Help, they Want to Move him to a Geriatric Psych Facility

Love&Light

Urgent advice needed from the group. My Father has had a number of outbursts at his MC home over the last few days. I have been working with his geriatric pysch to modify the meds to calm him down (coincidentally a bunch of family was visiting and the outbursts began after we left).

Due to some mishaps at the facility, not all of the RX orders/changes were done from Monday and they are attempting to Baker Act him to a Geri Psych facility. I am trying to work with them to take the interim step of applying the med orders from Monday before taking this extreme step. They are not being very receptive at this point.

My concern is that once he's in the geri psych facility the MC administration might refuse him coming back to his MC home which he's been in for close to 2 years. I have ZERO experience with this and I am so scared as I am out of state and out of my depth. Not to mention the fact that he will be in completely unfamiliar surroundings and this will likely take a big toll on his physical and mental state.

Can anyone weigh in on this? Am I overreacting? The MC admin said I should think of this as a positive step rather than them issuing a 45 day leave notice. 

I'm so overwhelmed and scared that I'm shaking.

jfkoc

I think your thought process is spot on.

They did not follow the medical orders.

The hospital stay will not be a positive even

Will they let him back. 

I would get in writing what the behavior in question is and how it was/is delt with.

You need to document all of this before you make any decision!!!

dayn2nite2

Sounds like the choice is geripsych or 45-day notice.  I’d cooperate and do the geripsych if that’s the case.  I’d also line up a plan b facility in case they refuse readmission.

Jo C.

Dear L&L, I am so very sorry for what is happening and can certainly understand the severity of the stress surrounding this situation.

To be fair to the care facility, they must be tremendously careful of the safety of their staff and other patient residents.  If he is lashing out physically, this is a significant issue and may be part of their needing him to be admitted to GeroPsych until he has had his medications further assessed and adjusted and know him to not be a danger risk. 

However; your concern whether they will take him back to their facility again is a very real one.  Has your father been stable and not acting out prior to this event or has he had ongoing problems of this sort from time to time?

If he has not been a problem patient disrupting others routinely and/or becoming a danger even if from time to time, by lashing out physically, the facility may possibly accept him back.  If he has those problem issues, that then may possibly make things more difficult.

Have you asked the Director of Nurses and the Administrator whether they will accept him back after his GeroPsych stay if he is calm and stable?  That is a question to be asked that may help guide decisions.

If they say they would be willing to take him back, that is in all probability not binding; but you also have the option of discussing the issue with an Elder Law Attorney in your father's state if you wish to get legal advice on the state laws covering such situations.

Also; the Alzheimer's Assn. has a 24 Hour Helpline that can be reached at, (800) 272-3900.  If you call, ask to be transferred to a Care Consultant.  There are no fees for this service.  Consultants are highly educated Social Workers who specialize in dementia and family dynamics.  They are very supportive, have much information and can often assist us with our problem solving.  If you call, let the person answering the phone know it is an urgent situation.

The idea of having a, "Plan B," is always a good one.  We never know what is going to happen with our Loved One (LO); having a potential plan keeps us from having to run hither and thither under time constraints if the most negative thing happens.  If your LO is admitted to GeroPsych, which it sounds as though it will happen, as soon as possible, contact the Psychiatric Social Worker for the unit and keep good contact with that person. They will be instrumental in discharge planning as most stays are not very long.  Let the social worker know you would like him to return to the same facility and he/she may be able to contact the facility to let them know that your father has responded well to treatment, (if that is so), and to find out if they will accept him back.

If the facility will not accept your father back, then the Psychiatric Social Worker will assist in finding a new facility to accept your father, but the family is also expected to work on that need too.  Be aware, if it is necessary to find a new living setting, that it may be more difficult to find a new accepting facility due to his history as well as availability, and the Social Worker may find one that does not meet expectations.  Being that Medicare is covering the stay, once an accepting facility is found, the continued stay will not be more than a day or two.

Communcation is important, so hang on and keep good contact with the people involved in all of this.  It would be a good idea to contact the Helpline and we too are here for you and will be thinking of you and sending our warmest thoughts and so hope all goes well.

J.

Love&Light

As always... jfkoc, day2 and JoC you were THE port in my storm of a day.

All I can say at this point is thank the heavens for Hospice. They came in and were able to negotiate with the MC administration and he has been transported to one of their Hospice houses which is fully capable of dealing with this situation.

I am so sad that it came to this point. I know this will take a negative toll on his physical and mental state. Perhaps he is in the pre-active stage of dying with this terminal restlessness and it doesn't really matter.

Either way, I trust the Hospice people more than anyone to help us through this. Two geri psych nurses and close to 2 years of trying different meds has not helped with my father's agitation and outbursts.

I will work on Plan B, although his current MC has said that they will take him back with 24/7 private nursing care for a trail period of time. I guess that's good news. Or is it? Given that they were ready to Baker Act him when there was some grey area with medication follow through on their part. Now to figure out how to pay for private nursing.

