My father was diagnosed with dementia almost 6 years ago. In December 2018 we had to move him into a memory care facility due to several issues but mainly because he was attacking my mother several times a day. Sometimes it would be verbal attacks and other times he would actually go at her with a knife trying to kill her. When he would come out of these moments he had no recollection of what he had done only that he knew he had done something awful, he would cry for hours after finding out what had happened.
Since moving in to the memory care unit six months ago, he has had several altercations with staff and residents. I've begged to have his meds adjusted but basically I am told there is nothing else they can do. This morning I received a call that he had again assaulted a staff member and another resident over the weekend. I was told that he is being evicted and that I must remove him from the facility within 24 hours.
I have no idea what to do or where to take him. The other facilities I have called all refuse to take him due to his violent history.
Can anyone offer any suggestions, I'm desperate.
if the hospital SW discharge planner still hasn’t found a facility for him, please please do not let your guard down and take him home. No matter how pitiful he looks or how much he / they say he is no threat.
Realize that the evaluation at the hospital is not one done over a long period of time. It more based on 48-72 hr observation and while he’s under serious meds. Plus he’s likely able to understand he is not able to manipulate the situation like he could do at the old MC or with you/mom, so he’s on his better behavior. It’s always amazing to me that despite however much dementia our elders have that they can “showdog” for short periods of time.... I’m guessing that he’s good at doing this, don’t let it happen, don’t let your guard down.
If push comes to shove, he can be made a ward of the state. It’s a big step to do this as mom & you give up authority to do or place on his behalf. But sometimes, it’s best. For “ward”, usually APS (or the SW at the hospital will contact APS) will ask a judge (usually it’s probate court judge as they hear guardianships) for an emergency ward of the state order. It likely will be time limited maybe 10 days or 30/90 days. The judge will appoint an outside guardian. Some PC (probate courts) have a list of temporary guardians that are vetted and approved by the state and he gets the next name on the list as his court appointed temporary guardian.
Now if he & mom own property, have joint accounts, need each other’s income or insurance coverage, unthreading their community property & affairs will be not simple. Your mom will be best off getting an atty to look out for her interests.
But that court appointed guardian can get things done for your dad & like now compared to you all. They can use their statewide database access to get him into a facility, perhaps in another county but they can find a locked ward bed for him somewhere.
If you do “ward”, imho You & mom do want to be cooperative with the guardian. & you do want mom to have her own atty to make sure her interests are not overlooked. Perhaps have the goal to have it as a temporary guardianship and have the atty that your mom sees help you all determine if it can work for you (not your mom) to be appointed to be his permanent guardian in a hearing in PC like in 90 /120 days.
There have been others on AC who have had to deal with a beyond combative needing a psych ward & with dementia parent, who have let the ward of the state action be done. Sometimes you need an outside 3rd party to make the decisions. It’s not admitting failure or lack of love but think of it as enlisting a professional that knows the maze to get the care your dad needs. Good luck & remember to get your own rest.
"My father is a danger to others. He has tried to kill my mother. I will have to have him arrested if he is returned to my mother's home".
If they send him home in a cab, call 911 and tell them that he is a threat to the safety of your mother. MAKE SURE that your mother will back you up if you go this route.
NObody likes UTI's they just mess with the body and brain. Ask anyone who has or had to care for someone with that... not fun..
My mom had to go twice and it was a godsend. She stayed about a week each time. Luckily in my city the care was excellent. She does occasionally get agitated but is no longer aggressive.
The MC unit should've sent him to the ER after the first altercation, and then he could've been admitted to the psych area. This is not something that you can take care of on your own.
I assume you had to remove your father from the MC? You can still take him to the ER yourself and tell them what is going on, and that he is a threat to both himself and others. They should be able to deal with it from there.
Once he is calmed down you can again see if there is a MC that will accept him, in light of his what will be new medication.
He needs to be in a behavioral care facility. I’m surprised the NH isn’t helping you secure a placement. Like Countrymouse wrote, sit on your hands.
