My FIL is in a nursing home and in late stages of ALZ. He is still very mobile but has next to no cognative abilities. We have had many problems in the last few months with his behaviour. He insists on kissing everyone, male, female, staff, resident - it seems to make no difference. He has been punched, kicked, pushed down, basically abused by other residents of the home.
We have tried all types of medication for him, against our better judgement.

He recently saw a geriatric psycologist(sp) who recommended a totally different type of drug therapy. He's currently on anti-seizer medications in an effort to combat his manic type behaviour.
This morning I received a call from the home telling me that they have had 4 formal complaints regarding my fil and they want to put him on Haldol. I have flatly refused Haldol as they tried this one already and he was basically comatose. As well he has decreased kidney function and it is not recommended for people with kidney issues. The home as now mentioned haldol on three seperate occassions.
Apparently he had developed this habit of belching in peoples faces, rude I know, but what am I to do to stop it. I have come to the point that I have threatened to move him out of the home that he is in and try to move him into another facility. We pay this place more than $2000. a month for him to live there. Of course when I say this they immediately say - oh no you don't need to do that. I'm at my wits end. :confused:

I need to know if there is some kind of drug therapy that people have had success with in combating inappropriate behaviours. Please any input would be appreciated.
Tammy

Dear Mao3,

"Inapproprite behavior is part and parcel of Alzheimer's Disease! There is no AD patient who is entirely free of it, and just how it manifests itself has a wide range .. from my Mom's nakedness, to Sally's MILs use of the f word and htting her, to someone else refusing to bathe.

Nursing homes are supposed to be the place where we can bring these poor souls to have them cared for and helped as far as it is possible to help at all in this devastating disease.

I am sure they are upset more by the possibilty that he could cause other patients to leave and go somewhere else than by anything else. They want him and all the others to remain there .. naturally, it's also a business, not a charity.

You have already had bad experiences with Haldol so there must be a better solution. How would he feel about being confined to his own room? If he were cut off from contact with others he would not be able to shock and annoy them. That is a physical instead of a medical possibility.

I suggest discussing it with his physician. The NH cannot prescribe drugs without a doctor's order in any case.

Good luck ..this is an awful disease, isn't it?

You are a loving DIL to be so concerned .. many others would say give him the drug, knock him out, forget about him. You didn't.

love,

Martha

I would be having serious issues with the nursing home that only have chemical restraints as an answer to inappropriate behaviour.

If he's belching .. he's belching .. there is WAY WORSE things he could be doing! I think that's pretty harmless really!!

Inappropriate behaviour usually happens because they are BORED OUT OF THEIR MINDS ... they may be losing cognition and inhibitions, but they do still have a mind, it's just in another world now, and even in that world they get BORED.

The nursing home is probably having issues with him because he's a little high maintenance, and a good patient is a quiet patient who doesn't create waves. Look how the attitude changed when you offered to move him. Lose Money? Good grief no, don't do that.

Read our stories, find the huge range of behaviours, print them out, show the nursing home. Also, check out other facilities - ring the other facilities and ask what they would do with a belching patient. Get other opinions, and arm yourself with knowledge. It's the ONLY way you can combat patient abuse and create patient care.

As Martha said, this is an awful disease, and can be made worse by other peoples attitudes as well - and if the carer has 'attitude', then it's not healthy for everybody concerned.

Hugs
Sally

Thanks to both of you, I spent a few hours at the home late this afternoon and early evening. They complain that its difficult to get him to eat and to sit for meals. Yet while I was there, a Health Care Aid sat and fed him and he was fine. He complained that it was hot and that he didn't like it, but he ate none the less. When he finished he got up from his chair and was immediately struck by another resident. I watched it happen. I of course reported the incident, and the staff said "oh my I didn't see that".
As for the belching being a problem, I know its not the greatest habit he has, but good grief its only belching. They also have issue with him being "overly friendly" He loves everyone and wants to hug and kiss everyone. While I realize some are bothered by this (personal space issues), I constantly say that it could be so much worse. I think that he is just too much trouble for them and that they would prefer that after meals he retreat to his room and remain there. He doesn't do that, he wanders the halls and when he finds and empty bed, he'll go lay down in it. Again its all harmless stuff but I guess they just can't seem to find the humour in it. I say at least he chooses empty beds not occupied ones.

