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Old 04-12-2011, 07:47 PM   #1
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Moved Dad into Assisted Living/Dementia unit and he's out of control!

I knew it would be a tough adjustment for my Dad. My mom has been his caregiver and just can't manage anymore. But Dad has been very aggressive with staff and they sent him to the hospital after five days to check for possible UTI and adjust medication. He's on both Seroquel and Depakote now. Maybe this isn't the right place for him?

 
Old 04-12-2011, 10:21 PM   #2
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Your Dad has had many major changes in his life that he does not understand. He is in a different place, cared for by somebody different, has a different routine... of course he is upset by the move. The dementia also makes it hard for him to be rational and think through his actions. He just reacts to all the confusion. This is just the way some react to this type of major change in their life. My Mom did just the same thing.

It was not the place where she was... it was the disease and what it did to her brain. You can't change that. No matter what happens you can't go backwards. Mom wanted to go home yet when she went back to her house she had no idea where she was. I had to take her there for a visit to prove that. She walked in, looked around, showed no recognition, and went back out and got in the car. I ask her where she wanted to go and she said "home".

It did take a hospitalization for medication adjustment to settle her into her new living arrangements. She too had repeated UTIs. I can tell you for a fact that they can create major behavioral problems. But when we got her on the right medication... it's been nice. She is content now. She still says she wants to "go"... but is easily distracted and does not get upset like she used to. So I would say it is not the wrong place.

My Dad was also on Seroquel and Depakote. He was on a few other medications as well. All designed to help him settle down. We would try a med, give it a while, evaluate it's effects, and then try something different until we found the best combination. Mom was hospitalized for 10 days. She was my tough case but they managed to find the right combination that has made her content

Also remember that Dad has probably always been in "control". Right now he feels out of control. Can he communicate? Is there something you can tell him that will make his stay there seem natural and necessary. Did he travel? Mom always wanted to go on an extended vacation where she didn't have to cook. We told her that Dad had taken her on that vacation and it worked for a while. Dad was satisfied that he had done something that made Mom happy. I learned to never mention "home". I rarely told them the whole truth. Instead I would tell them what was believable to them that would make them happy.

Hang in there. It sounds like the facility is trying what they can to make this placement work. Hopefully the medications will help and he will settle down. In the meant time if there is something he enjoys doing try to get him involved in that activity. Dad became the protector of all the caregivers.... and called Bingo with his own brand of humor Sometimes they just need to feel useful. Good luck, keep tying, and let's hope he settles in

Love, deb

 
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Old 04-14-2011, 03:10 PM   #3
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

I am sorry your Dad has problems right away after he moved. Usually it will take 3 months for the elders to settle down. My father-in-law took 3 months to get used to his new home last summer. However my FIL was lucky that he actually got better care in the home.

In your Dad's case, there are probably some medical issues that have not been resolved so the nursing home is dealing with it. It does not mean the home is bad or causes it and etc. Also since he may have UTI, he would be aggressive because he feels bad physically.

Give the new home a chance. Try a few months unless something goes wrong badly. If it is a good home, they will give him better care. He would resist the new home for a while, but I think the caregivers there will try to calm him down. Once he knows them, he would be better. As long as he does not stay overnight in the hospital, it is fine. It is the idea: he stays more in the new home instead of the hospital so the nurses can take care of him in the home.

Take care,
Nina

Last edited by ninamarc; 04-14-2011 at 03:20 PM.

 
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Old 04-14-2011, 04:29 PM   #4
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Hi Deb,
Thank you for your reply. It was comforting to know that this medication
issue is not uncommon. Both the assisted living facility and the hospital
have kept us informed on a daily basis. They are still working on getting
the right meds at the hospital and think he may have a UTI. The assisted
living facility has suggested a private room for him and will have one
available in a few days. So I am hopeful that everything will work out.
Unfortunately, my Dad has lost most of his ability to understand what people
are saying to him and he is also hard of hearing (and won't wear his hearing
aids). This makes it tough for him to engage with people. He likes music
and he can be friendly but has to read people's facial expressions since
he doesn't really get what they're saying. The main reason we decided
on assisted living rather than a nursing home is because my Dad really
likes to be outside and likes to sweep and clean up. They have a nice
garden area and hopefully he will be able to do that when he calms down.
I'll just have to be patient and hope for the best. Thanks again, Angie

 
Old 04-14-2011, 04:35 PM   #5
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Thanks Nina for your support. I'm going to try and be patient and see if things
work out..........Angie

 
Old 04-14-2011, 07:45 PM   #6
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

You are welcome. Actually the doctor has adjusted my FIL's medication for better care.
So it is good if they change the med. for good.

