MC sent my Mom to ER with a psych hold

atl86

My 92 year old Mom has been in memory care for almost 3 years. She is probably late stage 5 or early stage 6. She has become more agitated over the past 6 months and has begun lashing out at caregivers and other residents. A couple of days ago she hit 3 residents and the MC called an ambulance and put her on a psych hold. She's still in the ER because they cannot find an inpatient geriatric psych unit within 3 hours of metro Atlanta that has a bed available and will agree to take her. They are telling me that no place wants to take a person with advanced dementia who needs help with some ADLs. I told them that my Mom being 3 hours away was unacceptable to me and that they should keep looking. The MC has said that Mom cannot come back until the aggression is controlled with meds. I have no idea what to do next.

H1235

I’m so sorry you and your mom are going through this. I can understand why the mc is concerned about her behavior, but do they have a doctor on call? If she has been more agitated for the last 6 months, then what were they doing about it? Was medication prescribed? Ignoring the problem until it becomes an huge issue is not right. My state has a big shortage of available space in psych hospitals. It is really bad. If she is in a psych hospital 3 hours away or more (you may not be allowed to visit anyway), she will hopefully start getting the medication she needs. If she stays in the hospital for days waiting for something closer, it’s probably going to be rough on her. Hospitals are not a good setting for a person with dementia. So sorry. It seems like there is just no good option. I hope someone else here can help you with some wise advice.

Maru

I don't see any good options, either. Considering that you will most likely not be allowed to visit her, it might be better for her to be further away but in a facility that can treat her properly. The ER cannot do much of anything except give her meds, and change diapers as needed. They are not trained to deal with dementia or non-ADL adults.

atl86

https://alzconnected.org/discussion/comment/280796#Comment_280796

I appreciate your perspective. Last night at 10:30 PM, the ER transferred my Mom by ambulance to the inpatient facility 3 hours ago without informing me. I found out she was gone when I went to visit her this morning. I talked to the ER manager and he said that when Mom was placed on a psych hold, she became a ward of the state and I had not say in what where she was placed. He apologized for his staff failing to keep me informed of all that was transpiring and what it means when someone is placed on the psych hold that my Mom was subject to. At this point, I just pray that she will get the help she needs and can return to her room at her old MC.

H1235

https://alzconnected.org/discussion/comment/280837#Comment_280837

I would be absolutely furious. That doesn’t sound right at all, but I guess there are a lot of things about the medical system that aren’t right. I am so sorry. I hope she gets the help she needs. 🙏

jen ht

I am so sorry.

I hope the inpatient treatment center will communicate with you. Maybe ask to speak with a social worker there?

I feel for you. Different situation, but my dad had a geri psych hospital stay last month.

Ugh. Hugs and strength your way.

Jen

Marigold Starcrown

Hi. I just wanted to say that at her age you do need to be very very very careful with which medications she is on. Some of the psychiatric medications for aggression/agitation are significantly not good for people in their nineties, as in, can kill them.

My mom is the same age as yours. She hit me very briefly on the chin on August 1st. Not very hard and it didn't hurt. Hasn't happened again. The weird part is that she didn't even seem particularly angry, more like lost control. For me though this is a sign that she may be getting worse. On the other hand she was recovering from an infection (leg infection, second one in five years) at the time so it could be partly that too. She and my dad are both I believe out of Stage Three and into Stage Four but that's going by their behavior and what I saw online. They have had a very very very long Stage Three or what looks like it but they are still undiagnosed and still living at their home. They are able to do all their own daily living sorts of things. Cooking and cleaning are less than before but they are still doing some.

I haven't actually even told their doctor yet about the hitting incident and don't know if I ever will if it doesn't happen again. He does *not* actually know my parents very well and he might misinterpret something about the situation. I was not in any danger, no one was in any danger and she only did it once. Had that not been the case then that's a different story.

