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My mom who is in early late stage of Alzheimer’s has been in a memory care unit for 5 years. We moved her while she was still cognitive enough to be involved in this decision and the change and transition while hard, was do-able.


She is an “active” Alzheimer’s patient who seldom sits but is restless and busy. Usually, when I visit she begs me to take her home to her mom. She doesn’t always know who I am, but she knows I can take her places and I love her.


Recently, she has started going into other people’s rooms and going thru their things and refusing to leave when asked. She also helps herself to food that is on other’s plates. These behaviors have understandably triggered a lot of negative verbal comments by her fellow residents, but recently escalated into physical contact by another resident, which was reciprocated by my mom.


She is According to a geriatric psychiatric nurse (mental age 2-4 yrs) is being discharged from her memory care unit due to her behaviors


She is on Medicare and places to move her are extremely limited...She does not qualify for hospice yet. When and if a place is secured, it will be a skilled nursing facility and she will have a roommate.


I am dealing with extreme sorrow over this situation and trying to figure out how to help her transition to these abrupt and radical changes that are coming during this later stage in the disease.


Please if if you’ve been down this road, any help or support would be welcomed!

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I'm so glad that you were able to advocate successfully for your mom!
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Did she get the best of the other resident?
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Has your mom ever been on psychiatric medication? Some of the antipsychotics are especially good for combative patients. When I worked on an acute psych unit back in the 90's they used to have success with Haldol. It was very good at addressing hallucinations as well as combative behavior.
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Long-term Care Ombudsman - is the person to contact. That facility is Medicare approved because it has the ability to care for "memory care" residents. Nursing facilities love to discharge difficult residents, for more information, google "backdoor nursing home-evictions," To cover their asses,The LTC facility will cite a legal reason, whilst working every back door angle to get rid of her, the legal reason will be, that your mother is a danger to other residents. When you talked to your mother about her behaviors how did she respond? When you told your mother that she was being evicted, did you tell your mother that her assault behaviors were stated as the reason for the eviction? Nursing homes can and do as they please because their client population are older and often desperate,(social workers often lie and bully family members), so, please record everything, minimally get the recorded sound of every meeting, If zero has been provided in writing, ask for everything to be communicated in writing. Instead of thinking "they can't do that" ask how, could they do it"---- LTC staff lying happens every day, I've seen individuals lie before state surveyors (evaluators), and courtroom judges. I've been told it's easy to lie and intimidate, by saying a resident or family member misunderstood what was said, etc., which is stopped by recording words stated. Nursing home "backdoor evictions" help ensure successful evictions of difficult residents. Contact the state's Long-term Care Ombudsman office,ASAP. The LTC facility is mandated to contact the Ombudsman office about every discharge and the LTC facility is mandated to give you/her a 30-day-notice with reason cited, etc. If your combative mother is going to be discharged into another LTC facility then, she has legit reasons to stay in her current place, Being discharged into another LTC memory care facility indicates that the facility doesn't want to deal with your mother + her family. Medicare/Medicaid pays less per month, which is why lower paying residents are often back-door evicted or intimidated into vacating.Another popular tactic is transporting a Medicare resident to a hospital for a 3-day-admit, to kick-in a higher paying Medicare/Medicaid rate, or LTC staff get the resident into a hospital as a strategy to block that resident from returning back to the LTC facility. Possible backdoor solution = REFUSE THE EVICTION. I watched a resident refuse to get into a vehicle owned by a newer LTC facility that had been organized to transport him to be admitted into that newer LTC place, his refusal halted his eviction. His fluent language is Spanish, so the first 30-day notice presented to him in English was his first delay, when he sought counsel. His refusal to get into that vehicle halted his discharge. He is currently residing in that same facility that presented him with his 2 (English and then Spanish) 30-day-notices. Because he followed directives to refuse to leave (and thus, refuse to get into that second LTC facility transportation), he is still residing inside that facility.
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Mikersgirl Jun 2019
Thank you. I did call my local ombudsman who was able to talk with the care center and they have given my mom 30 more days there. During that time, her meds will be re-evaluated and adjusted. Then at 30 days end, they will decide whether she can stay or she goes. So grateful for the brief reprieve!

