Expectations for Geriatric Psych Unit and Process

John2.0.1

It has been decided that my mom needs a stay at a GeriPsych unit to try to get some control over her aggressive behaviors in memory care. She's been hitting and kicking staff and the behaviors are escalating in frequency, intensity and longevity.

Mon agreed to this when she was back on baseline.

She's currently in the hospital while a bed-search takes place. I'm not expecting much to happen until the long weekend is over.

Has anyone got some advice on what I should expect in terms of process? I was warned by the psych who evaluated her that they may not want me to actually visit. What should I expect? I think that I should be involved during her initial intake, at least virtually. Status reports? Care planning? I assume that I'd expect that the wellness directly at her memory care would be actively involved.

I am aware that I should not expect miracles. Her Parkinson's will only get worse.

Any advice to me on what I can best do on my side to help make sure that this is useful for mom?

terei

I can describe only what happened in my mom’s case.  The AL where she was living had her sent to an emergency room when she repeated threatened suicide.   She was taken to the ER + then to a geri psych unit.   I was NOT involved at intake at all.

I was told family could not visit the first two weeks + after that, visiting hours were for only a few limited times daily.(4-6pm as I recall). I visited her every other day for an hour or so each time.   The initial RX was not effective + they tried another which helped her mood + depression (Cymbalta) which she was on for the next 3 years. It was never changed or adjusted after the first RX, which was fine IMO

The AL was NOT actively involved during her hospitalization. They were given a final medical report at the end, with meds instructions.

I met with psychiatrist twice while she was there + had another 2 phone visits with her.  The psychiatrist could treat her only while she was a hospital patient, so if her meds needed adjustment later, it would have to be by another doctor.   

I thought her treatment there was fine.  I ignored her complaints about being there in the first place + took a hands off attitude.  I spoke with a nurse on her ward daily briefly to see how she was faring.

She was better when she she came back to AL(+ later to MC) I initially was irked when the AL had her sent to the ER because of what I thought was melodrama on her part but she seemed a lot less depressed + more engaged after she was on meds, so I am happy that she was treated at the time.

They should be able to moderate your LO’s behavior with meds, but they may need to try more than one before they hit on something that is effective + that takes time. Meds may need to be given for some time daily before their value is observable.  Be patient.

Stuck in the middle

I have been in your shoes, more than once.  

The psych unit will try various meds and doses until they find what is needed to control her  mood and behavior.  There is nothing for you to do at this point, and no need for you to distress yourself visiting.  Trying to involve yourself in this process will be about as helpful as looking over a surgeon's shoulder and offering suggestions.

This isn't any fun, but it beats the straitjackets and brain surgery used to control aggressive behavior a couple of generations back.

John2.0.1

Thanks for letting me know what to expect.

I don't really know what they can try that we haven't already tried. But dose changes...maybe. The bottom line is we need new ideas. What's she's on isn't doing the job.

I hope that mom remembers that she agreed to this treatment and stays cooperative. But she may forget. (Or perhaps not. They can't do anything if she stays on her best behavior I suppose)

I will likely at least need to bring her her wheelchair. All she can do is crawl at 3 feet an hour without it. And she falls out of a standard rental style wheelchair. Her mobility is that bad.

For behavior/moods, she's on:

• Seroquel
• Sertraline
• Memantine

We took her off Donepezil when she went on Memantine

And she's on 4 other meds for mobility in addition to the usual calcium, vitamins, Aspirin, etc...  26 pills per day.

Stuck in the middle

There are lots of other psych meds.  My son takes several.  They keep the voices quiet, and he can live in a RCF and go on outings instead of a beating his head on the walls of a padded cell.  I don't know what will help your mother, and neither do the doctors, which is why she goes to hospital where they can watch how med changes affect her and adjust accordingly.  

This is a little like when my doctor first prescribed blood pressure meds.  The first prescription had no effect whatever.  The second lowered my heart rate to about 40 bpm - glad we started with a half dose!  The third was just right.  20 years later, some changes have been needed, and it has worked - I'm still here.

