Please: help with advice getting into geri-psych

coastal_kid

Hi there,

My mom and I are at a total loss about what to do right now and I'm soliciting advice from your personal experience. Here's the situation:

My dad, 80, at a memory care facility (Alzheimer's), has had some impulsive behavior resulting in the facility questioning if its the right place for him, and demanding 1:1 care until his new medication is effective and his "behaviors" are settled.

• They feel as if they've been clear with us, and with his supporting GP and Nurologist, and they aren't moving quickly enough.
• Dad has responded physically to multiple scenarios in which he was not the aggressor.
• He has impulsive moments where he yells and gets really upset about things.
• The last occurrence was unprovoked - he put his hands on a woman's shoulders to move her away from a door she was trying to get into. She fell when he let go.
• We suspect underlying bipolar but too late to diagnose now.

The MC is demanding action, so his neurologist prescribed him 100 → 200 mg of Seroquel (quetiapine), but while he is onboarding to the medicine (which, from my understanding, takes 2-6 weeks), he needs more care than the MC facility says they can give him, plus they aren't convinced the aggressive behaviors have stopped. We aren't even certain if this is the right medication for him.

We tried taking him to the ER as an inroad to the geri-psych unit there, but because he wasn't suffering from a primary condition (depression), we were turned away. All of the other units in the area also say that they don't take dementia or alzheimers patients as the primary condition.

We are at a total loss about what to do — he can't come home with my mom because of fear of violence against her, he can't come home with me because I have two small children and we don't have a safe, monitored place for him, and in the meantime – are private-paying $1k a day for 1:1 care, on top of the MC costs.

We want him to be somewhere safe, where his dosage can be monitored and adjusted. How did you solve this?

SSHarkey

Oh my, you are certainly in a catch 22 situation! I wish I had some answers for you. I’ve not had to deal with this type of experience. I’m guessing because it’s the weekend, most people who would normally respond are tied up. You’ll get some good advice here soon. In the meantime, I’ll be praying for you all!

M1

This sounds nuts. I'd speak with the director of the MC and ask if there's a geri psych unit they work with regularly. If that person can't give you an answer, ask if there's a medical director for the facility and speak with that person too. Call around to other geri psych units in the area. I have a hard time believing they refused him admission, if you have the energy I'd protest that big time, but who has time or energy? This is standard fare for a geri psych unit. I'm appalled for you....

harshedbuzz

@coastal_kid

I am so sorry. What happened at the ER exactly? Were you there or just mom?

It would be odd for a PWD to be sent to a geripsych on suspicion of "just" depression unless there was a threat of harm to self or others. Your dad is clearly a threat to others. You seem to be downplaying dad's aggression here in pointing out "the other guy started it". Did this happen in the ER? No judgement; my mom often downplayed dad's worst behaviors when reporting to medical people out of some misguided sense of loyalty. (Dad's geripsych also though he'd likely had bi-polar and loss of filter resulted in his behavior) I once had to do an end run around them by sending video footage to the geripsych so he could see the reality of dad when he wasn't showtiming.

I might try again if the behavior continues stressing the harm to others aspect of his behavior. I would make sure you are assertive about his risk to self and others.

Does the MCF have measurable goals for behavior before releasing family from the burden of 24/7 1:1 care? This did happen to a family member of mine after her mom broke a hip and could not recall it. She was in a SNF that demanded 24/7 someone stay with my aunt around the clock. Because there was no money, family stepped in. My cousin took the bulk of the shifts including overnights. Her widowed DIL (who was working FT) picked up some of the slack and my other aunt (who was guardian to another sister with dementia) filled in where she could. It was nightmarish.

HB

coastal_kid

Hi there, I appreciate the responses.

I’ve been working directly with the Executive Director of the facility - and she has been pretty transparent in that she doesn’t know what to do and that the system is broken. Both she and I are continuing to explore possible options. But ultimately she needs to be confident the violent impulses have stopped prior to moving away from eviction language. But because dad’s new medication is severely confusing him (a huge drop in ability because of the sedative / making him hallucinate) it’s hard to tell. Yesterday, he took a swing at my mom who was trying to prevent him from moving another resident out of a chair so he could sit next to his girlfriend.

At the ER, it was my mom and I. We came prepared with a report of all of his behaviors, as well as the advance directive and other paperwork (we don’t have a guardianship - never though lt we might need one!) - and had a pretty clear narrative of he is a danger to others and is at risk of losing his placement at the MC. He couldn’t come home with mom for fear or violence against her, and not with me because of young kids and that we don’t have a safe space

We really did not downplay the aggression, but he was so malleable and calm and relatively kind at the time. I mean, there were tears, there was frustration, and they just said “look around you, there are sick people here”. They said no in no in no inconclusive terms. I don’t think I know how to advocate beyond that without throwing a fit and digging my heels in, which is not exactly how I typically operate.

There are three Geri-psych facilities in the area and one seemed a little bit more open than the others. Apparently we ended up at the (local) and most evasive one. So, after I touch base with the neurologist on Monday to determine if his extra-weird behaviors are expected to even out (Seroquil), I’ll consider if we need to try another ER visit. Meantime, I’m also going to try and get on an outpatient list — scheduled out until June.

No measurable goals outside of “we are convinced he won’t be aggressive to others”. It’s extremely frustrating because we can’t pay this for very long. It’s putting our financial plan at big risk.

I spoke with with our ombudsman to get some perspective, and she said that any “scheduled or unscheduled” behaviors are the responsibility of the MCU (she was appalled that we were paying for 1:1 care), but be like it very much and don’t want to be expelled. So it’s a very blurry line.

Very open to ideas, provocations, ANYTHING, if you have em.

M1

the Seroquel is generally a good choice for controlling these behaviors, but it is dose-dependent and there are adverse reactions. It does sound like it would be much easier to stabilize him in an inpatient setting. Keep trying, and please do let us know what happens. Wish I had something more concrete to suggest.