Thanks for your input.
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I would call a lawyer and find out about your rights and make sure they can do this. If you can't afford a lawyer, try legal aid. I would also contact a social worker and see what your options are. They know about programs you may never have heard
of. I worked with 2 social workers before I moved my sister into assisted living.

If you really want to rile them up threaten to call a news crew to film them while they throw your aged mother out. I am sorry you are going through this. I hope you can find a solution.
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I'm in agreement with Shane1124! She is in a Memory Care Unit. Even if she is THE most difficult patient they've ever had, THAT is why she is there, as well as the other's. I'd be sure THEY have used "Due Diligence" before coming to this decision although I can't understand why they can't handle this and come up with another solution. However, IF they try to say they are understaffed- that is not an excuse.
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My mom is in memory care and has been pretty docile for the most part. She isn't exit seeking and has always been very cooperative with the staff and kind to the other patients. Just within the last few weeks, however, she seems to be getting angry with everyone and is verbally nasty. She always thought everyone was stealing from her even when she didn't have dementia and goes around accusing others. I never knew her to be racist, but she has begun using unacceptable adjectives to describe the dining room workers. Needless to say, she is not winning friends.

Yesterday afternoon, she called and told me she had been kidnapped, didn't know where "they" had taken her, but she was certain she was going to be killed. She also accused "them" of flushing her handbag with money down the toilet and putting her family pictures in the sewer. I tried to reassure her, but she would have none of it. She screamed that I was "treating all of this like a big joke when our whole family was in danger." She further informed me that she was cutting me out of her will and was going to haunt me for the rest of my life. We recently had her checked for a UTI at the ER - she was clear. Looks like the dementia is just getting worse. She has not taken a swing at other patients or the staff yet, but I'm kind of worried she might. My sister and I discussed last night and decided to consult her geriatric specialist. Hopefully, she can suggest something to calm Mom down before she gets into trouble and the memory care discharges her.
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Isthisrealyreal May 2019
Are her hallucinations new?

I would be worried that she now has a UTI, they can come up so quickly.

If this is just a stage and there are no meds that can help may it be a short phase, it must be terrifying to think you have been kidnapped and are going to be killed, then thinking these same monsters are after your family. Can you reassure her that help is on the way and get a nurse or family member to go rescue her?
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Be certain that is not FTD.
Alzheimer's does not cause aggression. That is Frontotemporal Dementia FTD or specifically Behavioral Variant FTD or bvFTD

FTD is frontal lobe. FTDdoes not respond to medications that target the brain, even melatonin or any sleep aids.
Alzheimer's meds have adverse and dangerous affects.
Your doctors probably are not aware.
My wife suddenly became and autistic 2 year old at age 53, in 2006. The doctors could not find a cause.
I have care for her at home since. I had to retire from my career in 2013, at age 62, to care for her.
Only by a chance phone call to a social worker who's husband had suffered many years with FTD, did we have a clue. This was 2015, 9 years after the onset.
The university doctors jumped on it and confirmed, after they had already administered crippling Alzheimer's meds.

Christy has to be watched 24/7. She is hyperactive, will bump into walls. She is enraged by restraint. She is hand fed and hydrated with a turkey baster continuously, all day, often while she is pacing, head hung, drooling from the Alzheimer's meds.

Alzheimer's, memory care care, behavioral facilities, cannot accept FTD, only most don't know it until they have the bad experience.
She had been rejected from day care for aggression. She beat up the staff, drew blood on the director.
She was also denied the university's acclaimed geri/psyche ward.
Christy is toileted every 2 hours.
UTIs are the worst enemy, Constipation is the next.
Entertaining, occupying her is the greatest daily challenge. Her empty brain is curious and trying to re-connect, but the foundations have been erase.
She is a lot of work, but she has value. The fleeting moments of recognition, the smiles and laughter are worth it.
We have learned the triggers and remedies.
It is no more challenge than responsibility for a toddler.
I can do this for many more years.

