Behavioral Health Assessment

cpyle619

Hello All,

It's been quite a while since I last asked for advice. Mom was moved into MC this April from her IL apartment. It was the decision of the facility after she refused any type of help or assistance from family or paid caregivers. She is high functioning, has excellent verbal skills and is in good physical shape, but she can't remember anything; if she ate, took her medication, etc. About a year ago we got her paperwork updated and she gave me DPOA. I had been visiting her once a month (she's 4 hours away) to collect any stray mail and to see how she was doing. 

So, MC since April. To put it bluntly, she is mean. Always has been, but hid it beautifully from most folks. Being in MC has made it very clear to most, and that's where my question comes in. The facility wants her to be evaluated for Behavioral Health. It would be an outside agency and they just sent me a consent form. It is an Intake Form and after reading it, I would be agreeing to them doing pretty much anything they want to, and lots of language about Financial Responsibility. Have any of you experienced this? And what did you decide to do? I had spoken with the director of MC yesterday and she mentioned she would like an behavioral evaluation in order to decide on medication for calming her some, but what they sent me to sign is giving them free reign. Thanks for any and all thoughts. 

LaurenB

While I can see the benefit of a behavioral health assessment, do not sign anything that you do not feel comfortable with.  Call and discuss the form with the agency that wrote the form.  Ask to speak to the office manager to better understand what their objectives are and what the ramifications of you signing the form are.

Lauren

John2.0.1

Does your DPOA include health care proxy? Or are you HCP by a separate document?

I am my mom's HCP but it' a separate document that also includes her final wishes.

In any case, my mom is currently in Geriatric psych/behavioral heath unit at the hospital and they coordinate their care with me, not my mom's memory care facility

cpyle619

Thank you Lauren, planning to call tomorrow. I 

Yes, John, I also have HCP as a separate document.

Thanks so much for your responses. 

M1

I think you are right to be cautious and I would quiz them very specifically on what their "assessment" entails. We see behavior modification plans put in place all the time for developmentally disabled children and adults living in group homes, but not for elderly patients with dementia.  About the only thing they can do I think is put her on medication and I wouldn't think a separate consent form is required for that. I would ask to speak directly with whoever is "assessing" her andto whoever might prescribe for her.  What are they gonna do, withold dessert if she's mean and give her a gold star if she's nice?

harshedbuzz

cpyle619 wrote:

Hello All,

It's been quite a while since I last asked for advice. Mom was moved into MC this April from her IL apartment. It was the decision of the facility after she refused any type of help or assistance from family or paid caregivers. She is high functioning, has excellent verbal skills and is in good physical shape, but she can't remember anything; if she ate, took her medication, etc. About a year ago we got her paperwork updated and she gave me DPOA. I had been visiting her once a month (she's 4 hours away) to collect any stray mail and to see how she was doing. 

So, MC since April. To put it bluntly, she is mean. Always has been, but hid it beautifully from most folks.

This was my dad. I was not the favorite and always knew he was not the man behind his public persona. At his funeral a few of my old classmates turned up to pay tribute to this lifechanging educator with tears in their eyes while I sat their stoically thinking WTF? I suspect dad had some form of bipolar or perhaps was a sociopath and his geripsych agreed there was definitely something there based on the history dad couldn't give him. 

Being in MC has made it very clear to most, and that's where my question comes in.

It's probably the other way around. One of the losses in dementia is that of a social filter. As the disease progressed, she lost the ability to control her public image and that led to her being seen as agitated and needing MC.

The facility wants her to be evaluated for Behavioral Health. It would be an outside agency and they just sent me a consent form. It is an Intake Form and after reading it, I would be agreeing to them doing pretty much anything they want to, and lots of language about Financial Responsibility. Have any of you experienced this? And what did you decide to do?

I would absolutely make this happen. Behavioral health is kind of a euphemism for all things mental illness, developmental disorders and such. I didn't wait until dad needed memory care to sit him down with a geripsych; this person became the most important person on dad's care team. 

The paper sounds like boilerplate stuff. Basically, this is informing you that the person who comes in to see your mom is not an employee of the facility and will need to be paid by whomever is responsible for her finances. This may matter if they don't take her insurance which is not unusual in the world of general psychology/psychiatry; but less so in geriatric psychiatry IME. Both dad's geripsychs did accept Medicare.

I had spoken with the director of MC yesterday and she mentioned she would like an behavioral evaluation in order to decide on medication for calming her some, but what they sent me to sign is giving them free reign. Thanks for any and all thoughts. 

They should be consulting with you to discuss options. I would expect the geripsych to want to discuss her history with you as part of the evaluation and then come up with a plan. I would not be surprised if the "free reign" includes a geripsych admission to trial medications in the safest manner possible. 

cpyle619

Thank you all for your responses from my last post. It helped a bunch.  New problem.

Day before yesterday, another resident wandered into the room next door to my mother. Mom has become what the staff call "the Mom" of the unit, being the enforcer of what she believes is right and wrong. Going into another person's room is "way wrong" to her, which led to her pulling the resident out of the room, and they both fell. Luckily, neither was injured, but they sent Mom to the ER for a Behavioral Assessment. They did blood work and such, determined that she had mid-stage Alzheimers and sent her back to the facility. No recommendations or new medications. It was my understanding that they would do a psych eval? Anyway, we are where we are. 

I'm expecting a call from the medical director. They currently have her on 10mg of Lexapro. She is a super strong personality. Wish I knew a way to make her happier. Sigh. Thanks for listening. 

cpyle619

harshedbuzz,

So sorry to hear you had this in your own life. Not many people understand. I lost my father to a brain tumor in 2006. He sounds a lot like your mom.