Thursday, April 17, 2014

Monday, January 25, 2010 AlzheimersGrandDaughter, Community Member, asks

Q: My grandfather has Alzheimer's and is violent.

He currently lives in an assisted living facility, but is in immediate danger of being kicked out, due to his violent outbursts (kicking, punching, spitting, verbal abuse, etc...). He has been confined to his room for the last two months because his outbursts are escalating. He does not have 2 years of private pay - more like 6 months, and needs 24 hour care to prevent wandering and injury to self/others. His adult children are unable and unwilling to care for him in their homes due to his behavior and needs (incontinence, anxiety, other medical issues). He is on Aricept, and a variety of anti-anxiety and anti-psychotic medications - none of which seem to help with his outbursts. We cannot find ANY facilities (in virginia) willing to take him.  We have contacted referral services, the local Alzheimers Ass'n chapter, doctors, social workers, and state insurance commissioners, and nobody knows where we should turn. This cannot be an uncommon occurance! What do people do, leave their parents on the street?! What are our options? Civil committment in a psychiatric hospital? Any help is appreciated!

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Answers (3)
Carol Bradley Bursack, Health Guide
1/26/10 9:33am

You are right that this is not uncommon. Your stress levels must be over the top.

Since you've already contacted your local Alzheimer's organization, the only other thing I can think of is the VA, if he is a veteran.

 

If they can't help, contact someone on the state level - even your congressman's office. We can't have elders kicked out onto the street.

 

Please let us know how this goes.

Carol

 

 

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AlzheimersGrandDaughter, Community Member
1/26/10 11:08am

Thanks for the response.  Unfortunately he's not eligible for VA benefits.  We have contacted the Virginia ombudsman and insurance commissioners, as well as Medicare, Medicaid, etc... I don't believe anyone's contacted our members of Congress, though I'm not sure what they'd be able to do. We're starting to think that the best idea might be civil commitment through the court system. It wouldn't be hard to prove under Virginia law that he's a danger to others, and cannot care for basic needs (the requirements for civil commitment).  However, I think we'd like to avoid that situation if at all possible.

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Carol Bradley Bursack, Health Guide
1/26/10 11:22am

I'm sure you would like to avoid commitment, but it may be your only option. The only reason I mentioned the congressman is that they can use their authority to expedite things, sometimes. A lot depends on the person, however, and their willingness to get involved. And you don't have many choices for them to "expedite."

 

It looks like you are well informed and educated on Virginia law. I'm so sorry you are faced with this. Please do keep us updated.

Carol

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NC, Community Member
1/26/10 10:58am

GrandDaughter,

 

I am sorry your grandfather has such a hard time. Has the doctor tried to send him to the hopsital's psychiatric unit to calm him down and find the best medications for him? Usually the hospital will try to find a way out for him. On the other hand, sometimes the patient is so agitated that the patient ends up in hospice given strong violence and resistance....

Maybe mental hospital or some nursing home with hospital setting. You sure your family has tried all the nursing homes? Not assisted lliving facility, but the skilled care nursing home. Please discuss with the social worker and he/she can help you guys.

 

I know how hard it is as my father-in-law is also getting very agitated and we are sending him to an assisted liveing facility. I understand this issue and I am afraid we may run into the same problem as well.

 

Regards,
Nina

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AlzheimersGrandDaughter, Community Member
1/26/10 11:15am

Thanks for your reply.  Yes, we're trying nursing homes.  He's currently in assisted living, but his needs are becoming too great for their staff.  The problem is that he's fully physically functional (at least as well as he could be for 85), but he's combative - which is threatening to the staff and other residents who aren't trained or used to Alzheimer's patients.  The other compounding factor is that he has terrible long term care insurance - so out of all the nursing homes in Virginia, only a handful accept his plan, and from those, only one or two have the intensive Alzheimer's-based care that he needs (locked wards, staff capable of handling difficult patients, etc...)  As you can imagine, the wait lists for those are long (one place told us four years). So I guess my question for the community is, what now? What happens when the assisted living facility inevitably kicks him out? Is our family legally obligated to take him in, or is some other state/government agency? It sounds creul, but his adult children have young children of their own, and their safety takes priority.  Additionally, there are no adult children who aren't working and can provide 24-hr supervision, and he has the potential to be destructive during the day if left alone (I can imagine him trying to make coffee and burning the house down...) so even a temporary situation of living at someone's home is not an option.

