an otherwise healthy, and very fit 60-year old.

DH's medications were increased, specifically Seroquel, with Ativan added. To be honest, he was over-medicated for a while. I provided 24-hour additional, private aide. It was a crazy amount of money and I was able to move him to a different MC where they could handle his outbursts; that sounds like that may not be an option for you though.

Consider the private aide. While a significant cost, it does mean the spend-down to get to Medicaid eligibility would happen faster.

Good luck during this extra-stressful time.