Aggression in SNF

ronnab

My mom was diagnosed with mild cognitive impairment 7 years ago.  Her medical records from her PCP states dementia.  There has been average decline over the years.  Doesn't remember how to cook, doesn't know how to do laundry, hoarding, obsessive compulsive behavior, doesn't remember anything more than a few minutes, and the verbal and physical aggression has presented itself within the last 8-12 months.  She is also displaying incontinency (although not always).  She does her own hygiene but hates doing it and can be heard screaming and yelling while showering in her bathroom.  Her reasoning skills have declined, many financial mistakes, etc.  She is delusional and incredibly confused....but she can put on a good show for a doctor!

Three months ago she fell and we decided a SNF to help her with physical therapy for a short-time would be best.  It lasted 3 nights because she magically could walk and wander all over the facility.  The last 3 weeks she was experiencing severe pain in back and hips to the point she was not able to bear weight.  Was in ER and overnight in hospital and then transferred to SNF last week.

She is cussing, throwing things, calling my dad and saying horrible things to him, horrible things to the nursing staff.  This was not behavior pre-dementia.  My adult brother and I are visiting her every day for as long as she is lucid and calm.  We have had horrible things said to us, too.  She continually says she will kill herself and I did let the staff know that.  She refuses to take medication and we just found out she is resistant to the physical or occupational therapy at the SNF

We live in CA and do not have the means for MC or AL.  Medi-cal pays only for medical care.  My dad is elderly too and we cannot take care of my mom at home.  We do have an attorney and my mom gave us the gift of Powers of Attorney, Wills, and Advanced Directives pre-dementia. Suggestions???  Where are we in the stage process?  

loveskitties

If she is refusing meds and saying she will kill herself, it seems the SNF should have her transferred to the GeriPsyc ward of a local hospital for med tune-up at the very least.

Given her current mental state, I very much doubt that any MC would take her, and she is beyond an AL facility.

Make sure your POA is a durable one, or it is not going to cover your situation.

If your attorney does not specialize in elder care, then you may not have access to all the options available to you.  General attorneys don't usually have experience with dementia clients.

MN Chickadee

She may also have hospital delirium, which is common in PWD and can sometimes improve with time, but it doesn't sound like she was on good footing even before this. A geriatric psychiatrist or at minimum a doctor who specializes in dementia such as gerontologist or neurologist is best equipped to handle a special situation like this. 

As the previous poster said she may need a stay in a geriatric psych unit (sometimes called senior behavioral health.) There they have geriatric psychiatrists and nurses who specialize in getting a person with dementia who is having behavioral problems and refusing meds to get stable and get to the point they can be cared for. Likely no facility will take her until you get her meds and aggression straightened out. Inpatient is often the only way to do it. A regular setting, whether a hospital or rehab, is not trained or skilled in dementia care.  The person usually stays in such an in patient setting at least a few weeks to find the right meds and then you want to work with their discharge planner to find a facility to transfer to. Some folks do go home but it doesn't sound like she can go home if your dad and/or family can't provide 24/7 care. You need to consult an elder law attorney about long term care Medicaid. This is different from regular (medical) medicaid. The rules vary by state. You can google Long Term Care Medicaid California 2022 to get a sense of the income and asset limits. An attorney who practices in elder law can give the best advice on how to proceed and any benefits she may be entitled to and how to protect your dad and his financial needs.