How are facilities supposed to handle patients with aggressive and agitation

ndevlin23

My brother is in an assisted living that has staff trained in Dementia. He has dementia but don't know what kind. He has been there for 5 months but in the last 2 months he seems to get agitated and aggressive and has had some incidents. We and the facility have brought in the Drs. to see if there is some medication that may help. In addition, he was not sleeping very well so that was something that needed to be addressed. He is not an aggressive person by nature and never has been. He is 67. There are non demetia residents in the community as well as dementia residents. His main problem is that he cannot communicate very well. So it is hard to know what he is feeling and thinking especially when these incidents occur. What we do know is something is triggering him and the disease is causing him to respond in these ways. I just assumed that facilities who are trained in this would use their training to try to help him as he progresses through the disease. However, he had another incident where we laid hands on another resident so there is a safety issue.   So what do we do?  We have been asked to remove him from the facility as they have to secure the safety of the other residents.  I  understand that concern but where is the concern over my brother to get help in identifying his triggers so we can try to avoid them from happening?  His lashing out seems to be out of him not feeling secure himself. Since he cannot communicate well, he may often  misinterpret what is going on and what is being said around him and he lashes out. But  even if he goes to another facility, will they too just discharge him?  Where can we get support to find a facility that handles the disease through all its ugly heads?  This is an awful situation.  We are beside ourselves frankly. Perhaps they are licensed to only care for the dementia patients through certain things but are can 'opt out' if there are things they cannot handle?

Thanks, Nancy

M1

Welcome to the forum, I am so sorry you are going through this.  Is there a possibility of sending him to a geriatric psychiatry unit for medication management, and then see if the facility would take him back?  i would talk to the director about this specifically.  If they will not agree to take him back, you probably will still have to hospitalize him and let the social workers and discharge planners help you find another facility that will accept him.  This is a common problem, unfortunately, and seems to be more common for males than for females.

jfkoc

I understand the frustration etc. you are feeling and the need to find a solution for your brother.

I agree that the asisted living facility is not trained to handle behaviors that accompany dementia. 

A call needs to be made to your brothers neurologist and I suggest looking for a memory care facility for your plan B. Please update us when you can.

ndevlin23

Thank you!

ndevlin23

He is medicated and sees his psych doc regularly. He's coming out again this week. And, we have an appt with his neurologist next week. 

HIS OUTBURSTS are like daily now. We don't know what to do. We are bringing in a companion person to sit with him all the time now. We  know you are supposed to find the triggers but we are not there with him the facility is. But yes perhaps its time for Memory Care.  That may kill him as he is really in between Memory Care and Assisted Living. No issues with ADLs - he is mobile and walks alot. He cannot communicate verbally very well - he knows what he wants to say but it doesnt come out.   He went into the MC unit where he is as he was helping someone in a wheelchair and he couldn't get out of there quick enough and said 'Oh No, Not me', meaning he doesn't want to be in there.  Honestly, we don't know what to do, where to turn. 

This is a nightmare. 

We are actively looking for other facilities but not sure these outburts will stop just by being in another facility because we don't know what is triggering him.  How do you find that out in this situation?  Oh my gosh....

LaurenB

Maybe it’s time for an inpatient geriatric psych placement where they can figure out his medications and triggers.  Then a placement at a memory care or skilled nursing facility might be appropriate.

Jo C.

Hello ndevlin, and a very warm welcome to you.  I am so sorry for what is happening and can imagine how deeply concerning this is for you and how difficult this is for your dear brother. I am sorry that you do you not know what type of  dementia your brother has.  It is extremely important to know the type as treatment for one type of dementia can be contraindicated in another and even make things worse. Certainly between Neuro and Psych, they must have come to a decision for dementia type.   Also, as odd as this may sound, it would be good to have him checked for a "silent" urinary tract infection. These "silent" UTIs do not have overt symptoms, but can cause significant changes or contribute to changes in behaviors. 

All infections and physical causes should be ruled out, and he should also be assessed for possibility of constipation and unrelieved pain of any type from dental, to gastric, to joints or difficulty in ability to urinate due to an enlarge prostate, etc. so much can be  triggers for acting out behaviors.  His meds; all of them should be reviewed to ascertain whether one or several in concert may be an issue that may be contributing to the actions.  If there was a way that he could communicate that would help his frustration, but it appears at this point that it will be a situation of constantly assessing possible triggers from different standpoints including those possible physical issues. 

After reading what you have shared, I too think that perhaps the best approach after possible physical issues have been assessed and ruled out, may be to discuss with his psychiatrist or neurologist, his being admitted to an inpatient Geriatric Psychiatric Unit where he can be assessed on a 24 hour continuum, and to have medication adjusted.  Once the situation has been addressed with GeroPsych, then transfer to a Memory Care setting would in all probability be the best accommodation for him.

It can sometimes be difficult and take time to settle such situations; hopefully getting him to a good acute setting will be helpful if necessary.

In any case, your brother has been blessed with a wonderful caring sister to be his advocate and caring loved one.  Do let us know how it is going, we care and we will be thinking of you and him.

J.

Pearzee

My father had the same issue with aggression toward other residents.  Alas, his memory care facility was no better at handling residents with aggression than your brother's assisted living facility so don't count on that.  I think dad's trigger was that the women on his unit got on his nerves for various reasons (yelling, talking a lot, etc.).  We wanted him to be transferred to a unit with all men but it wasn't a locked unit so the nursing home refused to transfer him.  After each aggressive incident, he was sent to the local hospital's geri-psychiatric unit (for a total of four different times) for multiple medication adjustments which still didn't help curb the aggression.  He was eventually kicked out of the facility.

My advice would be to give the geri-psych unit/medication adjustments a try but if there is no improvement after a couple of stays at the same unit, to try a different hospital.  Not sure of your brother's financial situation, but I'm convinced that dad's facility would have been more patient with his behaviors had he been private pay instead of on Medicaid.  One of my many regrets.

I am sorry you are going through this.