Where do we go from here?(2)

Cinjk1

Hi. I’m new here and joined in hopes of getting some insight into how to best take care of mymother in law. She was diagnosed with Alzheimer’s about a year ago. She has been living in an independent living facility for about two years. About eight months ago, we realized that it was time to look for an assisted living facility. We found one that we were very happy with and got on their wait list. When they finally called to say they had a room, we quickly brought her in for an assessment. We were shocked to find that she assessed not for assisted living, but for memory care! So back on the wait list we went. We immediately began looking for other memory care facilities since it was becoming obvious that she really didn’t need to be in the independent living situation any longer. Through all of this, she began getting agitated, angry and started shoving people and slapped a lady twice. We found another memory care facility that had availability and started the process. When this new place tried to do an assessment, our loved one became violent and started yelling at them and they could not do the assessment. We were told that she could not move in until we got her behavior under control! Today she was especially angry and agitated and also paranoid. She was so out of control that we took her to the emergency room to make sure there weren’t any medical issues going on. There were not and they released her. She is now at our home and her doctor added another medication. We are hopeful that this medication will help calm her enough to get her into a memory care facility. My question is… what if meds don’t help? What else can we do for her? She needs and deserves more/better care than my husband and I can give her and we just don’t know where to find options/help!

M1

Welcome to the forum. She may need admission to a geriatric psychiatry ward to get her stabilized, and then go straight from there to memory care. Too bad that wasn't considered from the ER today, but I would have a very low threshold for taking her back.  My suspicion would be that most units won't accept her without confirmation that she's stable, and doubt that treating her at home will be enough. Good luck though, im sorry you're going through this. I would guesstimate about half of the memory care admissions discussed here require psych hospitalizations first.

harshedbuzz

Cobbling onto what M1 said, I would also suggest an admission to a geripsych unit as the quickest and most effective way to get control of this situation. Getting in to see a geripsych on an outpatient basis could take months depending on where you live.

The management of psychoactive medication in dementia is something of a dark art and best left to a geriatric psychiatrist. While a PCP or neurologist can prescribe, the geripsych is the one with the most experience with these sorts of meds. 

Most of the time, meds do work fairly at dialing back behavior. When they don't, sometimes all that is needed is a trial of a different medication or a slightly higher dose. In prescribing meds, it's best to start low and go slow, so increasing dosage is typical. You don't say what medication was added so it's hard to comment on timing. IME, if the doc started a SSRI for anxiety (Prozac, Lexapro, etc) it could be weeks before you know if it's working. The atypical antipsychotics (Seroquel, Risperdal, etc) seem to kick in much more quickly. Often there may be a few days of sleepiness that passes with these.

HB