Disillusioned with Geri-psych unit

clarinetist

My DH will be released from a Geri-psych unit soon. I placed him there because he’s had four aggressive incidents at his memory care in the last few months. His Seroquel was increased at the unit, but no other med changes were tried. The unit social worker told me the unit is only for acute care, and that any other med adjustments would have to be done on an out-patient basis. My DH has been there 8 days, and has never seen a doctor. I’ve been asking to speak to the physician’s assistant who orders the meds, but so far no joy.

I was under the (mistaken, apparently) impression that the Geri-psych unit was a place where we could find the best combination of meds for my husband. In addition to his agitation, he has depression, anxiety and many weeping spells. I had hoped those issues could be addressed in the unit.

He is calmer now, but the other issues have not gone away. The memory care’s Geri-psych is very hard to reach, and I’ve been trying unsuccessfully to get in touch with him for a month, which is one reason I decided to try the Geri-psych unit at a hospital.

Now I’m not sure what to do. I guess I’ll get him on a waiting list for a new Geri-psych, and cross my fingers that he doesn’t have another violent incident before he can get in to see a new psychiatrist. If he does have another incident, I won’t bother sending him back to this Geri-psych unit.

I feel very discouraged.

M1

It's appalling. I'd watch your explanation of benefits very closely and if they bill that he's seen a psychiatrist id register a Medicare/insurance complaint. Might do it anyway... I did.

Dio

Does the geripsych ward have any social workers or such to help? Is there a discharge plan? You may want to inquire about adding Depakote. Although it took appx. 2 months before we saw results, it was a miracle drug for my DH. And then, it may not work for everyone. Does your DH have a neurologist?

clarinetist

https://alzconnected.org/discussion/comment/211338#Comment_211338

thanks, M1. I’ll keep an eye out for the EOB.

clarinetist

The ward does have a social worker-he and the nurses are the only ones I can talk to. But the social worker is the one who told me they only do acute care. I will ask about a discharge plan and about Depakote. Thank you.

housefinch

I would make it abundantly clear that his outpatient Geri psych plan is tenuous at best. I am just stunned, even as an MD, by the discharge planning for someone who has that high risk a history. I’m so sorry you and he are enduring this. As a pediatrician, I am constantly reminded of how much we arrange on behalf of our patients/families to avoid these messy situations. I honestly think the adult world would benefit from learning from our approach. I will defer to @M1 for the specific steps to take but I’m very frustrated on your behalf.

M1

It is absolutely unconscionable if he has not been seen by a physician and that no one in charge of his care has called you. I would ask specifically who is the attending of record (use that language) and insist on speaking with that person. Assuming they call you, i would ask very directly if they have seen and examined your husband. Physician's assistants do not have hospital admitting privileges. If no one calls you back i would escalate it to asking to speak to the hospital administrator.

I'd have to look back but i believe the steps for filing a Medicare complaint are on the Medicare website. I think you could also rattle their cage if you tell them you are considering filing a complaint-believe me that's the last thing they want. The unit where my partner was hospitalized and so badly treated wrote off a nearly four week stay rather than face their sanctions.

clarinetist

Thank you housefinch and M1. I thought it was unusual that I couldn’t speak to anyone who’s prescribing his meds. Tomorrow I will ask who the attending of record is and ask to speak to him or her. I’d also like to see his patient file as I’m his medical POA so I can see what the plan is for his discharge.

His memory care is trying to get hold of their Geri-psych, but as I said, I’ve been trying to do that for a month. I’m wondering if it’s possible to get him transferred to a better Geri-psych unit. When I first sought this care, I was trying to get him to the better place, but there were no beds available.

I will also look up how to file a Medicare complaint. Thanks so much, everyone, for your support and advice.

clarinetist

this evening I got a call from the hospital. My DH passed out, and they almost had to revive him, but luckily he came out of it. Now he’s in ICU, and they’re running tests to see what happened.

Jgirl57

oh my! Another turn of events. Keeping you my thoughts as you go through this with your DH.

M1

Oh geez.....icus and dementia are a toxic mix.....

clarinetist

The good news is I finally got to talk to a doctor….am heading over first thing today.

ButterflyWings

Happy to hear that you are finally getting heard, and getting access. This must be so stressful for you. I hope it gets better from here in terms of the help for your DH, respect and transparency you deserve as spouse, advocate, caregiver, etc.

clarinetist

Thanks, ButterflyWings. My DH is sleeping now and his PCP came by. She will try to get him into a better Geri-psych.

wizmo

Glad to hear you are getting help from PCP to navigate this mess.

I had similar experience very recently - DW sent to psych hospital after combative incidents with residents and staff at MC, only 1 day after placement. First psych hospital was terrible at communication, hard to reach anyone, shared few details. They believed depakote was the answer, seemed to be stabilizing and discharged at 3 weeks. Within 4 days agitation returned and MC declined to keep her. They asked if I could take her back home, impossible for multiple reasons. So 2nd round through regular hospital ER and different psych unit where they decided to start fresh - removing depakote, increasing seroquel (dosages now 100+100+300), replacing venlafaxine with escitalopram for depression/anxiety, discharged after 4 weeks there. She is a different person after all this between stress of so many changes, progression, medications. During 2nd hospital stay I had to find another MCF that would accept a behavior case, fortunately there was an immediate opening. She has been there a month now without any behavior incidents. Very disappointed with first hospital and first MC but not sure I could have done anything different. Small blessing is the new MC clearly has a higher standard for just about everything.

clarinetist

Sorry you and your DW had to go through that, Wizmo. Am glad to hear you were able to find a better placement for your DW. That gives me hope!

SDianeL

My DH has been in MC for 6 months, he's now urinary incontinent and gets agitated & aggressive when they try to change his adult diaper & clothes. He lashed out at the caregivers. They called immediately and said they were upping his medication. I said OK. He's on Depakote and ?? The only downside is that he sleeps a lot more. But I'd rather him be sleeping than upset and lashing out at the caregivers. I hope the new Geri-Psyche unit and MC facility finds the right combo.

CStrope

My DH has had his meds changed so many times that I'm not even sure how they can figure out what should be done. He finally qualified for Medicaid after being in the MCF 6 weeks, and suddenly the next day the facility decided that he is not "appropriate" for their facility and issued him a 30 day notice. I feel the timing of the 30 day notice coming 3 days after they found out he qualified for Medicaid is a bit suspect.

Right now they have him on a med plan that has him almost like a zombie. I'm sure they're happy, he's quiet, non compative and no longer is able to show any type of aggression. It breaks my heart when I see him like this, but I know he couldn't continue down the aggressive path he was on.

Still trying to find someone that will accept him before he's kicked out!

ThisLife

ThisLife

"Right now they have him on a med plan that has him almost like a zombie. I'm sure they're happy, he's quiet, non compative and no longer is able to show any type of aggression. It breaks my heart when I see him like this, but I know he couldn't continue down the aggressive path he was on."

CStrope: DH was kicked out of MC and spent time in a Geri psych Unit where medication was adjusted. He went to a new memory care in the same zombie-like condition. I don't know what else I could have done. He went downhill quickly and passed seven weeks later. I'll always wonder. However, his up ticks in aggression always preceded a significant loss in skills. It's a tough road. (((Hugs)))

clarinetist

Diane, CStrope and ThisLife,

I agree with you that I’d rather see my DH calm than anxious and agitated. Spent the day in the ICU. DH got angry once, but I was able to calm him down. They have him on Haldol too, which does seem to knock him out.