In the interim, if you are faced with no other options, he should be transferred directly to hospital, a mental health facility or state mental institution for care.
Talk to the nursing home’s social worker about feasible options.
Try a private board and care = 6 pack. He may be overwhelmed at the larger memory care facility. But then again, he was showing signs with your mom..
ask about the UTI's with his dr and change of prescriptions. Is it at a certain time of day this happens, or just whenever? Sundowners possibly.
Can you request a CAT scan of his brain? Maybe there is something else going on that is causing this.
My friend's mom would practically go comatose. She would stare blankly into space with mouth gaping open.
So it's getting warm nowadays, make sure your loved ones have plenty of fluid especially water, and make sure they are clean down there in them parts.
24 hour notice doesn't seem right.
Ask for arbitration with MC admin in the matter. There is medication that can help. But you simply asking "them" to do this will not fly. He needs to be thoroughly evaluated by a gereatric doctor so to get the most accurate assessment. There may be other factors going on which is triggering this. In other words, be proactive and work with the powers that be showing that you are just as concerned with their welfare and operation as your loved one.
You're not his guardian, are you? - I'm assuming not, because if you'd been through the rigmarole of obtaining guardianship I think you'd have said so.
The contract is, then, straightforwardly between the facility and your father. If the facility wishes to terminate the contract, which they entered into knowing his history, it is for them to find a place to discharge him to.
It's also just common sense - they are experienced professionals with a wide range of skills and qualifications and a whole network of contacts. Who stands a better chance of finding the right option for your Dad, them or you?
When you say you've begged them to adjust his medications, who have you actually talked to? Are you getting the brush-off from members of staff, or have you had a formal care review with senior managers and the facility's qualified medics or psychiatrists?
People refer to the contract, if the contract says it, that is it.
No! That is not necessarily true, most states have a law that says you can not change state laws by contract. If the law says as a facility you must ensure a safe discharge, period. Then the contract can not be enforced if it says they can just throw someone out because of... The law takes over and the contract is unenforceable because it is contradictory to state law. The contract can say whatever, but it doesn't matter if it is in violation of state law. Make the facility provide you with the state statute that allows them to do what they are trying to do.
In writing is always best, then you have proof of what has been said or done. If anyone sends you something in writing, respond, because no response in 30 days is seen as agreement with what was written. By not disputing what is in writing you are agreeing to it.
Just for information, because I have seen big companies try to intimidate individuals who don't know any better and it fries my cookies when that happens. So these are 2 pieces of law that everyone should know, it takes a lot of fear out of intimidation methods used.
You have been given excellent advice. Refuse, Refuse, Refuse.
I have seen on this site before that the words “ Unsafe Discharge” are key.
I agree transfer to hospital then to their psyche or geriatric psyche floor, wing, ward is where you would hope your Dad would land. Even a psyche facility would work.
A good Geriatric Psychiatrist should be able to get your Dad’s mood stabilized.
Dad’s mood may become stabilized but still no, no, no, to a discharge back to you or Mom. The discharge planner at the psyche facility should assist finding an appropriate place for Dad. I agree a NH environment.
Dad’s meds might have to be tweaked often and this is best done ( imo ) within a NH environment that has a visiting psych service. The psych service is basically a phone call away should staff need assistance.
Combative Dementia patients can be scary and unpredictable.
My heart goes out to you and your Mom.
I have a suggestion but first.....
In my experience it’s only skilled nursing facilities aka a NH that is required by how they are licensed & regulated by the state to provide for safe continuity of care for residents; so if they need to move, the NH must find a new bed for them at the level of care needed. AL do NOT have to do this as the resident is viewed as able to do their ADLs for themselves with some assistance. MC are a bit more of a grey area as they are more than AL but usually not viewed as skilled nursing aka a NH, so they too can evict without setting up proper placement for his transfer. MC fully knows no other MC or NH will take him with his history. MC will do whatever to pressure you to get him. So the monkey shifts from being their problem to yours and they will deny pressuring you. It’s not a cute but naughty lil Capuchin but a seriously scary silver back ape.
