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Old 01-18-2009, 11:27 AM   #1
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Combative patient options

My Dad has become more difficult the past 8 months or so. Mom has cared for him all through this illness but the last 8 months have been draining on her, requiring 24x7 care. The past few months she lost 24 lbs. Finding it hard to have time to shower or cook for herself. On top of that, he became combative, threatening to "beat her brains out". She has not felt she had a lot of options. There are two of us kids; we both work fulltime jobs that we need. We were able to help some on the weekends or when he just got to be too much for a few hours but never enough, never enough. Monday before Christmas he awoke and thought she was a man in the home, he pounded her in the eyes, face and head several times. After seeking care for her, we decided to place him in a nursing home. There's a lot of this story left out of course, but where we are now is the hospital social worker has told me nursing homes will not accept him if there is documented combative behavior. We are floored. My Mom is 70. Their only income is social security and a nominal savings account. There is no money for 24x7 private care. Mom doesn't need to be alone with him. It is looking like we will have to place him hours away from us in a special facility. No one seems to be able to give us any clear advice. He has been a wonderful father and I can't seem to figure out how to help him.

 
Old 01-18-2009, 11:42 AM   #2
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Re: Combative patient options

If there is no money for his care, he can apply for Medicaid - whoever has power of attorney can do it. An Elderlawyer will help you get it exactly right so he won't be rejected.

Combative bhavior can be managed with medication. I never heard of any NH rejecting someone because of it. Try to find out if there are other NHs in the area.

I can see how it is urgent for you to protect your Mom and get your father placed.

Meanwhile there must be a medication his doctor can prescribe to prevent such aggression from happening again.

Love,

Martha

Last edited by Martha H; 01-18-2009 at 11:42 AM.

 
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Old 01-18-2009, 11:46 AM   #3
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Re: Combative patient options

I have been where you are dadsgirl and then we discovered that Mom has ALZ. Right now they are in AL together which works on some days and some days it doesn't but they are together in a facility close to two of my sisters who are there to interven if necessary.

What you need is a hopsital admission to regulate medication to control his agressive behavior. Once that is done, and the medication is regulated, you should be able to have him admitted to a facility. This is what my cousin did after my uncle beat up another resident at the facility he was in. He ended up in a different facility but once his mediation was properly adjusted there were no further incidence.

It is not safe for your Mom to be at home alone with your Dad. I know this from what I witnessed with my parents. The threats can turn into actions in a blink of an eye as you know. The mistaken identity can lead to disaster. Speak to the hospital social worker about a psychological admission. Don't take her negative respons as the final word. There is a way. It might be more difficult than a simple placement but it is doable. The agressive behavior torwards your mom make it an emergency. If necessrary talk to the social worker's supervisor...... but don't take her unwillingness to do the hard work as the final answer.

A little story for you. When Dad was in the hospital and we thought he had a stroke (in reality Mom had overdosed him with Xanax and was the beginning or her ALZ diagnosis) the hospital social worker told us they could not find a rehab bed for him. We requested that they call the rehab facility connected to the hospital my sister works in. The social worker said she couldn't get them to answre the phone. She had more excuses than a barrel of monkeys for why nothing was happening. So my sister called the rehab faility attached to her hospital, called in a favor or two, and they called the social worker to tell her Dad had a bed immediately. 24 hours later this little dweeb gal walked into the room to announce that she had found dad a bed. We all looked at her, smiled, and said in unison..... "We already know that!" Then, with her there, we thanked Sisiter 3. I tell you this to let you know there is a way.

Contact one of the local NH and talk to their social worker. Contact the county social services and talk to them. Here, if Dad hits Mom it is a mandatory psych hospitalization. We found that out when Mom was throwing things at Dad recently. If she had hit him there would be a mandatory psych evaluation, medication adjustment, and reintergrated when she stabalized. The near miss did end her with a geriatric psychologist who did adjust her medication.... and so far we have not had any more heavy weight bouts.

So I have great empathy for what you are going through. Your Mom definitely need a referee between her and Dad in the form of a good facility that is proactive in dealing with his agressive behavior. I do think there are more problems with men in this aspect than with women but there is help somewhere.... don't give up!!

Love, deb

 
Old 01-18-2009, 12:39 PM   #4
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Re: Combative patient options

Martha and Deb,

Thank you for replying. It means a lot to me. I have lurked on this board and another some. Honestly, at times it was just emotionally painful to read and identify with some of the posts. We should have been on these boards sooner.