Take care,
Nina

 
Old 04-14-2011, 10:51 PM   #7
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Angie... you have it. You just have to be patient and see what happens. I do remember those days with both my parents. Yes, the UTI can explain some of the behavior you are seeing and it will be surprising how much calmer he is once that is cleared up. The rest, caused by the dementia, will respond to medication once they find the right ones. I remember my Mom's days of packing, throwing things over the fence, and being combative. She still has a bit of feisty about her but she's more content and much easier to be around now So miracles are possible.

We do have Mom in a private room. She seems to do better if she has a place where she can be by herself. As your Dad she is hard of hearing, refuses to wear her hearing aids, and has lost her auditory perception. Her visual perception is better though not perfect. I have found that if I write things down simply she understand better. Sitting in the doctor's office recently she got antsy so I wrote "Waiting on doctor!". I had said it several times but she didn't get it. She got it when I wrote it and said...."He needs to hurry!" It is something you might want to try to let him know what is going on. Mom has also lost most of her ability to communicate. A few words might come our right but mostly it's gibberish. As you said... she cues in on the non verbal body language and facial expressions. I have to do the same thing to know how to respond. I just mirror her emotions and it seems to work fairly well. Most of my answer are... really?, uh huh, oh yeah, yes, no, I think so, you don't say! If she is serious I am serious, if she laughs I do too.

Mom also loves music... and to dance. They can get her to dance. She doesn't like a radio or CD player because it confuses her but she loves live musical entertainments. Like your Dad my Mom loves to be outside. She also sweeps, wipes tables, folds napkins, and picks up every tiny piece of trash on the floor. Mostly she just wanders with her baby doll and what ever other random item she picks us.

We opted for a locked ALZ unit that is attached to an assisted living facility. It looks just like the assisted living with key coded doors and an enclosed court yard that she can wander in until her hearts content. I have found that in the unit she will "communicate" with others that are there. You can't understand anything either are saying but they still socialize. Once your Dad is settled in and more familiar with his facility hopefully he will find someone that he enjoys.

Keep us updated and I hope for the best

Love, deb

 
Old 04-17-2011, 11:20 AM   #8
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Unhappy Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

My dad has just gone downhill since he went into assisted living. He
has not done well in the hospital ( having been transferred there when
they couldn't manage his behavior with medication). He has been sedated
so they can treat his UTI with IV antibiotics, he has a cough and thick
mucous that he can't cough up so they have to suction him, he has
mits on his hands so he can't pull out the IVs, another for hydration.
Today they said they think he is aspirating food in spite of being on
puree and thickened liquids and they are doing another swallowing study.
They attribute all this to end stage Alzheimers but I wish they could
have seen him walking up stairs and eating normally less than two
weeks ago at home. We are having a family meeting at the hospital
tomorrow. This is so discouraging!. The medication really caused this
decline but without it, he can't be managed.

 
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Old 04-17-2011, 11:25 AM   #9
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

I need to tell you that being hospitalized can only make him worse in a way but he needs to be there for the "treatments" and etc....
Is there any skilled care home that he can go? I heard that the nursing home is less traumatic than the hospital. For one thing, he hates the IVs. My FIL hates it and he always wanted to escape from the hospital at night and always hates the tubes on his arms... He slap the nurse for working on the catheter at that time last April...

If you can get him somewhere that is more cozy like a home, he may not be acting very badly. Your Dad needs to go home ASAP.... If it is really end of stage, maybe hospice is better. Hospice does not mean he will die for sure. It gives him comfort care.

Take care,
Nina

Last edited by ninamarc; 04-17-2011 at 11:27 AM.

 
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Old 04-17-2011, 02:19 PM   #10
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Nina,
Thanks for your response. I'm feeling the same way about the hospital. The social worker is looking for a nursing home and that would be better. I didn't think of hospice, though. I'm sure that would even be better if they would accept him. I guess it depends on what they tell me at the family meeting tomorrow.......Angie

 
Old 04-17-2011, 05:40 PM   #11
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Angie..I am late jumping in here. I understand your frustration.

First let me tell you that my mom is in a locked memory care unit...she is late stage ... It took her about 3 to 4 months to get used to it. It took time and the right meds!!

She had previously spent over two years in the asst. living portion of the building before going to the locked unit after breaking her hip last June...which meant time in a hospital and more time in rehab. It was a nightmare for her and it definitely caused her to worsen. She is also on pureed foods do to choking issues and forgetting to swallow... and she is unable to communicate much anymore. I take her out daily for walks and spend time with her...she is sweet now..(it took a long time for that to happen!!!) I hugged her the other day and told her that she must have saved all the "sweet" til the end.

