Why does the past have to hurt the present?

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Why does the past have to hurt the present?

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My BIL who has dementia was in a ALF Memory Care Unit that is located 4 hours from home. My husband has been trying to get him moved closer to home but no one would take him due to him having behavior problems. Recently he had a hospital stay to have 2 surgeries and then discharged to a SNF for rehabilitation. The SNF is ready to discharge him but the administrator at the facility he was at said she no longer has a bed there for him.

Long story short, we still cannot get him into a memory care unit close to our home. We are told he is not having any more "behavior" issues but that even Memory Care Units are turning him away due to having too many diagnoses of dementia/mental health. What can we do?

Alzheimer's & Dementia Dementia Behaviors Memory Care Violent Behavior

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You will honestly then have to have him placed outside your area, as far as I can see. Do NOT attempt to take him home. You don't mention that's an option, but don't. If you can visit him less then that is the case. Tell them it will work a terrible hardship if he is placed so far from home that family can see him much less frequently. But I do not honestly see what your options are in this.

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AlvaDeer

Thank you for responding. BIL is in a facility 4 hours away. We thought it would be nice if my husband could visit him and be a part of his care plan.

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What does nursing home suggest? He may be able to stay there? Hubby can still be involved in his care and could be by phone. A visit to his bro, once every month or two, would be possible?

If he has been a behavior problem in the past, it will effect your choices for facilities. Safety of staff and all residents in any facility is a very valid and primary concern.

Have you check to see if there are care homes in your location? My mom was kicked out of memory care, on hospice at the time, because of her behaviors. Hospice recommended smaller care home which worked out better for mom. And all residents there had been kicked out of previous facilities.

Care Homes have a lower caregiver/resident ratio and, in my mom's case, cheaper. Has bro been evaluated by hospice? Maybe that could be done and the services that they provide would be very helpful.

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So BIL is still in the SNF, yes? For now.

His place at the most recent ALF has now gone, so you are looking for a new placement for him.

You're not having any luck locally to you.

Where is the SNF now hoping to discharge him to next? - or will they hold on to him indefinitely, even though he does not have ongoing nursing care needs?

I don't know if this is something you and your husband would be in a position to consider, but if push came to shove would you consider moving nearer a facility if you could find one good enough to be worth doing that for?

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Have you tried getting your local Area Agency on Aging to help find a MC? Since your BIL is outside their area the local AAA may not be able to actively work his case but they may be able to give you lists of places to check and recommend ones more likely to consider someone with your BIL's history.

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TNtechie

Thank you for your response. We are not having any problems locating a MC, we are just having problems with no one accepting him. thanks

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My husband and I have checked at least 20 Memory Care Units and they have all turned him down. The only thing we have been told by the CEO of the SNF is that BIL is ready to be discharged and that he is ready to return to MC, however, the MC where he was at will not take him back. Everywhere else we have tried has denied him as well.

My husband and I have even tried Home Care (smaller setting) and they will not accept him.

I'm not sure why he is still being denied.

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How are you contacting these MC providers, Haileybug? Is it possible to have meaningful conversations with actual people who are senior enough to be making informed decisions? It's just that if you're not even being given satisfactory explanations for refusals, I wonder if a more personalised approach - e.g. getting on the phone to someone, having done some research about who's who - might get you further.

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Countrymouse

I researched these Memory Care units and usually speak to the administrator of the facilities. They ask for a referral and then they deny him.

What am I doing wrong? What are your suggestions?

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I guess the SNF is going to have to help find an appropriate placement for him. It is probably his past behavior issues that are keeping facilities from agreeing to take him, as I'm sure you've figured out. There is not guarantee that it will not recur, but with proper meds, it could be fine. Guess they are not willing to take the risk.

As someone else said, DO NOT take him to your home. This will put pressure on "the system" to help. I would not worry about moving him closer to you at this time , especially since finding a place anywhere is an issue.

I have heard of instances where a patient has been "stuck" in one place while the facility searches for an appropriate placement for the patient. So it can and will be done since there is a need for it. Especially if the SNF wants him to move out, they will be motivated to find a solution.

Good luck.

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Againx100

Thank you for your response. Yes, I understand what you are saying I just hope they do not send him away any further. That would be awful.

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Any chance that you can have a new psychiatric/behavioral profile done, to represent his PRESENT level of functioning?

Sometimes a DOCUMENT can be much more persuasive as your anecdotal report.

Does he presently take ANY mood/behavioral modifiers? That too should be incorporated in a document that is describing his present behavioral profile.

I literally lucked into getting documented evidence to indicate that my LO was presenting with specific behaviors and needs, and handing a copy of the document to the agencies I needed to deal with was literally a Godsend. See if you can find some geriatric trained agency who will do this for you. Perhaps ask if the SNF can recommend someone - psychiatrist/psychologist/social workers anyone who can speak with authority to the behaviors being presented NOW.

