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"Every behavior is a form of expression. It is important for care providers to understand this. If we address the source of the behavior, we can eliminate the behavior". Jean Makesh
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Hailey, I saw your follow up, that your BIL has pushed staff and will not tolerate bossiness.   Unfortunately, in an institution, residents must frequently do things on their schedule.  There is not one on one care.  You may have to look for another institution.
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haileybug Dec 2019
FloriaDD I have no idea what you are talking about.
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I’m sorry to hear this haileybug. Back to square one for your family.

I forgot-does the state have guardianship over BIL? If so they will step up but again the possibility of him being transferred somewhere far away from his brother & your family exists again- your husband will get stuck driving to wherever he is.

Unfortunately yes his MC can discharge him if they fear he is a danger to staff or residents. I believe that is the deal breaker. Giving 30 day notice is probably not required in this situation either due to BIL’s erratic and potentially dangerous behavior. My guess is he isn’t going back there.

Again I feel bad for your husband and your family. You’ve been a great advocate for what should happen (staff trained to work 1:1 taking care of BIL) but that is not going to happen unless it’s private pay.

I will guess BIL was admitted under a behavioral contract or is currently in a probation period at the new center. As he has again exhibited inability to make proper choices & can’t control his impulses - especially since they gave him a chance when no one would - I am thinking they won’t entertain taking him back.

As another poster said, leave this to the SW and DC planners to get him placed.

I hope it it works out for you & that maybe they will give him one more chance.
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gladimhere Dec 2019
Shane, good point. My mom has been gone for 2.5 years now so some memories have begun to fade.

Mom was in care for just over two years when she passed. Both memory care and the care home (last six months of life) required that mom have private caregiver, in addition, whenever her behaviors escalated.

Hailey, if BIL can afford that, perhaps you could get him back where he was. The 1:1 did help mom, kept her engaged with the mind more active. That was the advantage of the care home for mom. The staff/resident ratio standard was much better more like 1:4 instead of the common 1:6 or 1:8 or even more that you see in memory care.

Oh, and the care home was less expensive which did help with the increased cost due to the need for 1:1 care.
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Hailey

you don't need to share with us but I'm assuming you were told what BIL did to be sent out on Xmas eve for a psych evaluation -
is that not correct ?

if the administrator did not tell you, then you or more likely your husband (if he has power of attorney) needs to be fully informed, since you asked another member what danger to others means.

Has he hit anyone? Kicked, pushed, or choked anyone, or used a fork or a knife as a weapon? Picked up a chair or table and threw it ? Does he remove his clothing, urinate or defecate or masturbate in public areas?

these are all examples of behavior that can occur and result in being sent out of a memory care facility
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haileybug Dec 2019
MsMadge Pretty much pushes aides, for what reasons, I do not know.

The 5 days he stayed with my husband and I, he never pushed me. I was left alone at home with him and in the car alone with him, never once was he aggressive with me.

The month he was in the hospital, the case manager stated he she never saw any behaviors while there. Two months and a half in rehabilitation, administrator stated he was not aggressive and he would not harm anyone. That he just loved to wander all over the place and needed and activitiy to keep him occupied.

He has had many evaluations done with obviously no behaviors there.

My husband and I have been through this before. Administrator accused him of having behaviors and wanted to discharge him to us. I contacted the ombudsman and she stated that would never happen. Therefore, when she got involved, she turned that ship around.

When she investigated the situation, she stated that staff had done a lot of things that she did not like. She stated that once they got all new staff and got him involved in daily activities, he was not having any behavior issues.

I agree with her. He is a very intelligent person, he will not tolerate no one trying to be bossy with him and he does appear to like to be busy.
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Hailey

sorry you and hubs are going through another difficult period with BIL especially during the holidays

I've followed your posts over time and it seems the same folks will respond to you with the same comments and questions but you don't seem to respond with more information -
mainly your question revolves around why don't memory care facilities have to take your BIL ?

the only answer is No they don't

if BIL has had several psych evaluations then his dementia (if that is his only diagnosis) must be severe - the social worker at the current psych hospital must work to find a suitable discharge

during the past 4 years, I've witnessed behavior issues from residents in mom's memory care facility -
I've seen other residents hurt and I've been hit myself on several occasions -
there is no magic memory care or way to handle or redirect these situations especially if it is a strong man -
the only solution is to heavily medicate them which means they become immobile and less volatile if not walking around

You do not need to elaborate on BIL's behaviors but I'm sure you do not want to see him hurt anyone

I understand that it is difficult to accept, but there is no cure and no memory care facility no matter how expensive or what their glossy brochure says has a magic wand to make things better - it is awful I know
the best you can do is hope he is kept comfortable, safe and fed and clean

push back on the social worker to help find a solution - this isn't a first for them

contact your local Alzheimer's association and ask for suggestions

contact your county agency on aging and ask for suggestions
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haileybug Dec 2019
MsMadge Thank you for you response. You seem to be such a kind person.