Dad has been on Seroquel and Ativan from July till the incident. We did have him admitted to the behavior management unit because of this incident. Unfortunately, two things happened. He was overmedicated for his current personal health and he developed a kidney infection. We have been on a medical floor for a couple of weeks now. The incident with Mom occurred 12/22/09. They are medicating with different meds. Now he is on Cinemet, Depakot, and Abilify now. He is not having the shaking or tremendous involuntary muscle spasms with these meds that he had with the drugs the BMU originally tried. It's hard to tell if we have the agression controlled, yet. He has moments where he is combative. There have been a few incidents where nurses arms have been twisted or hurt. It seems that this happens when they try to roll him over to change diapers. He believes he is not secure and becomes combative. I often hold him in my arms and give him a hug while they clean him up. That seems to help but not everyone is comfortable doing that. A lot of this truly is in the approach. Some are great; others are pressed for time. The big concern I have now is the social worker. She basically told me as soon as she faxes documentation to a nursing home with behavior issues that door will be closed forever. She was very cold and really has not been helpful at all. My first conversation was a week ago and she said she would check into homes and let me know. Our second conversation she told me it was a lost cause and acted like we should take him home. I am going to have to talk with her supervisor if we don't get a result in a day or so. I can, will and have complained to get what he needs. I just try to give them a chance first. Last week I had to complain because we found him in dirty diapers 6 times in three days. The answer was we check every 2 hours. After reminding them diarhea is not on a schedule and I would like more frequent checks, things go better. I am afraid I am going to have to go to bat again. It is just so frustrating. I had to stop answering this post to intervene to keep him from punching a nurse. Do they eventually get the meds right? We have truly done all we could at home till it is just not safe.

 
Old 01-18-2009, 12:47 PM   #5
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Re: Combative patient options

Martha,

I spoke with two nursing homes myself who told me if there was combative behavior they would not accept him. I was floored. We did not know we would encounter this. I wonder if it is because we are in a rural area and the aging population has increased so homes can be more selective in choosing residents. Economics.

I also know of others who have been placed in homes out of state because of behavior issues. This is a cruel disease.

 
Old 01-18-2009, 02:19 PM   #6
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Re: Combative patient options

you have no choice but to put your father in a nursing home. get in touch with the dr and ask for medication to combat all the aggression. apply for medicade and they will pay. dont put yourself or mom thru this. i know its hard, but you will adjust-i did which i never thought i would. be strong

 
Old 01-18-2009, 03:48 PM   #7
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Re: Combative patient options

Grownups...i know this will sound cruel but you simply refuse to take him home.
I am in Canada and i'm not sure how the US works but i think it has to be the same. i remember this too clearly when my dad was hospitilized due to dementia. he had completely lost touch with reality and thought my mom was trying to kill him. we rushed him to the hospital by ambulance (he was swatting at the walls) and after they admitted him the resident intern tried to tell my mom that it was alcohol related and that he had chirrosis and we had to take him home. She would have said yes (everything the resident said was true) but i said no, that he was violent. (i was 17 at the time.) They reluctantly admitted him to the neurolocical ward. he was there for 7 months until he died from chirrosis. they also discovered that he had Korsakoff's physosis (sp) a true neorological disorder. had he returned home God only knows what may have happened. Your mother cannot go through this. Please tell her to refuse to take him home. she has that right. I've been through the medical system and know how it works. Noone will take responsibility if he injures her again or worse...

Last edited by upatnite58; 01-18-2009 at 03:51 PM.

 
Old 01-18-2009, 04:16 PM   #8
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Re: Combative patient options

My mom became combative when she was in the NH. IT was due to being overmedicated. She decided that she owned the home and that the residents hadn't paid their rent and that they needed to move out-right then and there. It was 2 am. So my little mom, I think she weight 112 lb at the time, started to pull 9 people out of their beds and tell them to leave. AFter she got rid of those 9, she clocked another 6 . Gave 2 guys black eyes and hit 4 ladies in the face. She was very busy that night. They put her on one to one for the rest of the night....

She ended up in a psych hospital for two weeks while they did a med adjustment to balance her meds so that this was taken care of. Her doctor arranged it because it needed to be done.