This is only the second time that I've ever posted about this. Tried Reddit r/dementia and it was not the appropriate place. People started getting too anxious about me. Tried Reddit r/AgingParents on another dementia topic and got told that if my parents are still able to take care of themselves then they don't have dementia and that I don't know anything about the topic (dementia). Seems it's either one thing or another with that place. Something's always wrong there, usually with my posts or supposedly so. Luckily that occasion it was at least only the one poster that had that one particular problem with my post.

Looking for a safe space where it's actually okay to post these kinds of things without getting all the unnecessary flack and negative attention.

Sorry to hear about what you and your mom are both going through. Hope that things do get better for you soon.

​fesk

Infections can certainly alter behavior. My mother's doctor would not address any medication for behaviors until the infection was cleared for a couple of weeks.

atl86

https://alzconnected.org/discussion/comment/280864#Comment_280864

I spoke to the social worker and a nurse at the inpatient facility yesterday morning. The psychiatrist hadn't seen my mother yet because she had arrived at 2:00 AM that morning. Both individuals I spoke with were pleasant and seemed forthcoming. I will call again later today in hopes of speaking to the psychiatrist to get a general idea of how long Mom will be there under treatment. I also scheduled an early afternoon time slot to visit Mom on Saturday. It will be a long day of driving there and back for a 1 hour visit, but I really need to lay eyes on her.

atl86

https://alzconnected.org/discussion/comment/280870#Comment_280870

No judgement from me. I have spent the past 9-10 years facing one unfamiliar situation after another with my mother. With each new challenge I was able to find the information I needed to make difficult and painful decisions. It's really hard to know the "right" things to do, especially when getting conflicting advice. You know your parents best and are most familiar with what is happening on the ground. But, be aware that if you aren't with them on a frequent basis they can get pretty good at hiding serious issues from you. Hopefully, you'll know when it's time (or past time) to make the necessary changes in your parent's living situation whether they like it or not.

SDianeL

Do you have Medical power of attorney? If so, they should have notified you. Make sure a Geriatric Psychiatrist is treating your Mom. Her medications need to be adjusted so she can return to MC. A Geriatric Psychiatrist is the best type of doctor to manage those meds for dementia. So sorry you are going through this.

atl86

Yes, I have medical power of attorney and the hospital already had the documentation on file.

A geriatric psychiatrist is currently treating Mom as an inpatient in another hospital where she was sent by the first hospital. Mom is now a 3-hour drive away from me.

Victoriaredux

I'd read the MC contract and be sure you meet their rules to keep them holding her bed while she is being treated. Last thing you want is them filling her bed. Document your wishes in writing . Keep them in the loop.

atl86

https://alzconnected.org/discussion/comment/280897#Comment_280897

https://alzconnected.org/discussion/comment/281057#Comment_281057

I'm providing the MC with updates on a regular basis. Right now, it seems as though they are planning for her to return. I will be paying the September rent on the 9/1.

TrumpetSwan

ATL86, I know I am a little late to this post, but holy smokes! I am surprised at the measures the staff at the MC facility took then again the acts the hospital staff took without your prior approval or awareness. Then, once they do that, the patient automatically becomes a ward of the state? That just seems way to aggressive to me. It takes my breath away.

It makes me wonder if it was just that if a resident displays physical aggression it gives the MC staff the authority to make such an impactful decision as sending a vulnerable resident to ER with a psych hold? I guess there is some verbiage in the facility contract on that? Otherwise, it just seems like a huge over-reach to me. I do not think that was a benign action, and it set off a sequence of other actions that can leave a patient too vulnerable. Staff in ER is not trained how to deal with a patient with dementia. Their behaviors can worsen in a hospital setting and staff there just seem to take extreme measures that make it all worse. At least that is what I saw happen, but maybe your situation is different.

By now, you have visited your dear mother and it is likely worked out. It seems she has plans to return to her MC with potentially new meds. It was probably a very worrisome episode for you and I am so sorry. Sending you strength and courage as you move for\ward through this.