My mother is currently placed in a SNF and we had a meeting today because the facility wants to remove her due to the verbal abuse my mother has towards the staff.
My mother has dementia and she is not exactly kind towards the staff. She is pleasant with the residents, but with the staff she is ruthless. I have spoken with her doctors and they have told me this type of behavior is fairly common and if she is not physically abusive they see no reason for medication especially if she is only targeting the staff. As they told me, medication will not alter how she feels towards the staff.
So, what exactly are my options? Can they really remove my mother because she is verbally abusive to the staff? What else can I do besides medication. Am I in the wrong to thinking the staff is being a tad soft so to speak.
Yes, the facility is correct. Clearly they respect and care about their staff and that's a pretty rare thing when dealing with a NH, MC, AL, or rehab facility.
If your mother is in a decent place and is getting good care allow her to be medicated instead of being moved somewhere else where the care may not be as good.
This is what her doctors have told me. Can a facility ask to override what her care team views as medical nesscary?
Your choices seem clear to me. Ask the doctors to try some medications (often dose anti depressants work great for this) OR try to find someplace that will accept constant verbal abuse.
What is she being nasty to the staff about? Is her dissatisfaction justified?
Anxiety medication will not alter how she feels about a person or situation. She just treats the staff this way and no one else. This is what I have been told by her doctors. So even if I medicate her God forbid she has negative side effects is not not worth the risk. Her doctors do not subscribe to the throw the kitchen sink and see what works.
I expressed being as she is fine with everyone else doesn't that prove that this is more a personal issue rather then medical one. Why should my mother be medicated due to name calling. I would understand if she was mean to the residents or physically abusive. Everything I have read about caring for those with dementia correcting no aggressive behaviors is not worth and can make situations worse, and using medication to make someone easier to deal with is also not ideal.
Edit: Yes she is under the care of a geriatric psychiatrist and she has been evaluated and no she has no signs of depression or anxiety. Her words are she just does not like the staff. So while not justified per-se in her head it is because she does not like them.
Perhaps a different facility with more activities or more jovial staff is the answer?
What is it about the staff that mom doesn't like? Is she trying to get herself thrown out so that she can go "home"?
To be fair I doubt anything would meet her demands. She wants to be with her family, and we do rotate and take her to our homes for the weekends when we can. We just cannot be with her every single day. She is absolutely fine with the residents she engages with them with no issue. We cannot pin point what it is about caregivers but she has always been mean to them.
Our options for placement are limited due to her being on Medicaid, and finding this one was a godsend due to limited aviability.
Try this: Get together with admin and staff and plead your case. Tell them all you told us. The docs don't want to medicate and YOU don't want to medicate and SHE has always been this way, and if the staff can just understand this, can't she stay.
Then you are down to either "Yes, she can; we will try knowing all you say", or "No, sorry, she cannot stay".
You acknowledge that it has been very difficult to place her.
Good old Dr. Laura (I can say this as I am older than her) has a saying "Not everything can be fixed". At 81 I must say, I couldn't agree with her more.
I hope someone has a real good option for you. I surely do wish you the best of luck.
I will leave you with this. I spent my entire life as a nurse and I loved it. And some of the feistiest and most outrageous patients were some of my favorites. I still remember Stella who waited for us to enter with her cane poised. Tiny and hair the purest white; I remember her to this day.
Alas, staff at Mom's facility don't seem to have the same delight!
The facility took her in knowing all of this I was 100% transparent with them before they accepted her. Not trying to downplay what they are going through but from what I gather using medication to alter who a person is if it is not harmful is not the ideal course of action. Correcting non dangerous behavior is also not advised.
Her doctors joined in on one meeting trying to figure out what the issue is cause in their eye's it seems their suggestion for medication is less about my mother's QoL and more so to make her easier to deal. In short for their convenience. This seems wrong on many fronts.
I called the alz association and their masters level dementia excerpts also do not understand the need for medication. They claim the staff should be trained and understand such behavior is fairly common for dementia and should be trained / advised to not take it personally.
Just seems they are flexing their power because they know I have a few options.
So while I may AGREE with you, there is really nothing that you, or I, or even the doctors all together seem to be able to do about this. We can call it "right" or "wrong" but that doesn't help the difficult situation you are in. I am really sorry. I wish you well, but not everything can be fixed, and I have no magic wand to wave.