There are ways to get these things taken care of. You need to push and push. I got this done because I had fired her Nurse PA and found another doctor and social worker that were willing to fight for my mom. You are going to have to push and not accept the SW answers. She is looking for the easy way out-it's quicker for her. She is taking whatever the NH says when she calls them. Don't let her get away with it.

Is your father a veteran? The VA hospitals can take him and place him in their homes also.,..

hang in there.....

 
Old 01-18-2009, 04:29 PM   #9
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Re: Combative patient options

Well, I have to confess my instincts have been to just sit here until the hospital and/or social worker find us a place to go or throw us out. Are Elder Attorneys expensive?

Your experiences are supportive. I appreciate you guys sharing them. I have been either very numb or strong. I like to think someone is giving me that strength. Then sometimes I wonder if I am just cold and blocking everything. But when the social worker told me I needed to take him home and that I would not be able to use a nursing home. I came back to his room took one look at him and needless to say I was on my way to the Chapel for a good cry.

 
Old 01-18-2009, 04:38 PM   #10
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Re: Combative patient options

I bake and pray.

Thank you for responding. He is not a veteran. I can be strong and I can take on a battle. I am patient and stubborn. Very stubborn. I just don't know this system at all. Would it be better to try to get the hospital to give me another social worker, talk to her supervisor, call the NH myself, try another doctor on the medicating. We don't have him medicated to the point the aggression has stopped, yet. Just today he hit my Mom out of the blue. She was sitting there holding his hand trying to keep him from pulling the IV out. It was not a bad injury; but it took us by surprise. When the nurse was trying to turn him earlier today; he drew his fist back at her. I intervened and distracted him. I can go back to the doctor again; but he seems to feel since I told him he went too far the first time that this is far enough now. I know he really is not any different than when we brought him in. Maybe I should try another doctor/hospital. Don't know if Medicare will let us do that, though.

Last edited by GrownUPdadsGirl; 01-18-2009 at 04:47 PM.

 
Old 01-18-2009, 04:57 PM   #11
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Re: Combative patient options

A possible option would be to ask the hospital he is in to transfer him to a psychiatric hospital for observation. Medicare pays for 30 days of psych treatment. By then he can be stabilized and have a more exact diagnosis as to why he is doing this. Dementia in itself does not cause aggressive behavior. Or did he always handle confusion and uncertainly with physical violence?

Once a psych hospital has made a diagnosis and has his behavior stabilized they can have him transferred to a NH which will probably have to take him - or, he can stay in the psych hospital, which often have closed units for AD patients.

I know it sounds harsh - but you have to protect your mother from his aggression. Something terrible could happen to her. He is not able to understand that she is trying to help him. I would let the staff worry about him pulling out IVs and just stay 6 feet away from him if I were her ...

So sorry you are having this trouble, and I hope a solution is found soon. Do NOT take him home! You could save your mother's life!

Love,

Martha

Last edited by Martha H; 01-18-2009 at 04:58 PM.

 
Old 01-18-2009, 05:31 PM   #12
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Re: Combative patient options

I'm not sure about the source of the violent behavior. I know he told us he was physically abused as a child until he left home at 12 to live with someone else. I know that when he was young and drank too much he fought. He never ever threatened us with violence growing up and I never saw him offer to hit my mother. I am wondering about the childhood stuff. He did suffer a head injury 40 years ago where there were lacerations of the brain. They told us he would get mad easier as he got older. There were many years of alcohol abuse in the first third of his life, too.

I do not plan to leave my Mom at home alone with him. We would have to have two at a time with him if we went home. I don't intend on giving up. I just am not sure where to start my battle. I will see what tomorrow brings. We have been sitting with him most of the time to try to keep incidents from occuring with the staff. They are holding Ativan right now so it will be easier to send him to nursing home. But I know in my heart, there will be an incident there if we get in. I think after your responses, I need to talk with the doctor again; we don't have these meds right. Maybe once the kidney infection is completely gone it will get better. And, I have to deal with the social worker. My impression is she is either not doing her job or afraid to do it; doesn't want to make waves.

Last edited by GrownUPdadsGirl; 01-18-2009 at 05:35 PM.

 
Old 01-18-2009, 11:54 PM   #13
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Re: Combative patient options

The social worker is not doing her job. yes, very often they are afraid to make waves. so you have to. Martha is right...if you refuse to take him home they will have to do a phych evaluation. as harsh as this seems your mother's health depends on it. Tell her this must be done. Please do not let her take him home in this state. stand strong...i did and i do not regret it for a minute and that was over 30 yrs ago.