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AnnReid

Thank you so much for your advice. While my BIL was in the hospital, his case manager says she did not see any behavior issues. She also stated he was getting a mental evaluation while there. My husband and I stay in contact with the case manager and social worker there. They stated every referral that they sent to MC was denied.

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Place him somewhere close to you, he doesn't have to be in your backyard. Perhaps an hour or so away.

Whatever you do, don't let him live with you. This behavior will only get worse.

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Unfortunately haileybug doesn't allow us to easily search her past threads but if I remember correctly neither she nor her husband have POA so they don't have the authority to do anything. Complicating that is that her BIL has a history of violent behaviour and his needs are considered too great for most facilities, or at least for the ones haileybug has considered appropriate.

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TNtechie

The SKF is sending out his referrals.

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cwillie

No, everybody is letting my husband and I be a part of the decisions for placing BIL. The hospital, SNF and Long Term Ombudsman stays in contact with us. They have never denied anything to us. Everybody calls my husband and I asking for names of MC facilities closer to home that we wish to place BIL.

I actually call these places and they do receive the referrals. They just can not take him.

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You keep saying the facilities "can’t take him." Do you mean they don’t want him as a resident or that they have no room available?

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Look for a 6 pack near you. Single family home, with wheel chair ramps permanently installed.

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MAYDAY

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We are a product of our moments, strung along into the present - future mments, moments at a time. May be that more medication is needed to curb his behavior. You may need to find a facilitate / home farther away than you are currently looking. I know not a welcomed suggestion. However, sometimes the best solution isn't the one that feels the best to a loved one in any given moment. This is also a lesson, if viewed and welcomed as such, of letting go. Learning to love and appreciate current circumstances in a detached way - to be able to manage your own feelings associated with the past, understandably. Perhaps google some Buddhist You Tubes and see if you find any support in their wisdom. I always do. A different perspective always helps. What we are all doing all the time isn't changing outer circumstances, it is our relationship to it that we shift - or need to shift - to find some inner peace and equanimity, while making a difficult situation a bit better for all concerned. Letting go is certainly not easy. It hurts. We move on with memories. Letting go doesn't mean to (or that we) forget. It is a coping mechanism to keep going.

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TouchMatters

Thank you for responding. This is all about what is best for BIL. In my heart, NOBODY and I mean NOBODY should be so far away from home that they are isolated from all their family and people they know. My BIL is located 4 hours from home and not able to see anybody. That certainly is not good for him. It's about him no anyone else.

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Keep a close relationship with the social workers on your BIL's case. Ask them to make calls and keep looking for places. That is their job - to help. Meanwhile consider what kinds of care BIL needs and ways to meet those needs.

Unfortunately, I am in agreement with those who say to NOT take him home with you. Behavior problems do get more difficult as dementia progresses. Those that lash out when confused/scared/anxious will tend to continue to do so.

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Taarna

Thank you for responding. BIL is 4 hours away from home and would like he closer.

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I am so very thankful for everyone that has responding. It very is very heart touching to know that people will actually reach out the way you all have and take time to offer advice. It is sincerely appreciated.

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Sadly I know that all states have their own regulations. But I have a thought. Is your father in law a veteran? There are some veteran nursing homes although few and far between. It's my understanding that they have to take the veteran as it was a promise made to a vet when they sign up to serve.

If he is not a veteran, I would suggest you contact an Ombudsman in the city/county were he lives. Especially because you had him in assisted living once before.

I'm sorry, this is such a miserable thing to deal with. It puts a strain on a family, and especially a marriage. My only suggestion is "don't go at this alone". There is help through Senior/Elder agencies.

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We2AreUnchained

Thank you so much for responding. I spoke to the Ombudsman in the county he was in while in the Memory Care Unit. I discussed the wish for him to be closer to home. She went to visit him at the memory care unit and asked if he would like to be closer to home. He told her he did. That following Sunday night we received a phone call that he was in the hospital for emergency surgery. At that time the Ombudsman stated that this may be the best case scenario and to work closely with the discharge planner to get him closer to home. However, the case manager and social worker there stated they could not get anyone to accept him closer to our home.

Long story short …. After he finished his rehab and was ready for discharge, I received another email that Sunday Morning from the Ombudsman wanting to know if BIL was still in the same Memory Care Facility.

I explained to her the situation, however, she states there is nothing else she can do. What has she done?

Would you please tell me what Senior/Elder agents you are referring to? Thank you so much.

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When you contact the potential facilities, is there any chance you are telling them where he had previously lived? Maybe you're giving too much information. The previous facility may be telling the new one why they don't want him back. With new evaluation in your hand, the past needs to be put in the past. Don't discuss where he had been. Just that he is moving to be closer to relatives after a hospital and rehab stay and give them the newest eval that you have.

