How do you care for an Alzheimer's patient when they have aggressive behavior and hit their caretakers?

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My father is basically the nicest guy but about once a month he gets stubborn and hits his caretakers. He has been dismissed from 3 nursing homes in the area for hitting. He has been baker acted and is currently at a mental facility to adjust his medication. Between hospitals for a UTI and rehab nursing homes he has been in 7 different places in 6 weeks. He can return to assisted living only if he has 24 hr private aid. That costs around 400 per day, who can afford that? What are caretakers supposed to do with an aggresive patient? I know with alzheimers this is not unusual but people treat you like it is. I do not know what to do. I am trying to get him qualified for medicare. If I put him in another nursing home this will probably happen again. Thanks for any advise you have!

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This is a tough problem which is, unfortunately, not unique. It seems like you are doing everything right - medication adjustment, checking for infections and other requirements to figure out what can be done.
I'm afraid a lot of this depends on where you live (their ability to cope with behaviors). A nursing home is the most likely place for him, so keep working on getting him in to one. They are probably more able to cope with these behaviors than assisted living. Either way, his assets will get depleted if they already aren't so eventually he'll qualify for Medicaid. Maybe in a nursing home, they can cope.
Good luck - we are with you in spirit.
Carol
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This is so normal, so many at the daycare went thru this when my Mom was there AND my mom. Lorazepam, etc constipated my Mom and she was unsteady on her feet, and tired. Depakote works like a charm for my mom! I try weaning her down a tiny bit and it comes right back so she stays on it. Its a common medication for this, please call his doctor or take him to a neurologist and ask about it, it works fabulous! My Mom WAS as sweet as pie as a person but once dementia and a stoke hit her, she got combative and this saved her and us. good luck
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I know how impossible this feels. I was in a very similar situation 20 months ago. My mother, who was always the sweetest woman you could imagine, began to hallucinate, then acted as if she were possessed by demons, literally spitting curses, kicking, biting – and all with her sweet lips narrowed to a thin, bitter line. I had to get her into a psych ward on an emergency basis. (NOT easy, but that’s another story.) As another poster said, after much trial and error, Depakote seemed to be the magic addition to her drug regimen. Depakote is an anti-epileptic drug, and her neurologist speculated that the violent episodes might be seizural in nature. We won’t ever know, but certainly a diseased brain might reasonably develop seizural behavior.
Just like you, I was told that 24 hour private care was a non-negotiable condition of her re-admittance to her care facility. I understood this, since she was very much a danger to others as well as herself, and no care facility is staffed to deal with this sort of a problem. Unlike many, I was fortunate that her estate, which I already managed, had sufficient funds to deal with the horrendous expense of nearly $15,000 a month. At least for a while.
The two things really helped me out, besides the Depakote. The first was that as a 7th stage dementia patient, she qualified for Hospice. Hospice didn’t pay for the private care, but they provided a great deal of her care while being paid entirely by Medicare. That cut down on some of her other costs, and allowed me to decline life-prolonging procedures for my beloved mother whom I know would rather be dead than like this, if she had the choice. The second big help was the willingness of her care facility to reassess her situation regularly, so that when the violent episodes decreased to a level that the in-house staff could handle to some degree, I could cut down the private care hours a little at a time.
Right now, episodic violence in dementia patients is either uncommon enough to remain unaddressed on a large scale, or it is under-reported due to shame, embarrassment, or the desire of some care facilities to deal with it as they see fit without oversight. Since the incidence of dementia is on a rapid rise, I believe we will see more cases of this episodic violence, and as we do, measures will eventually be put in place to deal with situations such as ours. Right now, unfortunately, you and I are on the forefront. It’s up to us to break new ground and see to it that our loved ones are treated well and appropriately, and that the costs for such issues can be dealt with by normal, non-rich people.
One final thought on this: I’ve run into much resistance from the medical practitioners to the simple solution of sedating her to the point that the behavior stops. There appears to be a perceived ethical conflict in that doctors are not supposed to sedate their patients for their own convenience. I suggest that this otherwise excellent rule should be reexamined in the light of end-stage dementia. Patients such as my mother, who has not known me for months and requires total assistance for all life functions, whose brain has literally melted, turning her into something closer to a veterinary patient than a human one, cannot be considered to be deprived of anything valuable by sedation. In cases where there is depression and despair, anti-anxiety sedatives such as Lorazepam, Valium, and so on should be considered humane rather than unethical. I’ve pushed hard on this issue with my mother’s doctors, and they’ve reconsidered their views on the matter to some extent. Maybe you can do the same.