I just want this to be over. I hate myself for saying it because of the ramifications of that statement. But I am just so tired and overwhelmed all of the time these days.

robinja

I am glad that you got a resolution that you are more satisfied with, but I just wanted to mention that my mom’s stay at the geriatric psych unit was a blessing in disguise. We were so upset with her AL facility sending her there, but it was absolutely the best thing that could have happened. They gave her tons of personal attention and got her meds straight. And they recommended MC, which is where she needed to be instead of AL.  MC had to send her back once due to some aggression (UTI and some further med adjustments), but she has been doing OK for a while. Her depression and aggression is much better.  Hopefully this situation will work for you, but if it comes down to a Geri-psych admission, it may not be the end of the world.

Jo C.

Please do not feel bad about your feelings; that is normal and seems to be part of the process for many of us when the suffering has risen to a significant level.  You are a very kind and caring person as well as  a good advocate for your father.  There is no perfection in all of this; only the best you can do under the circumstances with the challenges at hand.

I wonder; do you know if your father actually has Alzheimer's Disease or has the dementia specialist made a diagnosis of FrontoTemporal Dementia - perhaps a behavioral variant of FTD, or made mention of Lewy Bodies Dementia?  I ask because these diagnoses are different from Alz's in their treatment needs and they also have significant behavioral issues not easily responding to treatment.  Having an accurate diagnosis is key to everything.

Meds for one type of dementia can be contraindicated in another. My LO was misdiagnosed as having Alz's by the geriatrician.  Things got worse no matter the meds with behaviors and agitation being over the moon. When I finally got my LO to the dementia specialist, a thorough exam was done.  MRIs had never shown anything, but the Neurologist ordered a SPECT Scan - there it was - clear as day - FrontoTemporal Dementia which required  medication adjustment which made a difference.  If the dementia specialist made a diagnosis other than Alz's, be sure that any physician ordering knows that and that it is well documented for the medical record of wherever he is. 

Now that Hospice is on board, that will take a new approach, may it make a positive difference.   Hopefully, the medication adjustment will be helpful. Remember; if he is driving family to distraction, imagine what it is like to live inside his head not only believing all the things that agitate him but actually feeling them. 

I can understand the concern about affordability of 24/7 private nursing care on top of the facility cost.  Hopefully they do not mean a licensed nurse, but will accept an aide for the one on one for awhile as they assess your father's ability to be cared for at their facility. 

If your father's behaviors are much better and the MC mgrs. still want a 24 hour sitter, you may want to screen other facilities to see if they may be more accepting and better able to deal with the care needs and not demand 24 hour private care.  Just a thought.

Please do keep us posted on how things are going; we sure will be thinking of you and your father.  Remember that the Alz. Assn. Helpline as provided above is there for you any time of night or day and are there for caregiver support.  It is a good place to be able to vent and really be heard.

J.

Love&Light

Update -

It's barely a week since they moved him into they dementia wing at Hospice and my worst fears have been realized, he has started active dying. He hasn't eaten or drank anything since Sunday and he is beginning to cough up secretions from his lungs.

I think the reason I was so desperate to have the facility work his meds there was because I was afraid that the change in environment would have exactly this effect on his physical and mental health based on my reading. It's why we have not moved him back to the West coast, as difficult as that has been for our family.

I'm trying to reconcile how he was just a week ago when we were all visiting with him, and driving him around. He was lucid and ambulatory. He was ok. Today, they have to keep him sedated because of his agitation is so extreme, there are no other options.

I do know that his death was inevitable, I do. But this move hastened it for sure. And I can't help but feel like I failed him by not negotiating better on his behalf. Had his MC delivered the updated meds that had been prescribed on Monday they wouldn't have needed to move him on Wednesday. Had this new administrator who had no history with my Dad not been so belligerent and hard lined, my Dad wouldn't be alone dying 3000 miles away from us likely before we can reach him. 

I'm trying to be emotionally mature and not blame the horribly un-empathetic administrator whose approach last week resembled blunt force trauma, but I am struggling. 

SusanB-dil

Hi Love&Light - so sorry for you with all of this...

Really to blame is this disease, of course... (I know - we all blame mistakes we see that may have been made) - please don't beat yourself up on your own 'should'a-could'a-would'a' stuff.  Know that you did great with the info you had. Know that you are the one who cares so much. and know that he knows that, too.