BIL is not bothering the residents from my understanding it is the staff. Makes me wonder what they are doing to him My husband has told me that his brother was like a genius before all this happened to him. It says his brother is not going to tolerate no one being disrespectful or bossy with him.

I can not help but wonder if he is being provoked. My husband and I kept BIL for a few days this summer and he was a joy.
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This just proves to me that the system is WACK. He has had several evaluations in the past 5 years and the phychiatrists never recommend anything other than Assisted Living and now with Memory Care. In fact, in one hospital he was in the doctor refused to evaluate him again because he said BIL "acted like an angel" while at the hospital.

I have a gut feeling, BIL is more intelligent than all of them. Surely if he was the monster they betray him to be, his mother could of never cared for him in her 80's.
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I'm so sorry that this has all gone pear-shaped on you. I know how hard you've worked to stay involved in BIL's care and improve his quality of life.

Is the situation illegal...

Is that actually the right question? Where does it get you? Where does it get BIL?

So. To go back a few days. BIL was admitted for a psych evaluation. Which found that... What? To me it's bizarre that the social worker rings to ask what your plans are; surely the first step is a case conference where the findings of the evaluation are discussed and BIL's care needs are specified.

How is BIL now? Have you and/or DH been able to see him?
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haileybug Dec 2019
Countrymouse Thank you so much for your response.

The reason I asked if it was illegal for someone to get discharged and not admitted back was bc my BIL has no where to go. I was just hoping the administrator could not do this and she would have to take him back.

My husband and I thought we had him at a good place and we were willing to work through this, given a chance.

I agree with you so much about the first step should have been a case conference of findings and care needs specified. You are on point.

To me, this is the biggest problem we have been having. The facility will say they are having issues, send BIL for evaluation and then they are ready to throw him under the bus.

Husband and I have not been able to see him but I have been calling and talking with the Nurses and they say he is doing fine.
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Kicking, biting, throwing things, any behavior that is out of control and staff is not able to stop it. My mom did all of those things when she was sent for psych assessment, meds adjusted, she was ok for awhile, then started again. I think some are just more prone to disruptive and dangerous behaviors. Threats of hurting someone, or themselves.

My mom did end up being kicked out because of behaviors. She was on hospice at the time, they recommended a smallish care home that worked much better for her.

Read the admit documents. Think about it, Hailey, what would you want if another resident was actually your loved one and your BIL were allowed to come back. Think about the liability. The facility is responsible for keeping all residents safe.
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haileybug Dec 2019
Gladimhere Thank you so much for responding. So sorry about your mom.
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Yes. If the psych evaluation determined a problem that could not be addressed at facility, or if he was determined to be a danger to himself or others with his behaviors he could be refused readmission. He might be better served in a psych facility.
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haileybug Dec 2019
Becky04473 Thank you so much for your response. I am confused. I thought that is what Memory Care Specializes in. (behaviors)
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Yes, they can discharge immediately if the resident becomes a danger to themselves or others. You will need to be strong and refuse to bring him into our home. He needs more care than you can provide. Between memory care and the psych hospital they will find a place for him.
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haileybug Dec 2019
Gladimhere Thank you for responding. What constitutes as a danger to others?
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What does your papers say? Some facilities can do this type of discharge if the resident is a harm to others or to himself. Hospital is the easiest way to do this, since once he's off their premises, they don't need to care about him. Facilities pay hospitals for patients, so Hospital will probably do little to intervene.

At least she notified you, many don't, as long as they follow proper procedures for discharge.
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It sounds to me like your BIL has a psychiatric issue and not a 'dementia' issue, meaning any Memory Care facility is going to release him once they discover that fact. You may be able to put a band-aid over the current situation and buy him another 30 days at the current place, but that's not going to solve the long term issue which seems to be at play here. You need to get him properly evaluated so he can be placed where he belongs, because he's not having any success with Memory Care communities.

I work in a Memory Care and we erroneously took in a woman who's schizophrenic, as it turns out. She mimics dementia behaviors from time to time, but her overall behavior does NOT fit the 'dementia/Alheimier's' profile. Her daughter is now trying to figure out where to place her next since Memory Care is not the right fit for her.

Best of luck!
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haileybug Dec 2019
Lealonnie1 Thank you so much for responding. Here is the complexity of the entire situation. He has been hospitalized many times for a pschiatric evaluation and they never see fit to place him anywhere else.
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