Research FTD
https://www.alz.org/professionals/healthcare-professionals/dementia-diagnosis/differential-diagnosis/differential_diagnosis_of_frontotemporal_dementia
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pamzimmrrt May 2019
Alz does indeed cause aggression, with some people. I work in a neuro unit, and dealt with it with my father. It progressed differently with each person.
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I know you’re also worried about the “goose egg” on your mom’s head. Before you know it, It will go away and she will be fine. The body has incredible healing power.

We had a few “goose eggs” and they were scary so I understand how sad it makes you feel.
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It is hard. She may get over it faster than you. It is harder for the caretaker than the person sometimes. Look into different facilities like 6 residents 2 caretakers in a houselike setting. Do try to find some place close to you, so you can drop by for two minutes, 5 minutes 30 minutes any day or everyday. That is easier when the facility is close to you, between home and work route. That will take stress off as well. Sometimes people say there is an adjustment period when you first move someone, so you can always call and check up on mom that way for a few days or however long it takes. Knowing that I can get to my aunt within minutes is a relief for me.
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Skilled nursing usually means there is a nurse available 24/7 but your mom will still have caregivers who are also taking care of too many residents. She’s probably going to have the same problems.

My mom acted the same way. What finally worked was putting her in a residential care home. Usually a house that has 6/8 residents each with their own room & sometimes their own bathroom or only sharing with one other resident. You can’t get into too much trouble because it’s a lot smaller & the caregivers are right there with the residents. It’s a great care ratio & not as much turnover. Much easier adjustment for someone with dementia.

Don't know where you live but you might check into it. Some take Medicare, but even private pay will be way less expensive than Skilled Nursing.

Parenting parents is mot for the faint hearted. It’s very hard because even in a facility there are constant issues of all types. Take care of yourself! Your mom will continue to go through lots of
different stages. Take one day at a time but be proactive in all situations.

Find a good hospice service before you need it. Same advice for planning your mom’s funeral. If you have things in
place, you will feel much less stress.
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Mom's memory care sometimes lets behaviors go too far and I've seen residents literally knocked to the floor by others

while still, mobile, mom eloped and put up a fight - we had to switch her meds - seroquel wasn't the right one
now that she's immobile, she still cusses and will pinch during diaper changes - we just roll her top up over her hands to slow her down a bit -

I have private caregivers with her during the day
- unfortunately, during certain stages, meds are the only thing that will keep them calm enough to handle

it is a very difficult situation to handle
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shad250 May 2019
Entertainment for Memory care staff
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My mom was in a memory care facility for a year and a half when she was told to leave. She was on hospice at the time. Mom's behaviors were uncontrollable. She was sent to a Geri psych unit several times for med adjustments. The changes made to her meds worked for awhile then she would again become uncontrollable. She was biting, hitting, kicking, you name it, a danger to herself and others. She once bit one of the hospice nurses.

Has mom recently been evaluated for hospice? That would bring in some additional help for her.

When mom was evicted, hospice recommended a smallish care home. All residents there had been kicked out of previous facilities. Hospice had recommended this place. Mom did better, the resident caregiver ratio was lower and it was cheaper then the memory care she was in.

These are impossible situations. Mom had to have private caregivers come in on and off for the entire two years of facility living. That was an additional charge on top of the facility fee.

My suggestion get her facility to request a Geri psych evaluation at a psych unit. Hope they can get her meds adjusted appropriately. And call a well reputed hospice or several of them to see what recommendation they would have on how best to deal with this and to ask if they would have any recommendations for where she could/should go now.
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There is no point arguing that she should stay where she is. They are done. If someone was physically hurting your Mom at her residence, you would want the same resolution. If they were to allow her a second chance, it would only be short-term. They want her to leave. Don’t make things worse for her (and for yourself) by fighting a battle that cannot be won.