Stay firm, resolute AND refuse.
You cannot provide the level of safety and security that he needs nor can your mother AND the degree of health care & 24/7 oversight needed AND as such you will not and cannot pick him up.
Make this your mantra.
You cannot go and visit him either as they will hound / guilt or even threaten you to get you to put dad in your car. Whatever in his room at the MC, forgetaboutit. If you need to, please do a “role play” for this. If you have a bad witch strong personality friend have her play the MC staffer role. Really after you get that first panic filled crying fit behind you, you’ll be much better & prepared to speak with the MC.
What will likely happen is this..... dad will not be kicked to the curb as that’s lousy public relations and MC liability if he goes and knives somebody when he escaped. But what they likely will do is call EMS to come and take him to the ER under some plausible reason. A good one is that they seem to have had a TIA - transient ischemic Attack. TIAs are kinda subjective in symptoms, (google it, you’ll see what I mean) & really if they give him tranquilizer and another med in close succession could look like TIA symptoms. Then once whisked off in the EMS, off to the ER, the MC will refuse to take him back. In the ER, if he’s up in age and hyper aggressive, he will get hospitalized.
OR Another option if he pulls a serious threatening behavior at the MC is for them to call police and cops Baker Act him...... he’s sent on a 48 (?) hour hold for psych observation at the hospital.
Then hospital discharge planner - usually a Social worker - will contact you or mom as next of kin about coming to take him home. Again you go into your mantra.... you cannot provide yada yada. SW will have to find a closed ward unit for him somewhere. Could take a bit of time so he’ll stay sedated at the hospital till then. Good part is that the hospitalization is a Medicare benefit. It gives you & your mom a bit of time to figure out how to pay for his eventual LTC in a Locked ward facility. If he’s not on Medicaid, unless mom had oodles of $, he will end up applying for Medicaid. Or mom relinquishes her role as wife & you as POA and you all allow him to become a ward of the state. He’d get a state appointed guardian. It’s harsh but getting a good psych placement is really hard as not enough beds or facilities or trained staff nationwide. Sometimes ward of the state is best.
First big big step is he needs to get into a psych ward at a hospital to be evaluated & started on medication trials. MC will call EMS or cops pronto once they know you are not gonna get him. Good luck and stay focused.
again imho you really can’t go to visit him no matter how much you want to at the MC as they will do whatever to coerce you to just take him home as he’ll be happier & better off there. Nonsense.
Out of curiosity, how old is dad, mom & yourself?
All that said, again without your guidance I would be in such a mess right now. THANK YOU THANK YOU THANK!!
I don't think they can legally boot him out with a 24 hour notice. He has rights as a tenant of the facility.
He needs to go to a psychiatric hospital and get some meds on board that calm him down. That they are saying nothing else to do shows what a crummy facility they are.
I would tell them that you picking him up is a no go. You know he has rights and they have responsibilities and they need to step up and take care of him until you can find a place for him or they need to request a psychiatric admission directly from their facility. The psych hospital won't just dump him, they will help you find a more appropriate facility.
Right now, I can't blame dad. I want to smack the administrator of his facility, what a pos. He's supposed to be being cared for by people that know how to deal with this situation. That's why he is in a facility.
Don't let them bully you. Stand up and say NO! If they argue make them show you, not tell you the law that allows them to kick a resident out with 24 hour notice, not their contract, the law that allows them to do this.
May God give you strength and guidance. Hugs!
In some states there are state hospitals for the mentally ill with violent behavior. Some are long term care facilities. I see that you are in FL. The places that I am referring to are in NC. If your father is in NC, you might explore them. One is called Longleaf Neuro-medical center in NC. You can check out their website for details. There are several of those facilities in our state. I would think that FL would have something similar in their state.