Here we go again. VA Psych Unit Admission Round 2

jmlarue

DH has been back home from the VA Psych Unit just under a month. The meds (Quetiapine and Gabapentin) just aren't working. Aggressive lashing out was minimally improved, but not disappeared. The hallucinations (visual and audible) have ramped up to all-day, every day. Consequently the anxiety and paranoia is worse. His cognition has declined significantly. He no longer recognizes he is home. Family and a few friends still seem familiar, but he can't tell you names or say what relationship they have to him. He had a half-dozen attempts to elope, bur no idea where he was going. He could only say that "those people" told him he had to leave. Trying to prevent him from leaving is when he would try to lash out at me. Verbally, his thoughts are so disorganized now, it's a real struggle to understand what he says. He's also begun to mumble or speak in a near whisper, which makes it even harder.

I tried again to have him admitted for Psych evaluation and stabilization through our local hospital ER. For the 2nd time, it was and absolute logistical mess. The Crisis Responder, responsible for placing a legal hold on him, failed to do so. He claimed he couldn't find an available Psych bed anywhere in the State. I'd call BS, but that won't get me anywhere. So, once again, I am left to have him discharged to me and take responsibility for transporting him 2 hours away to the Seattle VA Emergency. They will be able to admit him for Psych there. This time, I am fortunate to have the help of our son to ride shotgun and help keep DH under control.

This is the last rodeo. I will never allow DH to be discharged home regardless how well they are able to stabilize his behavior. They'll try, of course, to tell me they don't have an available bed for him and whine about the long wait lists. I've steeled my resolve. Whatever excuses they offer will be met with a firm "NO!" My health is seriously in jeopardy. I can't and won't do this anymore.

Joydean

Jm I’m so very sorry! You have to protect yourself this time! Glad your son will be there with you! Please take care.

Ed1937

Jm, you just can't let them do that again. But you sound like you have your heels dug in now. I'm sorry it's so darn hard. Having your son along should help. I'm glad you have him.

Hoot619

Your doing the right thing , you need to help yourself.  I think to many on here don't want to give up on their LO.  It's not giving up on them,  it is getting them help they need from others. At the same time we as caregivers were going down hill also.  Now we also have a chance to live fuller lives .     We hear it all the time that this disease is a taker.  For some it is a slow slide and  for others I think somebody greased the slide..Hoot

Quilting brings calm

JM…. Are you going to run up against the involuntary commitment hearing and guardianship issue you had last time?   If so, can you steel yourself  to do it?    I’m not asking to be sarcastic or play devil’s advocate  - I’m hoping your answer is yes because I fear that may be the route you have to take to get him admitted.  

I totally agree that you can’t go on taking care of him at home.  He needs a 24/7 staff.  Hang in there.   We support you 

M1

Yes, will be thinking of you.  Please update us when you can.  I'm so sorry, I know how painful this is.....

jmlarue

Quilting - I've learned through my CELA that I cannot get an involuntary commitment for DH, even with a DPOA and Guardianship. A family member is legally prevented from doing that in Washington State. It can only be done through the judicial process, where the facility that has a "hold" to treat him is granted a temporary guardianship by a Superior Court Judge. They can extend that guardianship, but only with the Judge holding oversight. I had a frank discussion with the head Psychiatrist and the social worker about honoring my right to advocate for, and be fully informed about, any treatment they decide is necessary. I can't buck the law, so I'll need to take it on faith that they are sincere about their good intentions.

I know the road ahead will have some potholes, but the VA really must be held to their obligation to provide appropriate healthcare for DH to his end of days. That means they must find a bed for him in a LTC facility or keep him safe and cared for as a hospital in-patient until they do - this advice from my CELA. I feel less anxious about the future with a legal advocate backing me up.

I appreciate all the well-wishers here. I hope we all are successful in finding the help we so desperately need. Caregivers shouldn't have to take a vow of poverty or die trying to go it alone.

Mint

jm glad you have gotten outside help with how the system works.  Hope this will help you going forward.

toolbeltexpert

Jm I am so sorry that the meds didn't help, I am hoping you'll have an easier time this go around. As if dementia wasn't enough, the heatlhcare system is a maze and as different as each pwd is. Hang tough, be a bull dog for your dh. No disrespect meant.

Quilting brings calm

jm-  so glad that your CELA could walk you through the process.  Trying to get someone the help needed is so difficult, time consuming and stressful.  I know having the court involved without anyone fully explaining why added to your emotional distress last time.   This time should go better.

jmlarue

Just a quick update - DH is safe in the VA Psych unit and so am I. His Psych doctor called to discuss his treatment going forward. He agrees that the Seroquel and Gabapentin are not working for him, so they will begin a fairly quick withdrawal and try something else for the psychosis. They can do these med adjustments much faster with an in-patient because they are fully staffed and have all the resources of the hospital to handle adverse events. We simply can't do this safely at home. Taking DH back home the first time around was my mistake. It was well-intentioned, but a mistake all the same. I live and learn. I do understand that DH cannot be "fixed." He will continue to decline and he may even abruptly die in this late stage of dementia. I have to accept that. As his spouse/advocate I can only focus on quality of life issues going forward - for both of us. I am convinced that the best option for both of us is to push to have him placed in a VA community living center. He will benefit from the security and structured routine living in the company of other Veterans. I hope and pray a bed opens up for him there.

Mint

jm hope this works out for you to get a bed.  Glad you are feeling more comfortable with things.

Jo C.

You needed to try and your have done your very best.  This enables you to know at the deepest level that this approach is the only safe, sensible and caring one for both yourself and your husband.

Please let us know how you are; I will be thinking of you and hoping that the next medication will bring some relief to your husband as well as yourself. 

You have done the very best that anyone could do under the circumstances.  Now it is oversight advocacy and you are very good with that.

J.

jmlarue

Everyone - Thanks for the support and good wishes.

Buggsroo

Jmlarue I wish you calm and peace going forward. You have been through the wars.

Lynne D

JM, I am so glad you have the CELA supporting and guiding you, and that your husband is being taken care of so you can breathe. I wish you both peace.