If an Alzheimer's patient turns violent in a memory care unit and they won't keep him, what happens next?

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My dad has been in a memory care unit since Jan. He was mid stage 6. Overnight it seems has become late stage 6 and has become violent. The memory care unit won't keep him unless a geriatric psych evaluation is performed and he is stable. He is in a medical hospital at the moment to keep him safe, but they have him restrained. We were told today that the psych hospital won't take him while in restraints. What should we do?

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This is one of those things that will get a whole chapter if I ever write a book about my experiences with Alzheimer's. My mom, who just died back in February, went through the same thing. She had a nurse in a choke hold, and the memory care unit sent her to the regular hispital, where she was put in restraints. It was horribly demoralizing to watch, but I know it was necessary. She was transferred to a psych hospital, which in our area was essentially the place where druggies get sent for court ordered rehab, and I found that the staff there was not trained on how to deal with demented fragile old women--albeit violent old women, as my mother was. Everyone's advice was to then find the hospital social worker and get help, but the social worker didn't have many ideas either about what to do next. The doctors kept explaining to me that she has Alzheimer's and cannot be cured. DUH! I knew that already. The whole experience was horrible, and I feel like it's largely because the healthcare staff and infrastructure were not prepared to deal with an elderly psych patient. They were not prepared to deal with a stressed out beyond belief caregiver of an elderly psych patient (me). Hopefully things are very different where you live, and you find better support. I preach to everyone that will listen that as the boomer generation starts to go through this over the next 10 years or so, we better get better prepared as a country to deal with the physical, psychological, financial, and emotional consequences of this disease, because I think we are not yet ready for it. Well, I probably have just made you depressed. In the end, we restrained my mother with drugs. We tried to keep them to a minimum but we had to do something. Hugs to you. I know what you're going through, and it's very very hard.
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One more comment.. I was deathly afraid that my Dad would be a zombie after a month in the geriatric psyche ward. He was no longer so agitated and no longer violent. He still knew me which was a blessing. It did seem to make him more jovial.  The fact that he was no longer ambulatory may have been a factor with him developing pneumonia three weeks later. He only lived 22 days after discharge from the psyche hospital. 
After having gone through this with two parents who both had very different journeys.. I am still amazed at how much work it was for me to manage their care. It seems that there is a so much education and outreach that needs to happen with families. I often felt so alone and overwhelmed with decisions. It was this site and several other Alzheimer's caregiver Facebook sites I turned to for support. 
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I am curious as to what kind of violence this is. Is he hitting his care provider or other patients? Throwing things? My mother has Alzheimer's and after she broke her hip she would strike out at her care givers. After watching and investigating a bit it turns out they would try to manhandle her because she is hard of hearing and they didn't realize she was not understanding what they wanted her to do. Once they spoke louder and made her understand what they were going to do or what they wanted her to do, the striking out stopped. Try to find out if there is a trigger that may be making him strike out.
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When my friend, for whom I am POA, became resistant to all care after she had soiled herself in her memory care apartment, they advised me to take her to a geri-psych ward in a hospital to find a medication that would calm her without doping her up. It took calls to 3 different hospitals to find one that had an opening. She was there 3 1/2 weeks to find the right drug at the right dosage and time of day. After that she was cooperative with her memory care staff until she passed away 3 1/2 months later. They were so skilled in handling her, knew just what to do in a kind but forceful way. It was a stage many go through and the knowledge is out there about what to do. Your memory care people should know about this and it shouldn't be a mystery.
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I suppose the physical restraints could be replaced by chemical restraints (drugs) and then in the psych hospital hope they can adjust the medication so he is not overly sedated.

I think the hospital where he is at needs to come up with a good discharge plan, and that they'll need to consult with the psych hospital to do that.
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As a caregiver I have learned MANY things: One: you never can seem to stay one step ahead of the next "trauma/drama" Two: we spent waaaay too much time worrying about things that are likely not going to come to pass and 3: We never get used to the "new normal" before the next "new normal" shows up. And 4: we don't take good care of ourselves and wind up spiraling out of control into depression or free ranging anxiety--and then we're of no use to anyone.

Worrying about whether or not a parent will become too violent to stay in a facility---w/o realizing that nothing has been attempted to control the inappropriate behavior yet is a prime example of that.

I've learned (after MANY years) with Mother, that stuff just happens. And yes, it drives me crazy. But, hopefully I am slowly developing a thicker skin and more patience.
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This happened to my Dad a few months ago. I was lucky, there was a geriatric psych unit at a hospital 50 miles from him. They had him there a month and completely re did his meds. The social worker at the hospital found a nursing home to take him upon discharge. It was okay- but nothing like the assisted living center he was at. The plan was to develop a track record of good behavior and then reapply other places in 30 days. Due to the psyche medications he was on- he left the hospital in a wheelchair. He was very unsteady on his feet. He developed pneumonia two weeks later and died. It was just three months after my Mom passed. So I was thankful his horrible journey was finally over..
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I agree, JohnnyJ, the knowledge is out there; and I'm also delighted that your friend's memory care people were so good - this kind of skill is a pleasure to see in action. But the personal attributes needed to use it effectively aren't common, and the training is expensive and lengthy, and the facilities that fully deploy it are scarce, and the careers are poorly rewarded. Something must change, but I'm not holding my breath.
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I have had several years of this with my mother - and I continue to be her (sole)support team in all categories of Life. I also could write a book, but I will just say that I've been through every scenario (being kicked out) with retirement active adult community (where I bought a place next door to her) to assisted living to now memorycare, and working with medication is the only solution. I worked in healthcare, so I am aware of meds, and with psyche meds it is finding the right combination - there are SO many, and some have side effects initially, and some do not work, and some need to be combined (as in anti depressant and antipsychotic, low low doses (respiradol). Gave my mother a whole new life and she was able to be accepted and has done well in Memorycare. But, it is an arduous task to work with doctors, psychiatrists, etc in order to find that ONE SPECIAL med that works - and it IS possible!. My mother has NEVER been in a condition like a sedated person - NO WAY, she has had a full life with fun and continues to be a trooper with her challenges (now blind and wheelchair bound too - can't get much more challenged than that - along with the severe dementia and being 96. In summary, my own healthcare job experience combined with 30 years of Mom care has lead me to this conclusion. Note: In California "restraints" are illegal, so this is something else you do deal with, as in rolling out of bed because no bed railing is allowed in Assisted Living, et al. But, again, sleeping medication has helped her to not roll out of bed. Meds get a bad rap, but.....for those people in our shoes, it becomes a lifesaver for you AND for Mom because she can find some peace. Goal: to find the right medication combination.
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Not all memory care facilities will take those with behavior issues and those that do can be scary places - mom's facility lets behavior go too far in my opinion as other residents have been injured

I have seen 911 called to take one woman out on a psych hold - her family had refused to use meds and her behavior escalated - she unfortunately returned a zombie and died a few weeks later

I don't believe in letting the professionals make the decisions unilaterally and I don't use the facility's doctor or psych - I take mom out to her own doctors so I'm better in control - the first antipsychotic didn't help and we had a trying few weeks last summer until we switched - she is more calm, more confused and now doesn't walk in part from the many falls she had there

Having a loved one in a facility is oftentimes as much work as having them at home - there are a few really good caring folks but they are so underpaid they have to work two jobs - imagine how tired they are

There's not a day that I'm not involved in some way with mom's care even if I don't see her

Dementia is a long tiring journey for everyone
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