Finding AL/MC for verbally and physically aggressive

Vandi

My sister’s 82 year old partner with probably stage 5/6 dementia has been in and out of ER, hospital and nursing home several times over last couple of months.  He of course doesn’t really understand what is happening and he has been verbally and sometimes physically aggressive to the health care workers and other patients. 

My sister realizes that she can’t care for him at home anymore and so she will soon start looking for a AL/MC facility. She currently lives in a pretty rural area that is far away from family so I am helping her look for places that accept Medicaid which are closer to family. We are concerned that it will be hard to find a place given his verbal and physical aggression.

I am looking for any suggestions on how to go about finding a AL/MC facility and what steps will be needed when we do find one. Is there a checklist that might give the big steps we need to start with? In addition, I would appreciate hearing from anyone who has placed an aggressive LO and what were the challenges you faced and strategies you used.

Thanks.

Stuck in the middle

I bailed him out of jail and got him admitted to a mental hospital, where medications were titrated and the voices in his head quieted.  Meanwhile, I engaged an attorney who could persuade the judge that probation with confinement to a RCF was the best thing for the community and the individual.

The man I was helping was 60 years younger than your LO and had some people pretty scared.  You can probably get your LO under the care of a psychiatrist with much less sturm und drang.  There are medications that can control the aggressive behavior.

towhee

Hi Vandi, I don't have experience with aggression, only exit seeking, but I suggest limiting your search to MC only. I don't think AL will work.

star26

Hi Vandi, Getting the aggression controlled with medication will help with placing him in a facility and ensure he is able to stay there. A geriatric psychiatrist or a psychiatrist with a lot of dementia experience is the best MD to do this. I would make it a priority to find one asap to make the future easier for everyone and to start on the right foot. If the distance to such a specialist is too far to drive, maybe telehealth appointments are an option. The right prescriber can make all the difference. FYI: it’s normal to go through some trial and error with meds and dosing so don’t give up. 

One advantage of MC over AL is that the staff is usually (hopefully) better trained in handling various behaviors to avoid escalation. Sometimes just knowing how to avoid or respond to aggression can make all the difference. Asking about staff training specifics would be good to add to your checklist when shopping for a facility. 

Here is a link to another thread here with recommendations for finding AL/MC facilities. If you scroll down to Jo C.’s post she also includes links to some outside sources that may help you. In addition to all the good reccomendations there, I am also a big fan of reading past inspection reports (including complaint investigations) for any facility I’m considering. 

https://www.alzconnected.org/discussion.aspx?g=posts&t=2147552810

harshedbuzz

The simplest strategy would be to have him taken to the nearest ER that has a geripsych service attached for a short stay to titrate psychoactive medications. Even in a medically well-served area, not all hospitals will have this capability, so he could be turfed several hours' drive away. Your sister makes it clear she will not take him back because of fears for her own safety and that of others including him. From there, the social worker will arrange discharge to some sort of facility which might also be a distance away.

A couple of caveats-

Does your sister have the legal standing to make this happen? Is she his DPOA? Are their assets mingled? She might want to explore this with a CELA as there may be a legal obligation to support or sell off his half of assets.

In some states, Medicaid will not fund assisted living or memory care. Some will fund some care in the home or a SNF is the person meets the criteria for needing SN.