EXTREMELY COMBATIVE DEMENTIA PATIENT-HELP

p.goodson

Please! I am caring for my uncle-in-law and he is at the stage of complete anger. My family and I are at a complete and utter lose of what to do to help him. Just recently he has been very angry at everyone and everything. He won't eat, sleep, or go to the doctor. He just stomps around the house cussing and spitting. He stayed outside (where we have had to gate off the driveway so he can't get out out into the neighborhood) for 6 hours the other day refusing to come inside or calm down. I am so tired. Please help..

terei

If he is uncontrolled, I would transport or have him transported to an ER + then on to a geri psych unit where he can be evaluated + medicated to moderate his behavior. He could be in geri psych 2 to 3 weeks

M1

Agree completely with the above. You need to take him and clearly and repeatedly state that you cannot care for him at home. Does anyone have power of attorney for him? you are going to need it; if you don't have it you may have to pursue guardianship.

Jo C.

What a difficult challenge for your family; and your uncle in-law is also suffering and needs to get to care to find treatment bringing peace for him and the family.

Before discussion; M1 has mentioned a very, very important point. Whether Uncle is in the ER, or in the Geriatric Psych Unit or any other department of a hospital, you CANNOT be forced to take him back home. You simply keep stating that it is not safe for him or the family and you cannot provide the severity of care he needs. Then stick to that. No way can you be forced to take him. The Hospital Case Manager or Social Worker would then find a facility that would be willing to accept him. He cannot be discharged until such a setting can be found.

Okay; that has been said:

He does need to be transferred to an ER for assessment for physical issues and also mostly for potential referral and admission to a Geriatric Psych Unit. Not a regular psych unit, but a GeroPsych Unit as they are best to work with a person with dementia.

Getting him to the ER is the issue. If he has a physician, you can call and ask to speak to the doctor. You can explain the persistent ongoing severity of his dementia behavior and ask for a prescription for a med that would calm him sufficiently for you to get him to the E.R. It also may be that his physician may be able to facilitate admission to GeroPsych. When admitted to such a setting, a psychiatrist will be the primary MD as it is after all, a Psych Unit. They will be able to assess him on a 24 hour basis and begin medication to assist with his behaviors. It is usually a short term stay of a couple of weeks or so depending on the person's condition and how they are doing. If he is acting out and you cannot get him to the ER privately, you may have to speak to local law enforcement to find out since Uncle is out of control, if they can facilitate his admission to the ER. It would be done in an ambulance at that point.

If he can be cared for at home after GeroPsych care, that would be his discharge setting; however, if family feels that the 24 hour seven days a week care needs are too severe to manage, he could be transferred right from the GeroPsych Unit to a care facility. That will be up to family. If he has funds, it would be paid for privately; if there are no or very low funds, then one would look into Medicaid to pay for the costs. Remember; you do not have to take him home if it is not doable.

If no one has a Durable Power of Attorney for his care, that may present issues. Sometimes one has to see an Elder Law Attorney and apply for Guardianship if nothing else can be done. Hopefully you will not have to do that. An Elder Law Attorney would be very helpful regarding putting things together to best manage what is currently happening and for the future.

So hope you can get him to care asap; let us know how things are going; we will be thinking of you.

J.

p.goodson

I so appreciate all of the helpful comments! I am talking with the family about sending him to the ER. Everyone is in agreement that he needs help that we cannot give at this point. I will keep you guys updated for sure. Thank you all again!

mawvkysc

Just want to send some love!