MC failed us

wizmo

I reported a month ago DW had difficulty going from home to MC, explosive agitation, being combative with staff and other residents - went to ER and then psych hospital. MC gave assurances she could return when stabilized.

Psych hospital stay ended up being 25 (!) days with multiple adjustments to meds. She was already on seroquel 50+50+100mg and they added depakote, don't know at what dosage, maybe other meds but I haven't seen any docs yet. Communication with psych hospital was bizarre like I have never seen, impossible to reach anyone or get a return call. Visiting hours 3 per week Tue/Thu/Sat 4-5pm, that is it. I visited every opportunity and could not really see progress due to varying levels of medication.

They discharged her back to MC and she was reportedly weepy but compliant for a couple days then back to agitation - because she would not cooperate with administering meds. Trying to coax her as worsening behaviors returned was not working. Day 4 back at MC one staffer was able to calm her down and get through the day but they are not set up for that much focus on one resident. Day 5 (yesterday) they called me for a meeting to terminate service. Basically they are unwilling / incapable of dealing with difficult behaviors. I tried to ask during my search do they handle emerging behaviors and of course they said yes to get us in the door.

Choices offered: take her home (impossible/unsafe); hire extra dedicated caregiver to remain at MC and contain her short term until I can find another place (unlikely to get one with no notice); go back through hospital system. She was headed back to ER within the hour.

Social worker at the hospital said openly to me "we do not like that place (MC), they claim to offer memory care but have given up so many times offloading difficult residents to ER; that is not really memory care and they should be handling whatever comes with the disease which is pretty well known". I guess that confirms they are yet another cherry-picker, after the fact.

Previous psych hospital declined to take her back. I did not get any explanation whether they are full, don't think they can do anything more, or they would get challenged on insurance coverage. I didn't like them anyway. Two other places offered to take her, both of them close to an hour away - but not until next day. I now know to have low expectations for these places.

Referral agent I worked with before (a small local outfit, not APFM) has some new search criteria and is helping me find another place. I feel let down on multiple fronts having tried to be diligent/proactive over 6 months leading up to placement only to return to square 1 and work in crisis mode now. If there is any positive, I have gotten a lot of rest over the last month and have some energy to deal with this fine mess.

Original discussion here:

https://alzconnected.org/discussion/68420/mc-journey-off-to-a-very-rough-start

mrahope

OMG! I am so sorry to hear about what has happened to you and your DW. I am so sincerely hoping that you do find a much more appropriate place for her soon.

SSHarkey

Oh I’ve seen similar things happen just recently! The round robin, lack of communication, ignore the caregiver business that makes you want to scream at them! And the patient is left on the doorstep without services. It’s abandonment of care! And each facility pointing the finger at the other one. Obviously, from this rant, my experience is still fresh. I’m so glad you have an agent to help you! I hope everything works out well for you both! For us, it took a lot of cage rattling to finally get the help needed. But it came.

ImMaggieMae

it sounds like the psych hospital is the facility that dropped the ball. It sounds like they released her before they had her stabilized. And not communicating with you is unforgivable. They should have given you details of every med that they tried and her reaction to them. It sounds like the MC was just trying to protect their staff. If she experienced explosive agitation and was combative with the staff what’s to keep her from harming other patients? They couldn’t put her in solitary confinement. Is there another psych facility or a hospital that would do a better job? It must be awful for you, having to go through this.

harshedbuzz

@wizmo

I am so sorry for the situation in which you find yourself. This is a real nightmare.

This sounds like a perfect storm situation. The MCF seems to be cherry-picking residents; willing to deal with behaviors but not BEHAVIORS. And the geri-psych unit likely discharged your DW prematurely— probably due to insurance limitations. Unfortunately, the types of meds typically trialed in these sorts of hospital stays tend to take weeks to get a sense of what sort of benefit they may have.

I hope the current hospitalization is more helpful. It would be useful to connect with their social worker for help in finding an appropriate MCF. Another great source for us— as we anticipated challenging behavior from dad and he was actually rejected by mom's first choice MCF— was the local IRL support group. The members and moderator there had a good idea around which facilities would be best for dad. He did end up at the one place most often suggested to me and they were awesome. They even had a geri-psych affiliated who was able to address the medication piece for many without a transfer to the ER.

HB

wizmo

While the bar was low, 2nd psych hospital is already 100% better at communicating. I had a real conversation with psychiatrist who wants to remove depakote (suspecting toxicity) and get more of a fresh start. First call in to social worker for an update was returned in 15 minutes - night and day difference. DW also was moderately sedated for nearly 24 hours in ER and may now also have delirium from that to complicate everything. I got a note from insurance (a medicare advantage plan) about max 90 days coverage per plan year, 180 days lifetime for behavioral health. This is first usage ever so we're down 25 days but have more than 2 months left (this year) to get it right on 2nd round. Unfortunately this is now something of a black mark on her record and only a few remaining MC places will consider taking her. There are also group homes that will be an option, a bit more costly. I saw one that has had success with difficult residents, understands it takes time and patience to not give up after 2 days. Also saw one of the MC choices, seemed very average but said they take hard cases and do what needs to be done. They did mention concierge geri-psych visiting 2-3x weekly to be very proactive. Will have to see how psych hospital does in getting her to a better place and maybe there would be more options at that point.

ThisLife

I've recently experienced similar situation with my DH. I was more fortunate in that he was in a VA psych unit and the social worker was very helpful in finding another MC facility. I know your struggles.

M1

I went through this as well, with a disastrously bad hospitalization causing my first choice facility to reject her. Glad it's going better this time around. Hang in there.