MN Chickadee

I had a similar reaction even though there was no terrible administrator or mistake to blame. Lots of "what ifs" going through my mind. Wondering if we had done this or that a little different if it would have changed the trajectory. Wondering how it was possible I had just taken my mother out for a car ride 2 weeks before her death and she was alert and happy. I think it's a pretty normal part of grief. You'll never know with certainty that any decision or move hastened his death or if you could have prevented it. It could be something else was going on to cause his sudden combativeness. Maybe there was something physical and unpreventable related to his body or brain that caused him to decline. But I do understand how it would make this all the more difficult to wonder if something you or someone else did contributed to this situation. All you can do now is move forward. I am so sorry you are going through this. It is obvious from your posts you love him and have done your best for him. That's all anyone can really ask for, right? I do hope you are able to get to him in time. Hard as those last hours are they may be healing for you. He may be waiting for you.

abc123

Dear Love&Light, I was just checking in to see if you had posted an update. I'm very sorry to hear this news about your dad. I know this is extremely hard to go through. It is possible that your dear dad decided he was ready to leave this earth. I hope you get to him in time to say goodbye and tell him you love him, even though he surely knows how much you do love him! I think you did the very best you could do in a heartbreaking situation. There is nothing easy about this disease. Sending you peace and comfort. Please come back when you can and let us know what happened. Again, I'm very sorry.

Jo C.

Hello Love&Light, I am truly sorry for what is happening and can understand how terrible it must feel to be so very far away from your beloved father.

Please keep in touch and let us know how you are and how things are going; it is okay to ask Hospice what meds your father is being given and for what purpose to see if there is any med impact that can be modified which may possibly be contributing to the changes that have occurred.

If it would be comfortable to talk to a professional, the Alzheimer's Assn. has a 24 Hour helpline open 365 days a year.   It can be reached at (800) 272-3900. If you call, ask to be transferred to a Care Consultant.  There are no fees for this service.  Consultants are highly educated Social Workers who specialize in dementia and family dynamics.  They are wonderful listeners and support.  They can often assist us with our problem solving and have much information.  The support when we are under such heart wrenching stress can be very helpful.  Just an idea.

You have done everything you can do under the circumstances and the challenges that exist; I send warmest thoughts your way from one daughter to another.

J.

Love&Light

Hello all. My Dad passed away yesterday evening. By the grace of God my brother was able to arrive in time and we were with him as he passed. It's been such a long journey. This last week was traumatic to be sure, but I am so grateful he is no longer suffering and at peace. 

I am slowly letting go of the angst of what should have been done, or what I could have affected on his behalf. I have been his advocate and caregiver for so long I am not sure what I will do with all of this time now. It literally has become a part of my identity. 

What you all say about the second death is so true. I am living it now, and it hurts so very deeply. This journey has been a very trying one, not just with the disease but with the people who took advantage of him because of it.  My Dad was a wonderful man and how I showed up for him is because of the parent he was. I have no regrets.

This is my Dad:

He was born in England and emigrated to an island in the Caribbean at the age of 12 with his family in 1951. He led a full and unusual life as a pilot, vice president and engineer at a company he co-founded with his brother, loving father of his two children, and devoted brother to his 6 siblings. He experienced deep love three times in his life with his marriages.
He enjoyed spending time at the beach, sunsets and anything to do with aviation or heavy equipment. He treasured his pilot's license from 1965, which he kept in his wallet to this day. Above all, my Father was a family man, proud of and dedicated to the people he loved. A proper Englishman to the end, his deeply principled calm and steadfast nature, work ethic and love of family will live on through his descendants.

Thank you all for holding me through this.

SusanB-dil

Love&Light - so sorry.  ((hugs)) and peace

That's a great dad!  and raised two beautiful people. Glad you and brother got to be there.

harshedbuzz

Love & Light-

I am sorry for the loss of your dear father. May his memory be for a blessing.

HB

ButterflyWings

Love&Light, 

Sending heartfelt condolences on the passing of your dear dad. What a beautiful tribute!

I know what you mean about those who try to take advantage of our LOs with dementia. It makes our own lives harder as caregivers and is just so disgustingly wrong. What a blessing you and your brother were there for him during the healthy years and beyond, as your love and care overshadows anything else. Wishing you peace.

May flowers

I am so sorry for your loss. Your tribute to him is lovely.

Joydean

Love & light , my condolences to you and your family on the passing of your dad. He sounds like a wonderful dad. Happy for you and your brother that you got to be there with him. I’m sure he knows you were. God bless you and your family. 

M1

I too am so sorry for your loss, what a rough 10 days here at the end.  May time bring you peace and healing. Sounds like a wonderful guy, thank you for sharing his predementia story.

​fesk

I am very sorry for your loss. He sounds like a wonderful person.

toolbeltexpert

LAL so sorry for your loss. You are a great caregiver and advocate. Your dad had a wonderful life.  I will continue to keep you in my prayers.

MN Chickadee

There isn't much to say other than I am sorry. I lost my mother a month ago and it is still raw. It's getting easier with time but I can tell this is a scar I will always have on my heart. I am so glad you and your brother were able to be with him. Hard as it is you will be forever glad you were able to be with him at the end. Be gentle on yourself and take care.

Jo C.

I am so very sorry for the loss of your beloved father.   How comforting to know your brother was able to be with him as he left this earthly realm .  Your sharing with us who your father was, is greatly appreciated; thank you for doing that.  His was a life well lived.

With special warm thoughts being sent your way,

J.

NylaBlue

A beautiful eulogy. So sorry for your loss.