Sending you positive thoughts!
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NO, the depakote doesnt knock them out once they are used to it. At first it seems to but then it levels out. I recommend you ask your neurologist or Dr for it, its fabulous and when my Mom went to daycare it was the drug of choice for most of them, safer than seraquel, etc. My Moms been on it for a long time and I give 250 mg at breakfast and 125mg at night. The dr said 1,000 mg a day is normal but no way does my Mom need that much, trial and error. I have tried to wean down to 125 in the morning and within 3 days she is a royal crab again. I now skip sunday nights and all is perfect. I had students in my class when I worked on it, the ADHD kids who needed calming down, it didnt make them sleep! lol. Write me anytime, I also have my Mom at home with me and left my job now to take care of her.
Luvmom
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I agree with yellowfeever same thing with my mom when she was anxious. Lorazepam is Ativan for those who don't know.
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Don't know if this applies to your situation - but - Is your Dad a veteran? My husband was diagnosed with Alzheimer's - turned out to be PTSD. (wounded in WWII. exam tables, hospital beds were stretchers, personnel were "medics". PTSD "came out" after retirement. Seems this happens with a lot of older veterans. Knowing why they act out makes dealing with it a bit easier.
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fslack, I think that was me who mentioned Depakote, what a life saver!!!! The neurologist told me it calms the brain. She slept alot at first for a couple of months and then she was normal again. The depakote stopped those violent behaviors in their tracks and she not only acted better but when I asked her she admitted that she felt better. I would assume my Mom is in 7th stage, but she isnt totally bedridden, I get her up with a lot of coaxing and we walk small distances with two hands, maybe 5 feet, but we do it. MY question is to you is that I tried Hospice, she qualifed but they only had one person who would come "when they wanted" to bathe her and it was afternoon time, or when they could. My Mom needs to be bathed as soon as she wakes up as she is all urine, they did me no good. Do they supply diapers, bedpads? Thanks again.
Luvmom
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PS if your dad cannot swallow pills, as my MOm cannot, ask for the depakote in the 125 capsules, They are called sprinkles, I empty them into her prune mixture or you can put it on food but I prefer to make sure she gets every spec of it and the prune pudding I make keeps her more regular.
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Hospice has been a life saver for us. Our aide comes at different times, but she is normally there by 4:00 in the afternoon. She comes Monday thru Friday. We have developed a great relationship with Tomeka. There are days where she may finish with other patients early and she will call us ahead of time. Sometimes, we go ahead and bathe dad if he has had an accident. But they will still come to provide, diapers, bed pads, etc. All medicine is delivered to my dad's home. Mom calls about once every two weeks and all his medicine is delivered right to her door. We have a sitter who comes twice a week so mom can get out and just regain her sanity. We have tried Lorazapam, Ativan, etc for those times when dad gets a little beligerent. Does not do much good for him. I think he would have to have a horse sized amount for it to affect him. We started on this journey with one thing in mind. To do the best thing for dad. Our sitter came a few times for a couple of hours. Now she comes two days a week and stays for 8 hours a day. She cooks (at her leisure) and leaves the meal for my mom. She folds laundry and takes good care of our dad. She and our hospice aide have become part of our family. I would have no hesitation whatsoever in leaving either one of them alone with my dad. AT some point, you have to relinquish some of the caregiving responsibilities. There is no way a regular human being can manage this horrid disease by themselves.
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Galecki78. If I am not mistaken the doctor must refer your mom. Does she have home care? Because after mom came home to live with me we had home health care through the hospital. The nurse who visited was the one that advocated for my mom after hearing about my struggles with mom. It sounds like you are a good candidate to have hospice. Is your mom living with you? Your mom sounds like my mom in her last months. Mom passed away January 9 ...almost 2 months now. Check into all the resources you have available. There are agency's out there to help you out. Area of Aging and Disabilities is a great one to check into. If your mom has an income low enough she can qualify for help. I would call her doctor and tell him/her about what your mom is struggling with and see if you can be evaluated for hospice. Insist on it. They will come out and ask some questions and go from there. Good luck and god bless.
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