Spend as much time with her as you can during this transition. She recognizes you and finds familiarity and comfort in your presence.

None of this is is your fault.
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Mikersgirl May 2019
Thank you. I found some of the peace I need in your answer. It was a gift and I appreciate your taking the time to give it to me. 💝
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Hi, regarding asking your mother to leave, what else did her MCU do to resolve this issue? Do they have a policy that spells out the discharge process and did they follow it with your mother?
This past weekend I visited my 95 y/o MIL in MC. My husband told me prior that there is a resident there that literally “gets in his mother’s space”. Well I didn’t know what he meant until the visit where there is one resident, Maria, that yes, gets into everyone’s space at meal time and all day long. Maria is independent In ambulating but otherwise her poor mind is gone.

The staff watched Maria everywhere she went to assure she wasn’t getting in too much trouble. When she wandered the staff would go fetch her, disengage Maria by diversion or whatever, and led her away, guiding her to do something else. And Maria was restless and up and walking all day long.

The staff were pretty good watching Maria to get her out of those episodes where, yes, she did go into a resident’s space whether during a meal and afterward in the great room. That’s what MC staff are trained to do. I am wondering why your mother was given the boot and why her MC can’t handle her and am hoping they did try to make an honest effort to work with your mother’s issues.

But if its deemed your mother is a danger to herself or others then her current MC has a responsibility to try to keep everyone safe.

Did Management at your mother’s MC infirm you of mother’s behavior prior to the discharge letter? I am thinking yes if you’ve brought her to behavioral therapists & psychiatrists for medication titration.

I hope the transition ti SNF goes smoothly. This is a sad situation.
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Mikersgirl I'm sorry to split hairs, but it does very much matter whether the place where your mother lives is an Assisted Living Facility or is a Memory Care Unit.

If it's an ALF, it's not unreasonable for the facility to come to a judgement that they cannot provide your mother with the level of care she needs to keep her and others safe.

If it's an MCU, in which she has been resident for five years, you're in a better position to argue. It is the specialist job of an MCU to handle the challenging behaviours associated with dementia, and it is not in your mother's best interests to undergo a complete change in her environment. Moreover, she is clearly physically well and therefore has no need of a Skilled Nursing Facility: if they're going to discharge her to another setting, it must be appropriate to her needs.

Which is it?
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Mikersgirl May 2019
Memory Care. 3 buildings are Assisted Living and one building serves as Memory Care. It has a locked door and 2 people on shift while the AL buildings only have one.
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Oh bless you..just placed my mother with Alz in a AL and we requested the swab test that I understand many mental health physicians are doing and it gives the physicians an accurate measurement of which medications work best for their genetic makeup.. They have found the medication for for her and even though it is slow to build up, we are hoping that it works well in time. The exec director has said it has made a huge difference in other patients because if they are not on correct meds..it isnt going to work..just a thought..Good luck to you as this journey is soooo difficult.
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gladimhere May 2019
Swab test? Never heard of it. And my mom had uncontrollable behavior problems.

Wow! Just wow CM! 😯😯

I tried the link, it did not work, but googled and found it. Thanks. Read it and it sounds as if a new test would be required for each medication. I imagine that eventually based on genetics that the test will determine which med will work for each patient. Wonder about insurance coverage for this type of testing.
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What's been done to banish the resident that started the fighting with your Mom in the first place? The facility isn't doing their job in keeping your Mom safe.
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Mikersgirl May 2019
I have been told she is being discharged as well.
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I’m sorry this happening. Has the facility tried to help manage the behavior and help explore changes or additions of meds? I would think after 5 years of your Mom living there they would feel some sort of an obligation to assist you. Have you tried to call a meeting with the Director of the facility to see what if any other options are available? Maybe suggest a respite from the facility while she has a full psych work up and then a trial period back at the facility to see if behavior is improved? I hope it’s not too late and that they might reconsider. Best of luck.
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Mikersgirl May 2019
That is a good idea. Thank you.
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Thank you for all the responses. I definitely needed to know I’m not alone..., No UTI, she’s been checked. Yes, to medication. She is on twice daily seroquel and lorazepam as needed, but unfortunately we haven’t been able to find the sweet spot. Her Dr. has really tried.

