My dilemma

60 falcon

I'm having a big problem.  My wife is hospitalized and has been in there for a week now.  She's being treated just for comfort care, not officially on hospice yet. That will/should happen almost immediately when we find a place for her.  She's bed bound so there's no risk of exit seeking.  To my knowledge, she wouldn't even be able to get out of bed if she wanted to.  She's still having delusions/hallucinations, agitation, and resistant to hands on care like changing diapers, turning, etc.  She can and has slapped and pushed at nurses during those times.  I believe that's been documented as "aggression".  She's just resistant to hands on care and the slapping is almost a defensive action. She's being hand fed, not eating much. The first two days my wife had a nurse dedicated to her 24/7 and an observer in the room who just looked kept an eye on her.  Since then, my wife had been monitored 24/7 by a video camera.

I believe a SNF with a memory care wing is the best fit for her due to likely frequent med needs, hand feeding, etc. I don't think AL/MC will do all that will probably will be needed...I think it will exceed their nursing abilities. I also don't think my wife would realize the difference between the two anyway and I don't think her quality of life would be any better in a AL/MC at this point anyway.  

So me and the hospital discharge planner have been looking for SNF with MC.  Living in a rural area, they are few and far between.  The closest two (1hr away) have already declined to accept her.  Now we're looking at two or three that are about two hrs away.  If there's no takers after that, then I guess we need to look further away.  Documented "aggression" is a issue SNF don't want.  They also don't want residents that supposedly need to be closely monitored.  I've asked the hospital to remove the video monitor if it's not really needed.

I'm lost and don't know what to do.  Having her in a facility so far away can't be in her best interests since ability for family and myself to visit for her comfort and companionship will be limited.  I'm considering looking for placement in a regular SNF in an attempt to keep her closer but that won't be easy either because of documented "aggression"and monitoring "needs".  Is placing a person with Alzheimer's and on hospice in a regular SNF a reasonable thing to do?  

I'm just at a loss for what to do.  Has anyone else been in a similar situation and what did you do?  This is just killing me. Just driving to visit her in the hospital is taking 5 hrs round trip.  And I visit for 4-7 hours which doesn't seem enough but I can't keep doing that.  Today is my first day not visiting and I feel physically sick for not going.  

dayn2nite2

What is the hospital's plan to stabilize her behavior?  Because that's the barrier here, I can't think of a AL, MC or a NH that will take a resident who is slapping staff (it's also a danger for other residents).

So she is going to have to be stabilized behaviorally.  That is a non-negotiable.

Jo C.

Dear 60 falcon, I am so sorry for what is happening and can certainly understand the concern and stress.
 
I may be incorrect, but from how you describe your wife, she does not appear to be a candidate for most if not all MCs.  Most MCs are formatted like an ALF for persons with dementia.  Many, if not most, usually do not hand feed nor do they do in-bed care except in short term need.  If the MC is licensed on an ALF license, your wife would not fit criteria for such units.  You wife is full bed care and is going to be placed on Hospice.  That may be why she is being turned down for MC admission.

NOTE:  While your wife is in the acute med center, it would be a good idea for you to request that a dementia specialist be called in on Consult asap to assess and prescribe appropriately for her dementia related behaviors which indicate she is suffering delusions and other feelings which are affecting the quality of life she has. She need not suffer that way of being.  That agitation can indeed be assisted with proper medication.   If she obtains such assistance by a specialist, her quality of life for the life she has left will be able to be improved and placement will be for the better.  When an inpatient, when a Consult is called, it usually takes place within 24 hours.

 She may be able to be placed in a NH as a bed care patient on their Skilled Care or NH Care Unit rather than on the MC side.  You mention Hospice being called in; that would be most appropriate on the NH side units for the care needs she has.  They will be able to manage her meds as well as her physical care needs and most NH staff will have had some training in dementia as required by law for NH licensing in many states these days.

Getting that Consult in and then looking at NHs rather than MC may be more appropriate for what is present.  Do let us know how you are and how it is going, we will certainly be thinking of you and sending best wishes your way.

J.  

Ed1937

That's so hard, Falcon, and I'm sorry for that. If a SNF is what she needs, then that's what has to be done. But I agree that the aggression will have to be addressed before you can expect anyone to take her. Maybe a geri-psych is in order?

M1

Falcon, if she's really not eating much, you may not be looking at a long time span here.  I would go with SNF and Hospice.  Sounds harsh, but a quick end might be merciful for both of you.

60 falcon

I may not have been clear about what I wrote.  I am not looking for AL/MC.  I am hoping to get her into a SNF that had a separate MC wing. I just felt/assumed that would be more appropriate.?  I also felt it would be easier to get her accepted into a SNF memory care wing.  But my main question may have been answered regarding weather or not it's reasonable for her to be in a regular SNF.  The answer I'm hearing is that it is, or might be, especially since she's going to be on hospice.

When things came to a head a week ago, I was requesting and kind of demanding placement in Geri psych.  Things are apparently different in Wisconsin.  My requests for Geri psych resulted in much confusion and the sheriff dept initiating events that lead me to an emergency guardianship hearing amongst all that is/was going on.  Geri psych doesn't happen in Wisconsin for dementia patients. Ultimately I was awarded temporary guardianship.

The regular hospital has been much better than I ever expected.  Lots of specialists involved and med changes that have helped a lot.  There are meds that are being given for the behaviors with some on an as needed basis.  I've requested they be given when she's agitated etc.  I just think nursing staff hasn't administered them as aggressively as needed.  The result of the meds is sleeping or near sleeping, so it's a bit of a trade off.  Could be they need to be more proactive in administering meds for a few days to demonstrate she's not aggressive or a threat.  

Something needs to be done because she can't live in a hospital for extended period of time. And I'm an emotional and nervous wreck at times.  Quite honestly, we'd all be better if she'd pass on.  This sucks.

dayn2nite2

Why does the facility have to have a memory care wing?  She is bedbound and is not going to be participating in activities with the memory care residents and staff.

If her condition is as described, she just needs to be in a skilled nursing facility.  I don't know whether you're being led to believe that she's going to "recover," but she is not even likely to walk again at this point. 

Whether her slapping is "defensive" or not, it has to be addressed, especially since all her care is now hands-on.

Just concentrate on a SNF and get her admitted with hospice services.  She is not in need of memory care.  At this point, and I understand what you're saying about it being more merciful if she passed, she is at the end stage of life and "memory care" will not benefit her now.

June45

She doesn't need a MC wing at all.  She isn't exit-seeking. After my husband broke his hip, he went to a rehab/skilled nursing facility and that is where he died.  He was bed bound and verbally abusive, resisting any care because of his fear and the pain from his hip.  Go with the closest place that will take her.  She will not know the difference. Because she will be on hospice that should help get her admitted.