What to do if DH gets evicted due to aggression?

Dio

DH has become very combative when MCF staff tries to change his clothes, chases them out or physically pushes them away, and he screams at his roommate to "get out!" Several times his roommate had to sleep in another room for safety, not to mention the added attention required by staff when his roommate is sleeping in the room. His neurologist is very slow, or reluctant, to increase lorazepam dosage. He's just reshuffling the dosage during the course of the day. This isn't helping at all. If a solution isn't found soon, the best case scenario is DH will be required to change to a private room which will increase by $5K/mo. Worst case is DH will be evicted. What then? Damn this disease!!!!!

Denise1847

Can you get another neurologist or get the neuro to understand the gravity of the situation. It really sounds like the doc needs to step up and do his job.

toolbeltexpert

Dio sorry to hear this, we all worry about behaviours and whenit happens to me remind me of these words. It sounds like you have a great place that will work things out. Behaviours are something they deal with daily. Let them offer suggestions to you. They sound competent. I have seen residents sleeping on the day room couch.

The other night they had some type of incident where a resident went wild in the court yard and dumped the flowers out of the pots and made a huge mess some of these pots were big like 20inch tall 18 inch around They just said they had a problem and that was it. They cleaned it up and went on like it never happened. I worried what if it was my dw, but they never let on as to who did it. Full moon!

M1

Dio, I'm so sorry. Is there a psychiatrist affiliated with the facility? Can't hurt to ask.

Jo C.

This is certainly a challenge and I am sorry for what is happening. Since Lorazepam is a tranquilizer; (Ativan), some of our Loved Ones (LOs) do not respond well to it and some of our LOs may even have a reverse reaction to it. I frankly would question the Ativan approach if that is the only med prescribed for what is occurring. Has the Neurologist not prescribed other medication to assist with the behaviors? Is he on Seroquel or Risperdal or other like med? Not only is your LO causing problems for others; he too is suffering from the dreadful feelings he is having and needs help; it is also a quality of life issue. Right now, it is trying to not have him evicted and I do understand that is no small thing.

Sometimes, our LO is helped by being transferred to a GeroPsych Inpatient setting in a local med center. This way, the patient can be assessed on a 24 hour continuum and medications initiated and observed for effectiveness and side effects. Once the person is stable in behaviors, they can be transferred back to their long term care setting. it is usually a short term inpatient admission of about 10 days to two weeks or so depending on how the patient responds to treatment.

I also wonder if your husband may have one of those "silent" UTIs contributing to the behaviors which are notorious for ramping up behaviors. However; being that his behavior is so severe, while that should be ruled out, he probably needs a bit more help.

Best to speak directly to the Neurologist and if he/she is not responsive to the need, perhaps it would be time to seek advice from a different Neurologist who sees dementia patients as a routine part of his/her practice.

Do push and advocate for adequate medication, BUT also, if this persists, do advocate for admission to GeroPsych. Not a regular psych unit, but GeroPsych; that is where the skills are that he would need.

Let us know how things are going; this must be terribly hard on you and I am truly sorry; also let us know how you are doing.

J.

JJ401

Does the memory care have a doctor (who they mostly use) you could switch to? My sister-in-law's memory care had a doctor who frequently visited to see patients. The doctor was responsive to staff and family about med changes.

Dio

Thanks, everyone! So far, today we've been emailing back-n-forth with DH's neurologist, who is quite renowned in the area of dementia and head of Alzheimer's Disease research in Stanford and has access to the larger memory care center professionals. He just took over DH's care in late September last year. He asked for a list of meds that DH has tried, of which I just sent to him. Let's see what he comes back with. Being busy and in demand that he is, I can only hope he'll check emails in between meetings and/or patient visits before signing off for the day.

So far, DH has tried Quetiapine (Seroquel), Gapapentin, Paroxetin (Paxil), and Olanzapine (Zyprexa). He was switched back to lorazepam (Ativan) when none of these worked. The MCF's administrator thinks because DH is on the lowest dosage of lorazepam that the dosage should be increased. But I watched a video produced by Stanford's memory care center and gleaned that their philosophy for LBD patients is "less medication" is the best approach.

Who knows what will work? With LBD, what works today won't work forever...let us just get through this period for now. His aggression isn't sudden. It's been increasing in severity and frequency since placement the past 3 months.

Dio

Update: Dr just replied with an order for 50 mg quetiapine 2x/day and 25mg as needed 2x/day.

Ed1937

Great! I hope it works for you.

storycrafter

Our experience with Quetiapine: It really helps my dh across the board (of his behaviors/issues). It sometimes needs to be started at low dosage and slowly increased. For the first few days on it, my dh slept much more, almost around the clock, unusual for him. So the dosage was reduced and increased every so often until reaching a therapeutic dosage for him.

A side note, it took two weeks for his body to acclimate to the med, even at the reduced dosage. The sleepiness went away after that. Each increase caused a couple days of sleepiness again, but it would soon go away. Eventually he reached a therapeutic dosage amount, 300 mg for him. He takes it at night before bed and sleeps well at night; functions well (for him) during the day.

Dio

Thanks! Keeping my fingers crossed. At this point, I'd rather he be sleepy than aggressive.

M1

Hope it works Dio. Do keep us posted....

Dio

Finally some good news to share! I was told DH slept through the night with the added 50mg Seroquel. This morning while he still resisted being changed, he was less aggressive. But staff forgot to give him the morning dose of Seroquel. I guess the new regiment is, well, too new, plus the shift change. Anyhow, the new medication looks promising.

Ed1937

Dio, that's great news. It's always good to see posts that have a positive swing to them. I'm glad for you.

ButterflyWings

Good for you! And, umm...They need to not forget his meds =(

M1

Fingers crossed Dio. It's worked very well for my partner. 50 at bedtime has been very stable for a long time.

ElCy

My DH was kicked out of MC 3x. He went to geripsych each time and was allowed back into MC.

White Crane

Hoping the seroquel works. My DH takes a small dose at bedtime and it has been very helpful.