This has been on going over months and really accelerated when a new resident moved in who tried to micromanage my mom which didn’t go over well. The relationship between the two became volatile. My mom put a strangle hold on her. A few days later she shoved my mom down and her head hit the floor. A large goose egg but nothing broken. Shortly after these two incidents the discharge letter came.

Moneys already gone so she is Medicare/Medicaid.
I am most interested in learning how to help her transition from having her own room in Assisted Living to a new environment in a Skilled Nursing home with a roommate. Any tips for helping later stage loved ones transition would be appreciated.
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Monica19815 May 2019
Have they tried Lexapro? My husband's PCP prescribed this as we are waiting for tests and a diagnosis of what may be dementia/Alzheimer's. I wanted to know why (I have been on Lexapro in the past for situational anxiety) and read that it is often prescribed for those with dementia/ Alzheimer's and other memory issues. I remember how calm it made me when I was on it! Just throwing it out there.
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There are definitely ways to control your mom without expelling her from the place she has been for 5 yrs but of course you don't have control over that. I am surprised they haven't tried alternate therapies with her. I am sorry for your problems. Each day is a new day never knowing what will happen here.
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I am so sorry for what you are dealing with. My mother went through the same thing with my grandpa but....they never discharged him...they managed him. One brawl was so bad that he broke his arm! He would pick fights with other men on the wing. I believe he also rummaged through other patients' belongings, if I remember correctly. I was just starting my own family and living over 60 miles away at the time so I do not know HOW they managed him. I am guessing medication because he seemed to calm down after the broken arm brawl. I guess I do not believe they are actually telling you that your Mom has to leave. Is there a medication thay can calm her down so she can stay? Where do they expect her to go and be safe if not to a facility like she is in now? I hope it all works out for everyone and that you find a solution quickly.
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Was she checked for a UTI? This wouldvexplain the behavior.

Looks like LTC is the next step. Once her money is gone, Medicaid could take over. I would also ask about meds.
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Yep!  There with you as I write this!  Only, my mom had a UTI at the time of her "elopement", attacking an employee and threatening to "break out every window in the place if I don't get to go back to my room!"  That was two months ago.  She went to a behavioral hospital, got her meds adjusted ( and the UTI addressed) and now she is in MC.  However, MANY OTHER THINGS have occurred since going to MC, so now I am looking at moving her to a different facility because her MC care is NOT like it should be, what is being charged for by the facility, and NOT acceptable to me as her Guardian and daughter.  So....now I am looking at other avenues to follow to find out how to address these things.  Several meetings have happened with the facility, and we are in negotiations as to continuance there, or move on.  I should know by this coming week what the outcome will be.  One thing is for sure.  If I can't help my mom directly at this point, it should be helpful to those people who stay behind who have NO advocate for them to try to make it better for them and those that follow them.   I am not the other residents' advocate by court appointment, but I am my mother's and don't take what is happening to my mother lightly.
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Have you asked about having your mom being sent to a senior behavioral setting or inpatient psychiatric facility so that they can trial her on meds? It seems like that might be worth a shot.

I'm so sorry tthat you are going through this terrible situation.
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I haven't been down that road. I do have a mother in AL. I do find her isolating more but this may be the path she wishes.

My question to you is if your mother is on medication and or if she might be helped even to a small degree with a possible change with it? I am sorry you are having to endure added stress with a situation that is so very difficult for those who are the ones left to look after aged loved ones.
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