They have gone to our doctor and have asked for an increase in medication, he is currently taking Epival as a mood stabilizer and Trazadone for periods of agitation. The Trazadone is supposed to be PRN but I was told today he gets it three times a day. Sortof whether he needs it or not.
I'm going to take him to the Family dr. hopefully this week, (if I can get him in). As well I have an appointment to see another home tomorrow. This one has an Alz wing. I'm thinking that perhaps if all were of like mind that he wouldn't be singled out as much as he has been???

I was kinda venting this morning when I made the initial post, I don't feel much better yet, but hopefully tomorrow will be a better day. Everyday a new Challenge!!

Hi Tammy,

That is a good idea about putting him in a new home with an Alzheimers wing. Most alzheimers patients room are locked from the outside. They can get out, but other patients cannot get in. If course, the door has to be shut!

He sounds like he is a normal alzheimers person. They all have their own little or big quirks! He really does not sound that bad. I think the nursing home just does not want to work that hard. Maybe the new place will work out better.

Take care and good luck. Wannabe

Wow, that nursing home doesn't have a very wide window for behaviors! My great grandmother was a saint but with Alzheimer's disease she used language that would have made a sailor blush! Haldol!!!! Are you kidding me? No way. I think Tobefreetoroam is right. An Alzheimer's wing would probably be a nice place for him. He sure can't be somewhere where other clients hit him! Poor guy. You are a great daughter-in-law!

Just a little update. I took a tour of the home with the Alz Wing. They call it a secure residential area. Nice place. :D I was very impressed with the whole atmosphere. It was just about supper time when I was there, so alot of the residents were in the lounge or diningroom waiting for dinner. They seemed very happy, the tour guide was very helpful and actually told me things about Alz that I didn't know. (They have a balcony thats completely enclosed and only has a small amount of air flow because the residents don't like wind. Here I thought that little quirk was just my FIL. )
Anyway, they use some kind of Sweedish therapy to calm residents when agitated (not trazadone 3x a day), they don't encourage the residents to remain in their rooms. Kind of the opposite of where he is currently .

I walked out of the tour feeling like he should have been there all along. I have made contact with the Access Centre here, which is basically the keeper of the keys. They place anyone who requires nursing care into the appropriate places. My Husband and I will be going to fill out the paperwork on Friday - when he returns home.

Could take a while for him to get in though, there is a waiting list for all of the nursing homes here. As well as our Hospital is in "crisis" any patient in the hospital gets first crack at the room. The only saving grace is that we can afford to place him in a private room, many are waiting for rooms with a subsidy. HOpefully it won't be too long.
Thanks again for your advice and encouragement .
Tammy

Inappropriate behaviour usually happens because they are BORED OUT OF THEIR MINDS ... they may be losing cognition and inhibitions, but they do still have a mind, it's just in another world now, and even in that world they get BORED.

They don't have the same mind they use to have before the Alzheimer's. There is an overall shrinkage of brain tissue. The ability to perform routine tasks declines. As Alzheimer's disease spreads through the cerebral cortex, judgment declines, emotional outbursts may occur and language is impaired. Progression of the disease leads to the death of more nerve cells and subsequent behavior changes, such as wandering and agitation. The ability to recognize faces and to communicate is completely lost in the final stages. Patients lose bowel and bladder control, and eventually need constant care. This stage of complete dependency may last for years before the patient dies.

OH Tammy that place sounds wonderful! Caring, warm .. HOME!!

I hope and pray that a room comes through quickly for your FIL .. he will probably be very happy there once he settles down.

They sound so thoughtful!

I didn't know about the wind thing either ... explains why MIL keeps her part of the house locked up like Fort Knox! OMG it can STINK .. and I throw open windows and doors to get some circulation when she goes out -- the minute she's back home, everything is closed up tight as tight can be, shades drawn .. back to musky darkness ... weird eh?

**Had a cleaner come through for 3 hours yesterday .. downstairs smells WONDERFUL for now!!**

I am pleased for your progress!!!

Hugs
Sally

They feel cold. They had a bad heat wave where Mom is now staying with my brother, but now that the weather has turned bearable (still in the 80s, that's 28+ in C) Mom feels cold. She is freezing.

It is indeed a strange thing, I had my FIL outside Monday it was nearly 80 so hot I could barely stand it, suddenly a slight warm breeze and he was heading for the door. He complained it was windy and cold.

It did seem like a nice place and I'm hopeful that we can get him in quickly. My only issue with this place is that he can't go outside on his own. He will need either my husband or myself to take him out to the court yards.
But we'll deal with that I guess, and hey it'll be winter here in a couple of months then he'll not want to go out because of the cold.