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NC, Community Member
1/26/10 11:34am

I understand he needs 24 hours care, same for my FIL. My FIL is 89. I found that the book "The 36-hour Day" by Mace and Rabins (Warner Books) is very useful and in chapter 16, there is a whole bunch of info. for nursing home and outside help. I cannot say for you as you need to look it up to see what fits his need.

 

You mentioned long-term care. He is lucky to have that. My FIL does not have long-term care insurance so we are going for private pay (fortunately he got some investments.) Did you try medicaid? Does he still own lots of properties and have lots of money if he is retired? If he is poor for 3 years, he could be qualified for medicaid to get nursing home paid. It seems here it is tricky that he does have a little choice but it is the money issue.

I think going to court does not hurt. No one will want to leave him in the street and I am sure one cannot force the family to take in a dangerous patient.

There are day hospitals and mental hospitals, but the waiting list could be long and the quality may not be as good. This may be the last try.

 

Regards,
Nina

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AlzheimersGrandDaughter, Community Member
1/26/10 11:39am

Also, I neglected to answer your first question re: his doctor and sending him to the hospital's psychiatric ward... His doctor is a moron. Last time he called my aunt (who lives nearby) when my grandfather was having an outburst and told her to "come and get him", as if she can do something to solve the problem.  I told my aunt and mom that next time that happens, they should not go and pick him up, as they are not medical professionals. Rather, the assisted living facility should have him transported to the nearest psychiatric facility (in a hospital or otherwise) to be stabilized. I made the comparison between a psychotic issue and a broken arm - they'd never call our family to come 'pick him up' with a broken arm - they'd immediately take him to a hospital.  Later, they took him to a psychiatrist who suggested that my aunt take him to go 'swimming' to fix the problem?!  It's not that we're against taking him for outings (which my aunt and the facility does regularly), but that the doctor was so clueless.  What is swimming once a week going to do about him spitting on other residents and calling staffers derogatory names?  Unfortunately there are not a lot of physicians where he lives, so switching to another primary care physician may not be an option. It's unfortunate that so many doctors are so badly educated in the care of geriatric patients - families should trust that they probably are better educated than their physicians.

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NC, Community Member
1/26/10 11:46am

Oh my God. Such doctors are crazy... To tell your Mom to take him swimming or go get him... THis is so unprofessional. In the new home we are going, they told us they can do very good personal intervention and have a good doctor who can try to calm him down. Most homes also call the hospital and send them there. The thing is nowadays nursing homes cannot tie up the patient who is violent so only the hospital will help.

 

I don't know where you live but your family may consider a big city where there are more options?

 

I am sorry this is so unusual. In some case, the patient goes to the hospice in the psychiatry unit in the hospital and this is hard for the family too. You never know what to do about it.

 

I am not sure what this civil commitment is but try it also.

You have my sympathy.

 

Regards,

Nina

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SinkingFast, Community Member
3/29/10 4:49am

Did you ever think that possibly "taking him swimming" was in hopes that he might drown, thus finding a solution, however terrible to the situation.  Maybe I'm seeing something that isn't there, but I understand completely your situation.  My father is currently sitting in the mental unit of the local hospital in Virginia.  He's 92, has dementia, is heavily medicated, but somehow manages to be violent at the same him.  He spits and kicks at the nurses, throws his walker at them and has been kicked out of his latest nursing home, for punching a nurse, where he lived on a locked ward. I'm desperate to find a facility that will take him after this. And I'm not being picky. I don't have any children at home, but I'm retired.  I can't provide the care he needs and I certainly don't want to risk the possibility that I could be the next victim.  It isn't a good situation and the number of Alzheimer's patients in increasing. Good luck in your search.

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sue, Community Member
4/14/10 3:12am

my husband has had the out burst and the cussing and he used to spit not on anyone but on the floor or whereever he was at,nasty but I tried all kind of different drugs before I got one which calms him down and mellows him to a young child age.which then you can enjoy,except he sleeps to much to suit me but i guess that is better then cussing.i have to give him baths and feed most of the food he eats to him as he has forgotten how to feed him self other then sandwitches which he still can do if u place in his hand and tell him to eat it.

