Admission to VA Hospital Psych Unit (Update)

jmlarue

DH was admitted through the ER at the Seattle VA hospital on Saturday for psychiatric evaluation and treatment for violent aggression toward me, his wife of 54 years. This is a fairly recent change in behavior and he has been evaluated several times for a possible UTI, stroke, or other organic reason for this change. All testing shows everything in normal range. He has experienced both visual and auditory hallucinations of groups of strangers in our home and claims to hear them plotting to sell our house and make him leave. Worse, he hears them say that I am a part of the conspiracy. Since he cannot fight these disappearing threats, I have become the sole target for his anger and aggression. Because he often telegraphs his intentions to lash out at me (verbal threats, aggressive posture, clenched fists), I have been able to avoid being hurt - so far. The night before his admission to the VA hospital, his closed-fist punch was a frightening near-miss. It was a terrifying wake-up call for me that I could no longer defer or delay asking for him to be admitted for a psych evaluation - even if that meant a permanent placement in a memory care or psychiatric facility against his will. 

This is the absolute last thing I ever expected would be a part of his dementia journey. This behavior is 180 degrees out from the caring, gentle, non-violent husband and father I know. DH was hard-wired as a pacifist. He was opposed to the use of corporal punishment for children and the idea of a man abusing a woman was abhorrent to him. A veteran of the Vietnam war, he was fortunate not to be in a combat unit. In a kill or be killed situation, I doubt that he would have fired that first shot. It is shocking to see such a horrifying change in him and I feel helpless and hopeless in the face of it. 

I've been working closely with his geri-psych doctor(s) for a little over 6 months trying medication to moderate his escalating episodes of hallucinations, anger, and aggression, with only brief periods of calm. The emotional and health consequences for me have required medical treatment for things like: high blood pressure, anxiety and depression, immune deficiency resulting in frequent infections, and the inability to control my insulin-dependent diabetes. All these are presumed related to the unrelenting stress of being the sole caregiver for a PWD with extreme behavioral issues.

According to the Crisis Care Manager, DH will remain in the VA psych unit for 5 days without his consent. After that, his case will be brought before a judge who will decide if this involuntary commitment will continue or he is judged competent to reject treatment and leave. God help both of us if the decision is the latter.

Jo C.

 Dear jml, there are not words sufficient; it is a unique situation and you have had to be the one to stand tall and stand tough to get this far with the VA; I can imagine it has been exhausting. 

So hope you sternly inform the doctors and discharge planners/social workers that he cannot return home and placement is necessary if that is still your choice.  If the VA has a long term care facility in your area, that may be a worthy alternative, considering. It has been my experience that the discharge planning aspect looks for the easiest way to have a patient leave; if the family members do not stand their ground, the sending home is often the course of least resistance; easiest for the staff.

If your husband is in a regular psych unit rather than GeroPsych, their approach may be a bit different.  Considering the ongoing florid hallucinations, I wonder whether or not Lewy Bodies Dementia may be present rather than Alzheimer's. 

Please keep us posted on what is happening, I have been thinking of you; so hope this goes the best way for both of you and your husband is relieved of his suffering of the symptoms and hallucinations he has had.

J.

Joydean

Jmlarue, first I’m sorry your health issues have gone to pot (so to speak). We all hear take care of yourself so you can take care of others, we also know that’s easier to say than do. Saying that I do hope you will have a chance to see your doctor while your husband is in hospital. 

When you said after 5 days a judge will decide if dh could still be held. Are they talking like a regular judge, (civil), or through the VA, or medical judge ( if there is such a thing). 

I hope the doctors will be able to find the right meds to help him. Seems like they have tried different meds before, I remember when you had to give him the gummy bears just to get through before you could even see a doctor. 

Prayers for you and your dh and hope you can get some rest. 

toolbeltexpert

Jmlarue This is a tough go, and I will be praying for you, as this is hell. But I am sure you will get thru this too. I have spent more time back spacing tonight. I wish I could offer you more comforting words, but dementia has even take that.

Lynne D

JMLarue, thanks for keeping us posted. I, too, am wondering what kind of judge gets to decide your and your husband’s fate. I wish I had more than kind words and caring thoughts for you. Sending you virtual hugs.

jmlarue

Jo C - I liked your analogy about the trying to "nail Jello to the wall" when working with the VA. So very true. It takes real resolve and perseverance to get through the form filing, wait times, case reviews, health care referrals, caregiver supports, and securing the disability pay and benefits DH is entitled to. I've been involved in this ongoing process for 4 years now - 2 years pre-diagnosis and 2 years post DX, as his appointed Fiduciary, primary caregiver, and DPOA for health care decisions. Every responsibility falls on my shoulders, with the VA making passive/aggressive statements in every award letter about my legal liability for any errors/omissions/malfeasance I may knowingly/unknowingly commit. It's a heavy burden to carry. The reality is, we would be in serious financial straits if our only other option was Medicaid for DH's ongoing care. Consequently, I continue to jump through the VA hoops and try to grab all the brass rings for his benefit and mine.

Joydean - I'm not entirely clear on the jurisdiction of the Judge involved in DH's competency hearing. Since the VA is a federal entity, I can only guess that this will be a Federal Judge at the administrative level since it's dealing with a civil rights issue. If my DH was in a local hospital psych unit, it may be up to a State level judge, relying on State law to render a judgment on involuntary commitment. This is all just a WAG based on my extremely limited knowledge of the law and how it works. Although I hold a BA in Criminal Justice, in truth, you could put what I know for sure about legal matters in an eye tooth (so don't quote me).

ButterflyWings

Jmlarue - I saw your post this weekend and just could not get myself together to type what I was thinking, which is...thank goodness! Not that we ever want to be in this situation or dragged through all the mud and potholes en route to a psych hold, but it was unconscionably dangerous and unfair for you to be ducking and dodging while handling every single other task to keep you both alive. 

When I read your words I was wading through my own full moon escalation with DH which also crossed a line of physical threat and near-roughness that has never occurred in all our years together, nor thus far in AD hell. I hope and pray we do not get to where you have been treading water. I can't. My reflexes are not even as quick as yours because it is like an out of body experience when looking at this LO that you are trying to help and yet he is talking to you and God forbid, "coming for you" physically like you are the worst enemy ever. So I would have been sucker-punched most likely, and then what? It makes me sad, confused, but also numb. And then strong enough to do the next right thing. Whatever that is.

This aspect of his disease is heartbreaking on a whole new level. And an entirely new low. I am SO relieved at your presence of mind and good fortune to get your DH transported to the best place for him for now, and yes please let the reports during 5 days, and your clarity that he and you both need a lot more something! or neither of you is safe. 

I will HOPE and pray the VA does come through for you and this vet at this time. There must be major changes and support wherever his is to be after 5 days. You did work a miracle to get through the last several months, and to get him in intensive psych care right now. Enjoy the "break" if you can.

JJAz

JMLarue,

Has his doctor discussed the potential of Lewy Body Dementia (LBD)?  It is a type of dementia that frequently has hallucinations as a symptom. You can find more information here:

https://www.lbda.org/symptoms/

If you determine that he has LBD, you may want to join the support group specifically for LBD spouses, since they have many particular needs separate from other types of dementia.  It is a closed group, so you will have to apply and be approved for membership.  It is an active group and has been in existence for 20 years.

https://groups.io/g/LBDCaringSpouses

MaryG123

I’m thinking of you today jmlarue, and hoping for the best of all possible outcomes.