We now have her on hospice care...my one wish (demand) for her is to not be transferred to the hospital for anything! No more.

At what point do you stop trying to "save" them? I love and adore my mom but I won't let then do anything that would be considered life saving. I want this to over sooner than later for her. She has suffered enough with this disease. We have a DNR (do not ressusitate order)so that they do nothing that would be considered life saving. Each family has to come to that decision ..it is the right one for us.

Hopefully you will find some solace and answers tomorrow at the meeting.

Love, Meg

 
Old 04-17-2011, 09:02 PM   #12
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Angie.. they can not stabilize his medication for behavioral issues until the UTI is cleared up. I ran into that with Mom. You don't want to medicate to control the behavior that is caused by the UTI long term. Hopefully soon they will find something, in the right amount, that will calm him down yet give him as much function as possible. Yet with the swallowing problems and the possible aspirated pneumonia, it does sound like the end stage. I had Hospice with Dad the last few months of his life and they were amazing and wonderful. I don't know if they have a facility in your area for inpatients but there are several here. My FIL was in one. It was such a calming place. Hopefully there is one close to you that can care for your Dad.

Yes, any hospitalization or other traumatic changes can cause a decline in cognition. Medical conditions also cause decline. Even a stomach virus or the flu can cause decline. It is also not unusual for a very rapid decline at some point during the disease. Mom took a very rapid decline about 2 years ago and then stabilized. I did question how fast she declined at that point and the Geriatric Psychiatrist in charge of the Geriatric Psych Unit said it was not uncommon. It also seems to come in conjunction with some medical trauma.

Mom and Dad only lasted for about 18 months in AL and should have been moved to the locked unit earlier. It was Mom's rapid decline that precipitated the move. It followed a series of UTIs, a case of the flu, and a stomach virus. It was also at a time that she moved facilities and was hospitalized. She had EVERYTHING going against her!!

We too have DNR's and an Extended MOST form our both parents. I can not tell you medically what happened to Dad in the last days. I had stopped all the test, procedures, even most of the medication. He was on comfort measures only. He was tired after 33 years of heart disease and 11 years of dementia. He was ready and I loved him enough to let him go. My time will come with Mom as well. She recently broke her hand. We could have put her through a hospitalization, surgery, and a few pins but opted to let it heal naturally. We will know next week but suspect she will have full use of her hand. If not it will be functional enough for her to use it. It saved her much trauma. She has cystitis now... we hope. But if that is not what it is then we are not going to put her through the battery of test to find out what it is. She has been through enough.

My thoughts and prayers are with your family. These are hard decisions to make and you have to do what is right for you and your Dad. Try to hold together as a family and do what is best for Dad

Love, Deb

 
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Old 04-18-2011, 06:25 AM   #13
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Meg and Deb have had good experience on this issue.
I also want to add that often a minor operation is sometimes good for quality of life so he would not suffer too much. But at times we need to stop short of major procedures to make the elder suffer less. My FIL can no longer have major surgeries and we will not consider tube feeding either. With tube feeding, he would get infection and may not survive more than 1 month, so what is the point?
It is up to you and your family to decide what to do. One thing you can try is move him to a skilled care memory unit so the caregivers know what to do with him. My FIL almost died from stopping eating at home last year in June. But he got better after he moved to this memory unit with skilled care nurses (there are nurse stations.) They know how to make him eat, pureed or not.
I don't know if the home for your Dad has nurse station or not, but your Dad now needs more skilled care that can replace the hospital care. This means skilled care but in a locked memory unit.

Please keep us posted,
Nina

Last edited by ninamarc; 04-18-2011 at 07:12 AM.

 
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Old 04-22-2011, 05:49 AM   #14
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Just wanted to let you know that my Dad passed away on April 19th. We had a wonderful palliative care team that made him comfortable and cared for the family. We were prepared to move him to their hospice across the street but it didn't come to that point, everything happened so quickly. We were gathered together in a private room with chaplains available, food, a chance to tell family stories and be with my Dad. Of course we wish he hadn't had a few days of such confusion without us but we are fighting those guilt feelings. Thank you so much for your support, Love, Angie

 
Old 04-22-2011, 05:53 AM   #15
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Re: Moved Dad into Assisted Living/Dementia unit and he's out of control!

Just wanted to let you know that my Dad passed away on April 19th. He was cared for by a wonderful palliative care team. It all happened quickly but we were with him and he was comfortable. It was a blessing to have all the support from the team at the hospital and from the people like you that I have communicated with. Thank you so much. Love, Angie

 
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