But as I said he was really a terrible mess but we changed meds till we found one that works u may try with ur grandfather can't hurt at this stage.but the med is called Geodon.and it has been a blessing for me and a lot of prayer.also when I give him his oats at am I put cinnamon sugar in it and he does much better through the day.I hope u can find help for him I almost put him in a geratric home here in Indiana but I just couldn't do it.so I still have him home with me.god bless and keep you all safe.

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NC, Community Member
1/26/10 11:40am

Like what Carol suggested, do civil commitment if you really cannot do anything else.

Also, you sure your grandfather does not have any money to pay for nursing home? Many people actually have to pay for it out of pocket. So don't just depend on the long-term care insurance which does not have many choices.

 

If the family cannot do anything else and need to go with the rules with the insurance and etc., then you guys may have to pay it in private. On the other hand, if he is so violent that no homes will take him, you have no choice but commit him civilly and the judge will help the family. If you don't go the court, the government cannot help you.

 

Nina

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sue, Community Member
2/19/10 10:46pm

I had the same proublem with Husband which we were separated but I take care of him because I don't beleave in nursing homes,just my opion not everyones. Anyways he was very violent in the hospital even with the meds and tied down i checked him out and took him home has been with me now for 4 yrs. I found a dr. who tried different meds. but finally found one that controls the violence it is called Geodon.has been god send.plus i pray with him all the time he smiles and says I love you especally at dinner time.he eats a lot but has lost much weight. so i keep close eye on him because he is so fragile but he walks all the time,and also I put cinamon on his oats it helps with his memory.hope this will help u some it is not an easy job to deal with.only god can help u the most.

Smile

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Donna Reed, Community Member
4/13/10 4:10am

My family is paying $5000 a month for a nursing home locked unit. My father was brought there from a psych ward after punching me in the face 7 times and driving 90 miles an hour into a blizzard. His dementia has grown worse over the last 5 years. He punched a nurse and the nurse called my 85 year old mother at 2 in the morning to come pick him up. Besides being stupid, I believe she was out of line medically and legally. She should be fired. My mother worked on a psych ward for 20 years and had to tell the nurse to call the Dr. and have an ambulance authorized. 5000 a month for this crap? The psychotropic drugs don't stop someone from punching. They are for schizophrenics and all-- including Geodon -- increase risk of death in elderly patients. The ALZHEIMER RESEARCH people are taking in quite of bit of money and WHAT IS BEING DONE? All going to greedy big pharma? Administrative salaries?

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Donna Reed, Community Member
4/13/10 4:11am

My family is paying $5000 a month for a nursing home locked unit. My father was brought there from a psych ward after punching me in the face 7 times and driving 90 miles an hour into a blizzard. His dementia has grown worse over the last 5 years. He punched a nurse and the nurse called my 85 year old mother at 2 in the morning to come pick him up. Besides being stupid, I believe she was out of line medically and legally. She should be fired. My mother worked on a psych ward for 20 years and had to tell the nurse to call the Dr. and have an ambulance authorized. 5000 a month for this crap? The psychotropic drugs don't stop someone from punching. They are for schizophrenics and all-- including Geodon -- increase risk of death in elderly patients. The ALZHEIMER RESEARCH people are taking in quite of bit of money and WHAT IS BEING DONE? All going to greedy big pharma? Administrative salaries?

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sue, Community Member
4/14/10 3:31am

what works for one may not work for others,but as far as the drug geodon having deadly side effects,which if u read all drugs have these same side effects and it is not only used for this it is also used to control seziuers,And no one in our family could possiablly pay 5,000/to anyone to care for our family,I used to be a nurse before I became to physcally unable to work any more.If u think a home is better for them go visit sometime when they don't know u are comming in.I gurantee u won't like waht u see.but then that is me.

I leave the help I need up to God he is really the only one who can help,because as it says I will never put more on ur shoulders then u can bare.or if I take u to it I also will take u through it. so I just trust in god and go on day to day I am sorry if I offened u all telling u about Geodon.but it has worked for him for over 5 yrs now.And the dr.says u have to decide for ur self if the help is worth the risk and I seen him in the hospital when he was so sadated he couldn't even open his eyes but he was still fighting the nurses there and they called for me to come take him home.they do have althimers homes here In Indiana though if it gets to bad they send them there and they will commit from court if they have to.or the eldery cps unit will try and help u.Hope u get the help u need.

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By AlzheimersGrandDaughter, Community Member— Last Modified: 10/26/11, First Published: 01/25/10