Last edited by upatnite58; 01-19-2009 at 12:03 AM.

 
Old 01-19-2009, 07:43 AM   #14
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Re: Combative patient options

Martha is right. Your Dad needs a psych eval. and he needs it now.

The social worker is not doing her job. She doesn't want to get involved. Go above her. She has a supervisor. Don't bother to threaten to go to her supervisor, just do it. You don't have time to wait for her to try and do it, just skip that step. You are fighting for your dad's very existance and you are under a time crunch, so skip the mealy mouthed sw and go to the supervisor and proceed from there.

Do they have your father restrained? If not, why not? And make sure that you mom stays away from him so she doesn't get hit again. He will end up in a locked psych ward at this rate. But then that may be what he needs. You need to let the doctors medicate him enough that the agressions are subdued.

But he needs to get into a psych hospital so he can be evaluated and get on meds that will control these agressions. What ever you do, do not take him home! NO matter how much you love him, in fact it is BECAUSE you love him that you can't take him home.

If her were to attack your mother, you would have to call 911, the police would arrive, and your father would be taken off in handcuff to jail. And I don't think that that is what you want for him. That is what would go down when he would get violent at home. Did you consider that? That's what he can't go home with you....He would be his own worst enemy!

Last edited by ibake&pray; 01-19-2009 at 07:44 AM.

 
Old 01-19-2009, 06:11 PM   #15
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Re: Combative patient options

I promise I am not going to take him home. I know I have been spinning a bit, especially the past couple of days, but especially after that small punch yesterday, we know that's not an option. The hospital has a psychiatrist working with us. Not sure what his expertise is, but I left him a message I want to talk with him. The meds are not right. Eventhough the hospital is working very hard to get enough days without combative behavior to send him on to NH, I know he is not ready. Someone will get hurt. I saw too much yesterday. I talked with Mom today and she agrees the meds are not right. I am not sure she is ready for any delays this may mean though. I believe she will follow my lead. She is so tired. She just wants something to be normal and knows it will be a while before that can happen. The doctor said today the sw is working on a placement. I will be at hospital in the a.m. and hope to touch base with both psych and sw. If I don't see progress, I am going to see her supervisor. I have given her 3 business days now. I can handle dealing with her now. She just threw me for a loop. She was so aloof and cold. And, she made me feel awful for saying he could not go home. Now I know how she is and won't be blindsided. He had a calmer day today and we are home resting tonight. We had to stay all night last night. I was there 22 hours; slept 4 and worked all day. The nurses tell us we need to stay with him a lot. They said they will call us if he gets combative. They will call me. There was no recognition for me today. Dad had a different face and demeanor. He was calm but he did not even want to talk to me tonight. It may have been my dark purple shirt. A lot of days he hates dark colors. He has been know to tell us to get out if he doesn't like our clothes. Dark colors scare him. It's so weird. It hadn't been an issued for past four weeks but had for weeks and months before that. Who knows . . . We just came home. We are tired. Thank you all for caring and for your information. I want to save my Mom. I don't want anyone to throw my Dad away. Mom would rather I handle it; but she wants it done now. Sometimes I lose my patience. This has been going on with the hosptial for pretty much 4 weeks now.

No one mentioned taking my Dad to jail when we took Mom to the doctor. She will do whatever she needs to do as far as signing him in to a facility to get the care he needs and the protection she needs. She is afraid. I am not afraid when he's in the bed and can't get up. I can jump back for the most part. I am afraid if he makes it to his feet and is able to take a couple of steps. This is so sad. When he was diagnosed with congestive heart failure, he did everything his cardiologist told him to do. He walked 4 or more miles a day, ate right and told us every day he loved us and just wanted to be with us. Soon after AZ set in. We have beenon Aricept for 8 plus years now. I have had the man who never had time to let us girls shop 2 hours away from his farming follow me around Victoria's Secret and just patiently stand there and wait for me and follow me all day long. When I apologized for taking so long; it was it's okay honey I just want to be with you all. He has fought so hard to stay with us and well now you know how it is. I am comforted by knowing we have made the most of the past 10 years or so and we know how much he loved us. I have to make sure he ends up in a good place, too. When I was grown and married and had a virus, he would come bring me soup, puddings, whatever . . .

Last edited by GrownUPdadsGirl; 01-19-2009 at 06:14 PM.

 
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