Trust the doctors.  They have done this before.

Jane Smith

Hi John,

I remember your other post saying this might/would need to happen. 

I can only tell you my experience, which was completely positive in terms of assessment, care, medication, staff, visiting, communication from the nurses, and all things medical. It was less satisfactory in terms of the social worker—they tried to discharge her on short notice, but I hadn’t yet found the right facility to take her, so I said NO to the discharge until the right place had a bed ready—don’t let them pressure you if you think discharge is happening too soon. 

I was allowed to visit whenever I wanted, and stay as long as I liked. although was asked to keep it between 8 am and 8 pm as much as possible.  She was allowed to have other visitors but as next of kin and PoA I had control over who was and was not allowed on the unit. 

There was a nurse assigned to be my liaison or communication person. I could call her, or the charge nurse, anytime. 

I was not present or involved with intake although they did get some information from me separately. 

I had two in person meetings with the attending physician, and maybe a couple of phone calls?  Mostly I talked to the nurses. 

She stayed there for about 14 days and after spending a lot of time with her the first few days, I cut way back on my visits. Partly for my mental health but also because I was doing a lot of driving around and looking at facilities and paperwork and so on. 

Every patient I saw was treated with respect and kindness. 

Every patient was checked on visually every fifteen minutes around the clock. So for the first time, I was able to know if/when/how much my mother was sleeping. Turns out she was not a good self-reporter. (That sounds obvious now but at the time I didn’t know she had dementia or what that meant.)

They did things I thought could not happen like:

-gave her a shower (she hadn’t showered in at least two years prior)

-got her to eat regular, nutritious meals (she was underweight and clinically malnourished when she went in to GeriPsych and was a hair’s breadth from having rickets, which the doctors told me they had never seen outside of a textbook)

-got her on a regular sleep and wake schedule

-got her off caffeine and to STOP SMOKING 

-got her meds straightened out and regulated (she was taking a horrific cocktail of new, old, and ancient prescription and over the counter medications that should have killed her)

-got her a diagnosis 

-got her the care she needed

So for us, it was great.  I know that’s not the case for everyone. 

 There are a lot of meds in a lot of doses and combinations that can be used for persons with dementia. Please don’t give up hope yet.  

All best wishes to you. 

John2.0.1

Thanks for letting me know what I may expect. At the moment mom is still chilling at the ER.

I am pretty angry at the ER and the hospital pharmacy. On Saturday when she went there I asked and ask repeatedly if the pharmacy had all of the meds my mom takes especially the Rytary for her Parkinson's muscular control. They kept saying yes. I kept asking to double check because no other hospital pharmacy carries it. I was told again and again that they have it.

Today, Monday, they called mom's memory care asking that her Rytary and her ROPINIRole also for her Parkinson's muscular control right be sent over urgently. They should have called me. I told them to call me as DPOA and Health Care Proxy. They should have called me Saturday night!

So for a day and a half mom didn't get Rytary which she takes 4 times a day, 13 pills. She missed 9 med times on this!

Mom was asleep when I got to the ER so I didn't wake her up.

While I was waiting to get a receipt for the med bottles I get a call that mom is being moved upstairs today to their own Geriatric Psych unit. I say good. I write down the phone for that unit.

I go home and call the unit. I'm thinking that mom will need her wheel chair. She can't get around without it. So I call and I'm told that mom will NOT be moving to the unit. They have no rooms. So I call back the person who first called me about this and she said that there is mixup. She'll let me know.

Regardless I went to the MC and got mom's wheel chair. She's going to need it wherever she ends up.

If she gets in to this hospital's GeriPsych unit I hope they are more on the ball than the pharmacy and ER are. How could the pharmacy have waited 36 hours before asking for her meds that she takes 4 times a day?

So how's mom doing? Well she fought the nurses who were trying to get mom to take her other meds. (She takes 26 a day). She was aggressive but they finally got her to take the pills.