Mom's inpatient psychiatric evaluation nightmare!

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I am the care giver of my 86 yr old mother. I work full time and her dementia was keeping me up at night. I was so pleased when the local psychologist told me we could her have her evaluated at a geriatric psychiatrirc inpatient unit (5-20 day stay) to get help with her sporadic sleep. Prior to this admission, she would get up in the morning, wash and dress herself, I would feed her breakfast then put her on her Senior Center bus. She would spend a few hours at the center having lunch and being with friends, ride the bus home where a relative would stay with her until I got off work. She was admitted and it is now six weeks later and she is still at the hospital psych unit. Since admission there has been a rapid decline in her physical and mental health. They keep her tied up to a recliner-like chair, she no longer walks, although she walked in the day of admission. Her period of lucid thoughts are very rare, she usually makes no sense when tyring to converse with her. She now keeps her eyes closed 95 % of the time, the doctor has no explanation for this. She keeps both hands in a clenched fist position and can no longer feed herself, She has lost a lot of weight. There has been liltle to no change in her sleep patterns, which was the inital reason for the admission. She has had to be sedatated on occassion for severe agitation. She crys a lot and calls out to deceased relatives often. I feel so guilty for putting her there, my intentions were good yet it has only turned out to be a nightmare. I am an emotional wreck feeling like I made choices that caused harm to the person I love the most, I miss her so much. I cannot believe how rapidly she declined, we are now looking into hopsice and nursing home care. Does any one have any insight?

25 Comments

My heart goes out to you! What a nightmare! The situations is sad beyond words. Please do not add to your distress with thoughts of "if only." You did what seemed like the best choice at the time. You could not possibly have foreseen the outcome. I have known/heard of many people who have had their meds adjusted in an inpatient unit and whose symptoms where then much more manageable. I would have gone with the doctor's suggestion, too.

People with dementia do decline. Sometimes the declines are abrupt and steep. Perhaps Mom would have had a drastic decline even if she had stayed home. I don't suppose you'll ever know. Know this, though: this is Not Your Fault.

Hugs to you and to your dear mother.
First of all I would find out what meds they have her on and why! I would question everything they do. My next thought is to get her out of there. Speak to her family doctor about getting her placed elsewhere. She does not belong in a psych unit! I worked in a psych unit and saw all kinds of things when patients went on meds. The elderly cannot metabolize meds as well as a younger person, they have different side effects. Many meds will cause confusion in the elderly. Unless she has been diagnosed with schizophrenia, bi-polar, major depression or some other psychiatrist diagnosis, she does not belong there! Contact your local Department of Aging and they will point you in the right direction. Once she is taken off the psych meds they have her on, you will see a big difference in her! Please do this ASAP before the situation becomes worse!
donnarae, that was my first thought, too. Did they give her something when she became agitated on the first day, could she have had a stroke, or did something in her mind snap. I was concerned that they have her strapped down. Isn't that illegal? I don't know. I've read it is illegal to strap a patient in bed without some legal order (criminal or something along that line). I don't know what is going on here, and I don't know what would be the best way to handle it. I would start out by talking to my mother's doctor (primary care physician on the outside).
It is against the law to restrain a patient unless they show harm to themselves or others. The patient has to be in the least restrictive setting. Talk to her doctor, get the name of every med she is on and ask why she is on that med. Psych hospitals are very dangerous places.I would call her today! Don't wait. If I sound alarmed it is because I am. Why that doctor would put her in a psych hospital for a sleep disorder is beyond me! She should have gone to a sleep center. Sleep disorders are very common among the elderly. For legal advice, call your local chapter Dept of Aging, they should have an atty that will give you free advice. Why are you looking into hospice? Has she gotten a diagnosis that states she has 6 months or less to live? What is her diagnosis?
I totally agree with DonnaRae - get her out of there asap! I'm no doctor, but I believe she should never have been to a psych unit. Assisted Living or nursing home - but not a psych unit. She didn't have mental issues - just sleeping problems. I also agree that she is probably being given too much or the wrong medication. I would INSIST they take her off the meds immediately and unstrap her. She is not a prisoner and probably became agitated because of where she was - but that is no reason to restrain her or overmedicate her unless she was a danger to herself or others. And it's understandable that you were trying to do what is right for her by following the psychologist's orders, but there's something wrong with this picture. So talk to her primary care physician immediately and see if he agrees with this treatment plan or has any better ideas. Let us know what happens as we care. ((Hugs to you))
There are good geropsych units and bad geropsych units. If this one is acting like, hey, its no big deal someone who was walking and talking when she came in a few weeks ago is now bed and chair bound and non-functional at all, ready for hospice, it is a BAD one.

Antipsychotic meds can cause drug-induced parkinsonism and other movement disorders. I don't necessarily think every drug on the Beers list is absolutely contraindicated for every elederly person in every situation, but side effects have to be considered. I'm hoping you have medical POA so you can get her out and get meds revised. If not, you could make reports to the local ombudsman and/or suggest subtly that you would consider taking legal action and that might encourage them to want her out.
There is another thing I considered. She may be in delirium from being in an institutional setting. I hope it clears quickly when she can get somewhere and become oriented again.
If you have POA get her discharged. They can only hold her for 72 hours, then they need a court order. By law, restraints can only be used if they are in danger of themselves or others and only for short durations. She has been over medicated enough to put her into a somewhat catatonic state. If you have POA you have the right to refuse her being medicated. The mental health department in your state can help you and explain a patients rights. You need to get her out of that hell hole and evaluated by an a more responsible psychiastrist recommended by her primary care physician.
I am so sorry that you are going thru this situation. Six weeks for sleep adjustment is a really long time. I also worked in a psychiatric hospital for the elderly. Medication adjustment would take about 7 to 10 days at the most. You did what you felt was best, I would have also wanted to believe the MD. You don't really have a way of knowing if her decline was going to happen at home so try not to beat yourself up. I would insist on a meeting with all of the team members at the hospital. You can arrange it thru the social worker. Get everyone together at the same time and try and get some answers. My heart goes out to you.
Sad situation! And I know the dilemma - I placed my brother into nursing home at 56 years old because of his balance issues getting worse, but I knew that he would lose skills from being in an institutional setting. He did, but he gained companionship in some ways, because living alone was not good for him, without extra help. It is horrible that psychologists are seen as leaders in areas where social help and help with community engagements, would be SO much more helpful than medical interventions - one can avoid meds and retaining skills used often in the day to day environment, if we could get support to help us keep our loved ones IN that environment, making small improvements there! Even if you are not POA - as daughter you can just tell the hospital you want to take your mother home. Once they had my brother in a psych unit for evaluation, and I told them if they didn't let me take him out, I'd hire a lawyer, and they suddenly realized I would take responsibility for him, and they said, "Oh, we won't go against YOU, if that's what you want." And they released him toi my care. It took me a couple of weeks to help him walk every day, which gradually improved, and then I had a different day program lined up for him, and I got him started in it - and he regained his ability to live in the community. He was then about 45, so he was younger than your mom, but your mom had so many more social skills already, that my brother didn't, I think you would find it works. Just make sure you have a plan - it might mean taking a few days off work as she gets adjusted to being out of there - getting off psych meds often causes withdrawal symptoms, so it would be good to find an MD to help with that part. Try to set up a schedule for her days, such that she is helped ot get up (she will have regressed in the hospital!) and out every couple of days and gradually build that up again. Keep trying to find help that believe in you and your mother - make a list of the skills she had, and just keep telling people, this is what she could do before, and you believe she can do that again, but MOST people lose skills in institutional settings. They are designed for people seen to need rest from the world.

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