You might talk to the psychologist and explain that his past problems are causing him to be denied a new facility. Find out if they can do a report for you that addresses ONLY his current evaluation. The current rehab should be working FOR you to get him placed in a new facility near your house. They all have social workers that might be able to give you some insight. -- as well as patient notes that might serve you well to support his current demeanor.

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My2cents

Thank you for responding. Great advice you gave.

I am just giving the CEO of the SNF the contact information to the memory care units near home he does the referral.

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I like the Ombudsman idea that someone mentioned. They are paid by the giver to mediate between nursing homes and the patient’s family member. Ask Ombudsman if a social worker is in order and what that entails. Somebody had to lasso these facilities in line and make them cooperate and not discriminate in any way.

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I didn’t mean to type giver. I meant paid by the government.

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Try NAMI (National Alliance for Mental Illness) in your area. They might be able to help or at least offer suggestions to you.

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Debbiesdaz

Thank you for responding. I already contacted NAMI. The ED there told me to call The Disability Rights or Health and Human Services.

They all just keep me in circles.

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Wow, reading all your replies I can only imagine the frustration at the run a round!

Reading your replies my understanding is that BIL is currently in a SNF where he rehabbed following surgery and you are attempting to get him into an MC. Unfortunately many of the MCs are stating they cannot meet all his needs with some referencing his past bad behaviors, but perhaps not all unless that's covered in the "too many needs" language. Maybe it's not his behavior as much as his medical needs that the MCs cannot handle. You might considering re-targeting to a SNF that belongs to a continuality of care group providing AL, MC, and SN. If they accept him into the SN wing, maybe they would move him into MC later when his medical issues resolve a bit more.

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TNtechie

Thank you for responding. My husband I and I tried to get BIL moved closer to home while he was in ALF memory care. We had the same problem.

The SNF CEO states he rehabilitated very well and that he is ready to go back to the same level of care of ALF memory care.

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So, Perphaps BIL would be better in a "smaller" place. Some private companies, will run home care from a single story home... Some people call them "6 Packs, 6 residents, 2 caretakers 24/7.

Sometimes, in some cases, people can adjust to a smaller community with less personalities to deal with...

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MAYDAY

Thank you for responding. These private companies have denied him also.

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Are you or BIL financially able to hire a geriatric care manager locally? It can be an expense but having someone who is accountable to you keeping an eye on him in his present facility could give you some breathing room while you continue your search for a place nearer you.

This is a relatively new profession but projected to grow with the increase of an aging population living distant from family,

The manager can monitor care, medications, bill paying, dr visits, etc as required. Since he/she is answerable to you and not the government you can expect better attention to your BIL'a needs.

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Frances73

Thank you for responding. That is something we need to consider. Thank you so much.

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After just seeing my sister in law with Alzheimer's tonight, I understand what you're going through. You could speak to the Ombudsman of the facility.

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Hi again, haileybug!
QUESTION- Have you been given an actual DOCUMENT that describes BIL’s CURRENT level of behavioral functioning?

What you are told is not the question- you NEED that paper, containing the names and official status of who saw him, what THEY saw, and the DATE he was seen.

What the case manager stated is valuable to you as you proceed, but can be overlooked when you begin trying to build the case for moving him closer to you.

If the previous residences/hospitals/therapy sites refuse to produce a document for your use, consider hiring an independent evaluator and pay for the written report.

Continuing to hope you have good luck with this.

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AnnReid

Thank you for responding. At this time, the only documentation that I have is from a previous Ombudsman that sent me an email stating that she was very pleased with his current status. She stated (at that time) he was not having any more behavioral issues, no more falls and that he was involving in daily activities and being showered with attention.

The SNF that he is at is the one who is sending out his paperwork (referrals). I do not know what is going on behind the scenes.

I would think his current status would help him get closer to home … they obviously don't think so. smh

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I think another key factor in my BIL favor is ..... The previous Ombudsman admitted that she was not pleased with a lot of the way things were handled at the previous MC unit. She stated that they were not giving him his medicines (mental) like they were supposed to and even stated that some of the staff was disrespectful toward my BIL which caused some behavior issues.

The previous Ombudsman stated since there was all new staff …. that she was very pleased with BIL current status. She stated that he was not having any more behavioral problems and no more falls. She stated the staff began involving him in daily activities and that he was doing great. She said this may help get him closer to home.

Therefore, I do not see what the problem is? Thanks everyone

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Thanks everyone for reaching out to me and be very supportive. It is so nice to know that there is so many people that care what other people are going through and they want to reach out and help with advice. Such a very nice thing to do.

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Frances73

I am sorry. I'm meaning they do not want him as a resident.

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Hailey, I read from your post that no one will take him closer to home due to his behavior. This is why I mentioned possibility of opening up to checking out other areaa or locations of where he might be best served.

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TouchMatters

Thank you for responding. Now they are trying to claim it is not his behaviors.

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Why does the past have to hurt the present?

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