Hospital Visit

K327

My father (71 with dementia) was admitted to the ER on Wednesday, after becoming agitated and then 'violent' when wanted to leave the clinic while waiting for my mom to finish an iron transfusion.  

My mom explained when he tried to leave the room that he has dementia to please not let him leave because he is prone to wandering. This triggered the guard and a couple nurses to approach him completely inappropriately for a dementia patient and escalated to him kicking at the guard. This led to him being admitted to the ER and heavily sedated and strapped to the bed to calm his agitation. He was held in the ER and heavily sedated until late Thursday afternoon when they transferred him to hospital side where he has remained since. 

Until this point he had never been physical with my mom, who is his primary caretaker. He would just be verbally abusive, anxious, agitated, and have trouble dropping hallucinations even with distraction, which he had gone to urgent care that Tuesday after a reoccurring hallucination (on a natural gas leak in their house and the house was going to explode), but he was negative for a Uti. 

Since admittance he cannot walk on his own at all, needs 2-person assistance to stand and be moved from chair to bed, can't eat on his own, is incontinent, has severe muscle spasms, and can barely talk he is so heavily medicated. 

My mom and I advocated that he should be transferred to a geriatric behavioral unit because we were already doubting and speaking to his geriatric psychiatrist on the Seroquel not working and maybe making him more agitated and increasing his hallucinations. We feel he needs this prior for anxiety and agitation and now because he is so heavily medicated by them he presents as a 'vegetable' not able to do anything he was capable of before Wedenesday. 

The hospital is saying he doesn't qualify for a geriatric psych unit, so they are holding him on observation in medsurg (not mental health) and then will transfer him to a nursing home or memory care. (Which we had been in the process of moving him to assisted living memory care this week before this happened and now, he is not able to be in assisted living at all and the place we were looking at has told us and his social worker that they would not even entertain finding him a placement at their facility until he went to Geri psych after this violent incident at the hospital.

On top of all of this we were only able to talk to the family practitioner today (sunday) since admittance, and his social worker on Friday after many requests and complaints on how she has handled things. 

This has been so overwhelming and frustrating, i'm not sure where to go from here or how things went down hill so fast.

ChicagoGal

This is all so "crazy" and "difficult" - I had a similar situation with my 88 year old mom.  After three nights in the hospital where she was tied down and doped up I had her discharged per my "demand" (legally they have to do it) and took her back home.  She "bounced" back after a few days and then we moved her to Memory Care.  Unfortunately she is not doing well there - does not sleep at night, sleeps during the day - no longer "connects" with you.  I don't know how much of it has to do with the change in her environment or just the disease itself.  But keeping your day in the hospital tied down and doped up makes no sense.  The hospital "treats" sympthoms and not how best to deal with the dementia.

MN Chickadee

Can you elaborate on why they are saying he doesn't qualify for the geriatric psych unit? Who is telling you that and what are the reasons they give, and is there another unit or health system he could transfer to. Even if it is a great distance away. From the sounds of it a senior behavioral health unit is exactly where he needs to be to get stabilized and then go to memory care. I'm sorry for all you are going through it does indeed sound incredibly stressful and sad.

K327

Thanks for your responses:

They claim he does not qualify for geri psych because he had not been physically violent besides throwing things and pushing at home and that he became physically violent due to the hospital staff approaching him aggressively. 

To me it also seems they do not fully understand the purpose of geri psych and 'cannot' find a bed so want to push it off that he is fine and can work with his doctors to stabilize him.

It has become impossible to find a placement without him going to geri psych because the hospital has  'classified' him as having a violent act even though they explain it away to us as they brought it on and he isn't violent elsewhere. 

The hospital is also not properly 'observing' him as they will admit to because anytime a slight agitation or restlessness occurs, he is drugged with Ativan because they can't risk him trying to leave or get overly aggressive again. 

it has been so frustrating and our social worker seems to not understand any part of her job and that the needs a secured memory care unit or will not speak up and explain why the couple of memory care units that have openings will not take him. 

MN Chickadee

Huh. So he's violent but not violent enough? Make sure you say you cannot safely care for him at home and they must find placement. Just say his care needs are too much and you cannot care for him. Period. Make sure mom is firm as well. They may pressure you to take him home but they cannot force you to. They  may change their minds on geri-psych if it is clear you will not take him home. Continue to advocate, they won't keep him in the hospital long term. Cast the net wide, geri-psych generally does not allow visitors so it does not need to be super close to you. The closest one to me is a couple hours away but has still been worth it for the families I know who have used it. He would probably go for at least a few weeks to get stable and then you could work on finding an appropriate MC during that time. Geri-psych would likely have its own social worker you would work with to find placement.

K327

Thank You MN Chickadee for your assurance and advice. We are also from MN. The assurance means so much during this trying time.  

I had thought those things to be true but feels good to hear it from someone else. Especially has we are starting to see rumblings on the right ups in his MyChart about not being able to find beds, he may need to return home.

I have also contacted several memory care units and some do have beds, but as we suspected are nervous to accept him before he would go to a Senior Behavior Health Unit. 

MN Chickadee

There are a few geriatric psych units in the twin cities and surrounding suburbs. Alina and Fairview systems have them in the city, Hastings, Fridley and maybe other places.  The only one I am familiar with is the one in the Mille Lacs system in Onamia; I know a couple people who used it and were happy with the outcomes. One had to be transported there from a great distance by ambulance, another was transported by an off duty police officer and it was a 2 hour ride. Where there's a will, there's a way. One was transferred from the hospital (and it was a totally different health system) another straight from memory care at the request of the MC facility.

jfkoc

Based solely on what you have posted and my experience I would bring my father home and have 24/7 outside help waiting. Until then you need to have someone with your father 24/7.

My husband was "restrained" when admitted...Long, ugly story. Please feel free to message me if  you want to hear more about that horrible time.

Regarding the meds...please check side effects of all that your father is taking. I use drugs.com but there are other sites.

Judith