Memory Care Referring DH for PSYCH/MED Evaluation

cw2502

My DH was placed recently in a stand alone Memory Care facility a week ago. Prior to that he spent 3-1/2 weeks at a Memory Care home that was part of an assisted living community. They were NOT equipped to deal with a Severe Stage dementia patient and he was aggressive and uncooperative. His hospice team totally redid his meds, trying to figure out what might work for him to acclimate to being placed there. Seems it only got worse. That facility truly had no skills at all with intervention and redirection, and the home set him up for failure (he figured out how to get out the door if he held the fire release bar for 15 seconds, it would open without the code; residents were not supposed to go into the kitchen, yet the kitchen was open, etc. etc.) He got in trouble all the time for these things.

The new facility is known for dealing with "behaviors" and is truly locked down, but he has not started out well. We already had to schedule a care plan meeting, that was scheduled for Wednesday, to discuss more med changes as he was acting out from the get-go. I got a call this morning from the Director and he is currently too violent there. Throwing salt shaker. Taking others food and then turning his plate over. Grabbing workers' arms and leaving bruises. Ripped shower head off. Vulgar cursing and hostile words to other residents. This morning, he socked his roommate (a much older, fragile man) in the eye, that will require stitches. They need him to go to a Behavioral Psych ward where they will perform "pharmagenics" testing on him and see what meds work best for him. This will be inpatient for 2 weeks up to 30 days. Has anyone had to do this with their LO? I am just sick about the havoc he has wrecked, but also fearful if they cannot get him to a place where he can be a good resident, what does one do?? He has, all our married life, been an independent, hot-head, strong-willed, belligerent person, who is not one to be "caged". I fear placement will never, ever work. Please respond if you can offer anything. Thank you!

terei

Many many LOs from this forum have been placed in Geri psych wards, including my mother. They will find a mix of meds that will calm him enough for MC placement again. One thing that you must know is that under no circumstances must you take him home. If this is proposed to you, stand your ground + just tell them neither you nor he is safe to be in your home with his behaviors + repeat it as necessary. They cannot force you to take him.

It is unlikely that you will be allowed to visit him at least initially. This is standard procedure, especially if your presence is a trigger for his acting out. Good luck

JJ401

My sister-in-law went from home to a geri-psych. She went through a few medications before they found a combo that worked. She was there almost two months.

Since she went from home, there was no facility to go back to. Since she was to be Medicaid funded, it was difficult finding a place for her. The family's first choice had their limited number of Medicaid beds full. So she ended up in a much less desirable facility. But, the family got the desired facility to place her name on the their Medicaid bed waiting list, and six months later she moved. The medication did its job and the move went smoothly.

Jo C.

cw; I can well imagine how deeply worried you must be; I am sorry this is happening. My own Loved One (LO) was admitted to GeroPsych and spent two weeks there.

The positive side of it is, that a Psychiatrist will see him daily and he will be assessed on the 24 hour continuum. They will do any necessary labs and adjust meds as their assessment of him evolves. They will be able to monitor the effectiveness of the meds as well as watching for side effects.

It is true, you may not be able to visit for a few days or so. They will want to eliminate as many behavioral triggers as possible. When visitation resumes, it is strictly regulated for times, etc and this is a good thing as a LO in that situation really requires routine and structure in their daily life.

It would be good to make friends with the Psychiatric Social Worker from the beginning. This person will be able to answer questions regarding placement and other issues that may arise. If the behavior continues for a period of time after GeroPsych which we hope will not happen, there will be special care facility accommodations while this stage continues, but it may not be as close to home. If persistent despite his GeroPsych stay, this will be a stage that eventually will be worked through, but it takes some time.

Whatever happens, do not let anyone try to talk you into taking him home; there is absolutely no way that you can be made to do that and it would be dangerous for you and too much to be able to handle and he would not get the care at the level he so badly needs. You can refuse and stick to it should such a suggestion arise.

Please let us know how you are and how things are going; we understand how hard this is and we truly do care.

J.

M1

Just a word of warning, the “tests “ they are talking about doing to see which meds might be optimal are not proven. They looked at genetic variations of different liver enzymes that are important in drug metabolism, but no such tests have ever been shown to have any positive predictive value in terms of drug efficacy, there are just too many variables. And a lot of those tests are not covered by insurance, for good reason. It will still come down to trial and error. Im so sorry you are having to go through this, but it is pretty common. My partner was hospitalized for three weeks before going to memory care last year

Ed1937

I don't have any words of wisdom, but just wanted to say that we're all here for you whenever you need someone to talk to, or maybe get answers for whatever questions you might have.

Joydean

CW, I have no experience in this area but just wanted you to know you are in my thoughts and prayers! Best wishes for you.

cw2502

Thank you all for your comments. I appreciate the feedback, and will heed all. I do have another question: he got COVID for the first time, in the month before placement. I have now read that COVID can accelerate dementia (he is already at severe stage). He was never violent at home with me, although he was getting uncooperative and "mad at the world" so to speak. Do any of you have any knowledge about this?

Marta

It’s too soon to say what the influence of Covid might be on rate of decline from dementia -there is no long term data. What we do know, in general, is that any intervening illness or event reduces the ability of the PWD to adapt.

There is incoming data about long Covid causing ‘brain fog’ in people who were previously cognitively normal. Whether a PWD is suffering from long Covid vs the natural progression of dementia would be difficult to parse out.

So sorry you and DH are in such a difficult situation

My DH spent two weeks at behavioral health and was then able to transition to MC.

IT’S SO HARD! Hugs to you.

Pearzee

I am so sorry you are going through this. My dad was admitted to the local hospital's geri-psych unit from his memory care facility four times for aggression and the hospital never did figure out the right combination of drugs that would keep him calm. He was kicked out of his nursing home after the fourth incident. During the fourth admission and against our wishes, the geri-psych doc had dad involuntarily committed to a psychiatric hospital an hour away where he passed away several months later.

My advice would be if the original hospital doesn't seem to help your LO, don't hesitate to have him taken to a different hospital if the behavior happens again. I should have insisted dad go to a different hospital for a second opinion after the second or third admission but I didn't know then what I know now.