Mom's aggression

dmorgman

Hi, I'm new here and hope you can help me.  Some background: My mom was diagnosed with dementia in 2016 and in 2020 that diagnosis was further specified (upgraded?) as Alzheimer's and has progressively gotten worse to the point my Stepfather raised his hand and declared he wanted some help with mom's care.  This wasn't a shock as he himself is over 80 himself and honestly I don't know how he supported mom for this long.  Early January, we had mom admitted to a memory care facility within walking distance my Stepfather (he and mom live in Illinois, I live in Colorado).

Since my mom was admitted to the memory care facility, she has acted with what I would call 'unusually severe aggression' on two occasions.  Both times assaulting the staff there and both have resulted in Mom being taken to a hospital via ambulance.   

The first visit she had a UTI, which for someone without dementia would be a brief discussion with a doctor and daily dose of antibiotics for a week or so.  In mom's case they ordered a battery of tests (including an MRI even though she had one a month ago) and kept her restrained and sedated and in the hospital for a week to the tune of more than $50k in fees.

Second visit they kept her overnight again ordering a host of test releasing her without finding anything new (she was released today).  Not sure what the bill is yet but overnight at a hospital and any tests they ordered won't be cheap. 

My questions are, will the memory care facility be calling 911 every time mom shows aggression?  Is mom's situation unusual?  Is the memory care facility doing the right thing sending her to the hospital every time she has this type of aggression?  I don't condone mom's behavior, its not ok to hit anyone. I also don't blame mom.  I know she's not really mom anymore most of the time and from what I understand aggression is a common side effect of Alzheimer's.  I just don't know what is normal for these memory care facilities.  

What I do know is this cannot last long; between the memory care facility and the constant trips to the hospital, mom probably won't be able to afford even another month of these kind of bills.   

Tfreedz

Welcome dmorgman, so sorry you are dealing with this. 

I’m not sure if you or your Stepfather is your mom’s POA, but I would definitely contact the facility and ask to have a meeting. Usually they have a team consisting of the administration, social worker, head nurse and possibly doctor. You (via zoom or phone) and stepfather along with the team can discuss a “plan” to deal with any further behavior problems of your mom. If your mom is still with her own PCP, contact them immediately on her behavior and possible medication to help. If she is now in the care of the facility doctor discuss possible meds to alleviate. During the meeting I would discuss what behavior warrants a trip to the hospital, what behavior will get her removed from the facility and what actions do the staff use when dealing with aggressive behavior from residents. If you can show that you are contacting her doctor on your end to ease her aggression, they may be more willing to work with you.

Please keep us posted on how it all turns out.

Quilting brings calm

Why didn’t Medicare cover the hospital?

robinja

I am sorry you are going through this. We had a couple of similar episodes with my mother last year. My dad was her primary caregiver, and he passed away in early January 2021. I won’t go into all of the details, but she had a very rocky start at AL and eventually MC, with a bout of COVID (hospital and rehab) in between. She ended up in the geriatric psych ward of the local hospital twice, and they were finally able to get her meds adjusted so that she is less agitated. She’s still not the most cooperative, but her behavior has been acceptable. One time she did have a UTI also (by the way, those can cause unusual symptoms in elderly folks without dementia - my MIL has had a couple of bouts, and she is in pretty good shape normally.)

I would highly recommend getting her referred to the closest geriatric psych facility - I am kind of surprised that didn’t happen already.  At the time Mom went, I had no idea such a thing existed. The doctor and staff were wonderful and caring and really good at what they do. 

Best of luck to you and your family. This is so hard. 

MN Chickadee

Her behavior is not unusual for someone with dementia. It also isn't uncommon for the MC policy to be to send them to the ER, but she shouldn't just bounce back with nothing changed. I would request a care conference with the MC staff to make a plan. And to find out what is precipitating this aggression. Is it at a particular staff member? Is it around bathing or some other activity? Is there a way to try another approach? Sometimes there are triggers to the behavior that can be reduced. Other times not, medication is needed to control the aggression and make the person more calm and comfortable.  

She may need geriatric psych intervention. Either to be seen by a geriatric psychiatrist outpatient or go to an inpatient facility for a little while to get meds right. NOT a regular psych facility, a geriatric one is staffed by doctors and nurses highly trained in dementia and getting people stable. You might google geriatric or senior behavioral health units in your area. The closest one to me is a few hours away but worth it for the families that need it. Most people stay a few weeks to get meds figured out and then are released back to their home or facility. If she goes to the ER again you should be able to have her transferred to one of these inpatient settings. Also consult her primary care doctor, they may be able to arrange admission to an inpatient unit. 

When I have had my mother in the ER for falls and other things I have to really intervene on invasive stuff. They don't always understand dementia and will just throw around the usual things they would recommend for a cognitively normal person. After a fall when it was clear nothing was broken I put a stop to blood and urine labs. Too stressful for her in that setting and her doctor can order it done at the facility if it became necessary. They were just going through their normal motions but were totally open to me requesting less intervention once I explained the situation. 

Is she not on Medicare? Why is she paying out of pocket for all the medical care? 

Donnajoy

So sorry.....My sister has had aggressive episodes in memory care as well.   Are the caregivers at memory care trained in behavioral techniques and how not to escalate behaviors like this?

Ours have been really good about it, and usually just leave her to herself until her mood settles down.  They also have a geriatric psychiatrist on staff who has prescribed antipsychotic (Resperidone) which has helped somewhat.  

I would ask about both those.   Also, does her facility have a copy of patient's rights?   I would ask what their protocol is for dealing with aggressive behaviors; I don't believe this is unusual for dementia patients.

I sympathize with doing this long distance;  I am 3 hours away, which is doable for a day trip....but with videoconferencing hopefully you can get a better plan in place than sending her to the ER everytime she "acts up."