Best of luck ongoing. I hope somehow this will work out.
They wanted her money. Then they sucked out enough money, now they prefer to get rid of your mom, because in their eyes, she causes — extra work — trouble.
I agree they shouldn't kick her out. But they can. And they can also invent whatever excuses to get her out.
Keep in mind:
1. You’ll probably lose. She will get kicked out.
2. Even if somehow you win, she might get mistreated, because she’s not welcome there.
It’s work for you: but get her out, change facility.
By the way:
Airplanes:
Similar:
They intentionally lower the temperature on long flights. Passengers are cold: this encourages them to sleep, blankets. Less work for the stewardesses. That’s why they lower the temperature.
My guess (possibly quite wrong) is that she was an old-school Director of Nursing or a School Teacher, who expected to be boss of employees, and was never polite to any of them. She still expects to be boss. My mother was a School Teacher, and I met several of her friends like this.
If this is a good guess, you might tackle mother about her changed circumstances. “You are NOT the boss here, you are a child in the class room. You need to do what you are told”. Or “the Union is planning to bring all the staff out on strike if you continue to abuse them. You can’t get away with it any longer”. Tell her that if she is evicted, she needs to find someone else to look for alternative accommodation – you’ve done your bit!
Nah my mom was not a teacher or anything, she was a therapist. Granted, yes she has always been a control freak so that may be a factor but every book I have read in caring for someone with dementia they all advice against correcting the reality.
I am going to talk with my boss on Monday to see if I can get some extra time off to look around and see what my options are.
Is the hope that Mom will LIKE the staff at a new facility? Or that staff will handle her behaviour better?
A move will be a lot of effort.
The risk seems the problem behaviour will come to. Seems like anger of loss of independance & control?
Has anyone had success with talk therapy when dementia is involved? (Obviously not for Alz or other dementias with short term memory issues).
I'm also wonderong if an OT could help? An OT with experience with positive reinforcement behaviour plans, like with ABI, Stroke & other brain injuries. Some of those people have aggression & require Behaviour Management Plans.
Aggression can be fear or panic too. Just a thought.
Has a Psychologiest been involved &/or viewed her interactions with staff?
Tbh though based off how she acts around others I am hard pressed to say it is aggression more so general disdain for the staff, and that is my concern. Even if I move her she probably will not like the staff. She wants to be back home with her family, it is just hard for us to provide proper supervision at all times.
Medicaid was not being accommodating with hours. She nearly burned down her apartment when I was not looking. Without constant supervision none of us feel comfortable with her being home by herself. We can provide that supervision is short bursts but everyday is rough.
On Monday I am going to have a meeting with all of her doctors and see what can be done. Maybe now we have tried a SNF and I have documentation that she has been asked to leave. Maybe she will provide home care, and what our family can do is just rotate where she stays so even with a stranger watching her she will be among family so she might be less likely to be rude.
Goimg to see what can be done, cause I know keeping her where she is is not an option. They want her to treat the staff with respect and for whatever reason she has an issue treating them with respect and medication and I doubt OT will change that.
She might be doing it on purpose (being rude to staff) (she doesn’t want to over-do it, so she keeps it at the verbal level), so that you take her back home. Some people (even with dementia) on purpose create trouble in a facility, hoping they’ll get kicked out.
She might even be justified a little (in being rude to them), in the sense that maybe some staff is actually really not nice.
I hope you’ll be fine and your mom.
However that comment is usually about correcting something like ‘going home to visit mother’, long since dead. It doesn’t apply to everything – not to things that are actively dangerous. Your mother’s behavior is not currently dangerous to her, but it can become so if you can’t find her care acceptable to her and feasible for your ‘rotating’ family. What alternative is there then, other than medication? If your suspicions are correct, and she is deliberately being difficult because “she wants to be back home with her family”, you may have to think again about how to handle it. And it might include being blunt about the alternatives.
Dementia is difficult for everyone, but it isn’t a blank check to get your own way.
If your mother is disdainful of those with less education than she (and this is a lifelong personality issue), I would be inclined to ask her doctors to try an antidepressant. Sometimes they soften the edges a bit.
