After a month long stay in a nursing home, is it normal for dementia patients to rapidly decline?

I would have him taken to the ER to rule out an infection like a UTI, pneumonia etc .

Also , A bad fall and surgery , often is a game changer for an elderly with dementia . This is considered a traumatic event . Each traumatic event can result in your step Dad not coming back to where he was prior to an event .

I don’t know if you planned on keeping him at your home permanently . If not you may want to look into facilities soon because he will need 24 hour care and can’t go back to living alone unless he has 24/7 caregivers coming to his home or a live in .

YES, YES, YES!!!!

When my FIL first got to his SNF - we noticed a rapid decline - then he leveled off again - before the last rapid decline. I actually asked the Nurse Navigator about it and here is what she said.

1. "Institutional" Dementia is a very real thing. Much like "isolation dementia" - when a person is still capable but does not use their mental capacity, social skills, get out into the rest of the world and interaction, limit their own interactions with other people for any number of reasons.

(FIL had made up his mind that living at the SNF was temporary - so he didn't want to "waste time with those old people. They are all crazy and I'm not like that" (his words), so he refused to leave his room unless he was going to rehab. As a result - he severely limited his social interactions, his ability to actually USE his mental faculties outside of playing on his phone. He couldn't hear or see well - so in many ways it was like he was in a bubble with no mental work being done.

2. When someone goes from their home to a rehab, LTC, SNF it is entirely possible that the move can impact their mental faculties severely. In my FIL's case he was in the home>rehab>home>hospital cycle and "moved" locations no fewer than 7 times between 11/23/2022 and 5/21/2023. He was muddled and confused for a while after he finally settled. But even when he was home it was clear he was no longer the same.

3. If the person has been getting 1:1 care at home - a move to a residential facility can be eye opening as to exactly HOW MUCH other people are doing for them and keeping them on track. Before FIL went into the cycle - we thought he had at least a rudimentary ability to use his phone -but underestimated how often SIL plugged it in without thinking about it or I fixed all of the things he had messed up. Within 3 days of being in SNF - he had deleted his entire contact list - which was not backed up. he had deleted all of his icons. And he had managed to turn his volume down and never knew the phone was ringing. Because the staff, rightfully so, wasn't spending exorbitant amounts of time ensuring that his phone was working properly.

4. If the person already has dementia - a move can increase symptoms. OR it can just really shine a light on what those around them didn't see because they were too close - that they were already at that point and were being propped up by others.

So yes - rapid decline is not unusual, especially if you consider all of the possible reasons why.

What you are really looking for is if they bounce back. Or if the decline just continues.

But once my FIL's real decline started - it was also very rapid. So there is that too.

My mother, in care for 2 years (99), now appears to be relearning skills, such as feeding herself. Which makes me think she hadn’t lost the skill of feeding herself, but the logic behind the need. As if dementia impaired her “why” just as much or more than her “how”. Still articulate and opinionated. Bigger holes in her filter.

It sure is an individualized decline.

Not uncommon. Both my MIL and my mother declined after falls. MIL hurt her head and was never the same again. Dementia had already started before the fall. She lived to age 99, but no one could tell how well she could see or hear. She lost most of her hair. She only talked (when she talked) in a whisper, and then only a word or two. Dementia was her cause of death.

My mom had several falls and often there was noticeable decline afterward. She lived to age 95 and died of dementia. At the end she was curled into a fetal position, teeth brown, unable to speak.

In both cases, in my opinion, they both would have been better off if they'd died when they had the fall. As they waited years to die with no hope of recovery, neither had any quality of life.

There may be several things going on at the same time.
1. A decline is common after any surgery due to the anesthesia. It may take months to return to "baseline" cognition. (some do not fully recover to baseline)
2. A stay in the hospital alone may cause a decline.
3. A move to rehab, again another move a change that is not handled well by people with dementia.
4. A move to your house. And I presume this is not the house he was in previously. So again another change, move that is difficult to process.
5. Each one of these events caused a disruption in his "normal" routine and that can set someone off as well.

I can tell you he probably will not recover to his previous level of cognition.
99% sure he will get worse and become more belligerent.
If this is something you are not up for it might be a good idea to begin looking for Memory Care facilities now.

It is a normal thing for rapid decline, yes. But it is thought that this is more due to the fact that the rapid decline was ALREADY HAPPENING prior to admit, and that the admit is a RESULT of the rapid decline, not a cause. It you extrapolate, there was a fall here, then surgery and anesthesia and decline so that the patient was already in a state of decline so severe that he could not return to his own home.

In such situations there is placement, and this unfamiliar environment may compound problems already occurring.
In the end, it little matters.
I just mentioned to someone else that for many seniors a fall ushers in the beginning of a long end. It was so for my own mother. It moves to one thing after another until all systems moved into failure. It is so very very sad. But so true as well.

My Mom went downhill in rehab became incontinent and couldn't walk and ended up in a wheel chair . She could Not smell or taste food . Ended up in a Nursing home and Passed 3 and a half Months Later .

"After a month long stay in a nursing home, is it normal for dementia patients to rapidly decline?"

It's not uncommon but there may be reasons behind it that are treatable.

You don't mention the time span between his surgery and his current cognitive issues. If he had anesthesia for his hip surgery, who could have what's known as "hospital delirium"... but you said he went through rehab. How was he in rehab? Was he cooperative?

Also, he could have a UTI, which is very common in the elderly. Also, the abrupt change in his routine, his health, his residence can maybe cause him to become depressed and out of sorts. Or, he could have had a clot from the break that caused a stroke (very common with this type of fracture).

Is he on anything for depression?

Is he currently in your home?

If he's belligerent, please call 911 and have him taken to the ER to see what's up. From there (and depending on the outcome of testing) you can decide to transition him into a facility local to you since you are his PoA and you can't put this burden on your brother forever.