Dusing the meeting the head nurse even acknowledged that it is generally not advised to correct none violent behaviors, or use attempt to use medication alter how someone feels. Yet, she quoted that is the ideal or optimal solution. Went on to state as many have here the diease is not a blank check to be an a**hole. She stated she values the mental health of her staff more so then the QoL of some rude patient.
I tried to push her on this point. Since it confuses me, I cannot fathom what it is like to take offense over the means words of someone with a damaged brain has. To me it is akin to getting upset over getting insulted by a child.
I do understand my mother has a sharp tongue and she is very good at finding what triggers someone and she will keep pushing that button until the person snaps. Even her doctors said it would only become a dangerous situation if the staff plays her game. If they ignore the comments and just complete the tasks it should not be an issue.
Cause even by their own account my mother does not fight or put up a fuss when they are doing their job. As one aid said my mother simply verbally judges and berates her. It is possible she feels they are beneath her as one has said.
Yet even the doctors do not understand how exactly that is grounds for medication or removal. Her doctor even stated if such behavior bothers your staff then clearly they do understand dementia behaviors. When the head nurse simply said this is not 30 years ago where aids were expected to take abuse because someone was sick. We are under staffed we have to protect the staff we have and make sure they want to come back to work.
They don't get paid enough to deal with such behaviors, and if the family does not want to do what is nesscary to keep the staff safe from physical and verbal abuse they can take their mother home.
Overall I understand where they are coming from and I also see how myself and my family are being entitled. As the RN respectfully told me, once my mother was placed and my options were so limited my powers as an advocate became next to zero.
Either I bend a knee and understand what I or my doctors want is irrelevant. All that matters is what the facility wants. Play by their rules or walk. In short beggers cannot be choosers.
If worse comes to worse I will look into putting my mother in a specialized private facility out of my own pocket, I can down size and sell my home. My other family members would still take her in on the weekends.
Well, I know you're not going to like what I have to say, but here goes: your options are to 1) do as the facility is telling you and place your mom on medication or 2) expect her to be asked to leave.
I understand everything you're saying about not wanting to medicate your mom. I understand everything you're saying about the doctors ' thinking medication is not necessary at this time, and that this behavior is common. I get your thinking about the staff perhaps being "a tad soft". I can't even say I necessarily disagree with you - although I may have a different opinion on just how much verbal abuse one should be expected to take in a work environment under the auspices of "well, it's your job"; but that's from personal experience of working a job where I was often subjected to verbal abuse, and not really germane to this conversation.
But all that doesn't change the fact that the facility is giving you an ultimatum: either mom gets medicated, or you find another facility. And you can cry and scream and shake your fist at the heavens that it isn't "fair" or "right" or "proper", but this is where you're at. If the facility is giving you this ultimatum, then I would be willing to bet my next pension check that they are well within their LEGAL rights to do so, because I imagine they have lawyers on staff and I'm sure they have run scenarios like this before those lawyers before issuing such ultimatums.
So. right, wrong or indifferent, it looks like you will have to make a tough decision about what to do about your mom: leave her in this facility under medication, find a new facility with a less sensitive staff, or take mom into your home(s) and take on her care. None of these options are ideal, I understand that. But sometimes in life, your choices aren't good v. bad; sometimes the only choice you have is between bad, worse and worst.
I'm so sorry you have to go through this.
We just cannot commit to 24/7 care all the time but with aids it should we possible that is the tentative goal we have come up with.
Such places really should not have such authority to force a family to do something they or their doctors do not desire. I get it though, like it or not I am desensitized to verbal abuse you get use to it growing up on the spectrum. So I cannot empathize with their pain but I get understand it. Reason why I am not going to fight it, no point since they can come up with any reason. Granted I have everything documented and recorded in her room still will not matter. My mother gains nothing staying in a place that does not want her.
You and your family are extremely sweet. Please tell your mom, I say you’re great OP.
A couple more things to think about:
1) Your mother is only 63, according to your profile. That is young to be behaving like this, probably the same age as many staff members. This may be part of why the staff find it hard to bear.
2) Your mother is a therapist. She may know that “general disdain for the staff” is usually more acceptable than being offensive to residents. Clearly she can tell the difference.
3) Have you actually heard what M is saying? Repeats may have been softened for your benefit. You say “she is fine with the staff when family visits”, so you may not have the full picture.
4) You say your mother is “a control freak”, “uses hurtful language”, is “harsh and mean towards non family caregivers”, and “with the staff she is ruthless”. Has she always been like this? Has no-one ever stood up to her (eg you? the family?). You say that you are “desensitised to verbal abuse”. Your relationship and tolerant personal expectations are very very unusual in an adult on this site.
5) Your mother has her own ‘care team’, not the facility. That may not help the issue of superiority to the care staff. She has a geriatric psychiatrist, who says “she has no signs of depression or anxiety”. How thorough was the assessment for dementia? Conscious behavior that could be aimed at ‘going home’ is worth a double check.
6) You mother is on Medicaid, and she could be on it for 40 years. You are willing to sell your home to care for her, and you have an unusually helpful family who are prepared to care on rotation. Have you looked at the long term situation?
Perhaps you and the family should talk it out together.
That is part of my issue they already accepted her and I was 100% transparent with them regarding my mother's behavior. As another poster suggested it is like they got money out of her and now she is proving not to be worth the effort.
What does her age have to do with anything? She has dementia, she is sick. Unfortunately this was the hand she was dealt, imo the age factor should be more reason to not want to start someone on the medication roulette.
It was extremely thorough. Sure, she had a desire to be home but she herself has expressed she understands that is not possible. We make sure she is with family on weekends and holidays. We visit as often as we can during the week. No we have not personally seen the extent, but I know it is harsh. My mother does not hold back punches and has never been afraid of telling people how she feels.
She might have greater tolerance towards the residents verse the staff. Maybe her lashing out at the staff is the only way to cope with a shit situation of being in NH in her early 60's. It could be a lot of things, that being said one thing I know for certain calling her behavior out will not make matters any better. As I said even when she was not sick she was a control freak, now that she is sick that is a 100% losing battle.
No one could reign her in before she was sick, no way anyone will do it when she is sick. That is not a winnable fight.
Even if she was slinging racial slurs which they said she was not, even then though I do not think someone should be medicated for such a reason. That is my issue with the facility pushing the idea of medication.
To me getting upset over what someone with dementia has to say is akin to getting upset over a toddler saying hurtful things to you. Just shake it off.
Generally speaking the comments my mother makes are about weight, ability, speech, education, physical appearance like hair. Is is targeted per person it seems. She is not a kind person, not going to pretend she is. My mother is a genuine a******e towards the staff. She is still my mother, and I am her advocate. My role is fight for what is best for her with the help with her doctors.
In short she hates being in NH who wouldn't. Problem is those without money do not have many options.
Hi OP, I think that was the plan all along. “Let’s take the money. We can always kick her out later, for whatever reason.”
They’ve done it many times. You’re not the first.
Regarding your mom towards the staff, she might be doing it on purpose. She doesn’t want to be rude to the other people, but only staff. And the ruder she is, she might get kicked out, which might be exactly what she wants. She’s on purpose only verbal, not physical, because that would be too mean.
A lot of people in facilities are intentionally unpleasant, hoping they’ll get kicked out.
I agree, please don’t “medicate”/drug her.
They were not exactly pleased, the social worker asked about me taking her home because I said that before. I simply told her I did not know my options then. I also confirmed that they will not be able to give my mother medication without myself and her doctors signing off on it. The I house doctors can only bypass this if she is deemed a safety risk to herself and others.
Verbal abusive does not meet the standard required to give someone medication against the directives of those in charge of her coordinating her care and advocating for her. I am her POA so they cannot override my wishes unless it is a truly harmful situation towards others.
We are also able to remove her temporarily and the facility is not allowed to prevent her from coming back if she is medically the same as she left or stable. Which was also my fear, so they cannot take her to the ER and keep her at the ER. If she is cleared to be discharged and has no medical reason to stay in the hospital the facility has to take her.
I did put more cameras in my mother's room, because I pretty much told the facility you are stuck with her until you find her a new place and if you do anything I will make a huge stink. As the ombudsman told me sometimes you have to be a Karen.
My plan is to not keep her where where she is but the family has agreed to visit her a couple of times a day until we find a better place just to make sure the staff does not treat her poorly.