Does anyone have experience letting an assisted living facility call adult protective services?

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My 61-year-old sister lives in a wonderful assisted living facility but is a bully and very disruptive to staff and residents. This is an amazing facility with top notch staff. My family has no complaints, but my sister (the resident) does. She calls and pesters the staff constantly, bullies patients to the point their families complain about her. We don't know what to do, she does not qualify for a nursing home because she is mobile, but she suffers from advanced diabetes that has progressed where she is blind in one eye, her kidneys are failing, and she is asthmatic on top of it. She loves to call emergency (we think she is addicted to the attention) and we think the AL is ready to ask us to move her. She can't live by herself and we are seriously considering calling adult protective services because we have no other solutions at this point. My elderly parents can no longer transport her to hospitals for emergency visits or regular dr. appts or her shopping needs. In fact my dad went to emergency we suspect due to exhaustion trying to help my sister. We suspect my sister has some mental issues going on maybe due to minor strokes or whatever else? We have been dealing with this for 10+ years but in the last week it has escalated to an impossible situation at the assisted living facility. Does anyone have experience letting an assisted living facility call adult protective services? We don't want them to get into any kind of trouble.

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She needs a psychiatric evaluation, in patient. They will work with her to determine what meds and how much she should take to try to control her behavior.
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My mom was kicked out of memory care and went to a smaller care home. Her behaviors were more than over the top. She did not have a uti, the behavior had been present since she first moved two years ago. The facility kept trying to find a med solution. They were effective up until February this year, the move happened. Mom's new facility had 16 residents all of which had been kicked out of previous facilities because of behaviors. They had become a danger to themselves and others.

Mom had Alzheimer's Disease, that was killing her brain, just a bit at a time and is different for everyone. Mom was not being picked on, but she certainly was out of control with other people. The problem was mom and her disease not how she was treated by others.

Get your sister a psych evaluation a different level of care is needed. And as Jeanne said have her checked for infection.
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Lots of people in my mother's nh were mobile ... I don't understand why that would be a requirement for your sister. But there is no guarantee that she would suddenly become cooperative and happy there, either.

Since this escalated severely suddenly, have her tested for a uti. That sometimes causes behavior issues in older people.

I agree with Glad that the next step should be an inpatient psych evaluation, to sort out mental health issues and come up with a treatment plan.
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I'm not sure who you think could get into trouble for seeking help with your sister's care? In fact, I'm if anything surprised that she hasn't already been assigned a caseworker. Your parents must be in their eighties, at least; and it is high time that thought was given to who is going to take over responsibility for your sister's welfare once they are no longer able to manage it.

So all round, yes, for goodness' sake, go right ahead and call APS - not a moment too soon!
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Thank you all for caring enough to answer with experiences and good advice. I researched and found a hospital that offers in and outpatient psychiatric and behavioral evaluations. We took her there and they have put her in the outpatient program for at least the next 5 days beginning on Monday. We are all praying this has something to do with the cocktail of meds she is on...we will see. Yes, I do agree my sister will be miserable wherever she lives. It is truly sad. She is on Medicaid but we have been told she has no specific caseworker assigned to her. I am still working on that since as Country pointed out, my parents are in their 80's, and we need a plan. (we truly thought we had that when we moved her to the assisted living home 5 months ago). And as for not qualifying for a nursing home where we were hoping 24/7 medical care would be available, we have not been able to prove a medical necessity for her to qualify. We will test for a uti if this route through the psych and behavioral Evals don't show anything. Thank you all. I will post more as we know.
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OH my gosh, don't misunderstand. My entire family is heavy hearted about the suffering my sister is going through. It is why we are working so diligently to find help. As of now, her AL put us in touch with a wonderful inpatient facility that is going to test her meds, and observe her to help improve her situation. We love my sister and are not willing to do anything to compromise or put her in a bad situation. I may have not represented the situation in a clear concise way, but it is why I reached out on this forum to educate ourselves and find the options that will best help her.
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It sounds to me like people need to start standing up to her and putting her in her place, this is about the only thing you can do with a bully. No matter where she goes, she's going to be a problem no matter where you move her. Just encourage everyone to start standing up to her, I sure would if approached by a bully. I don't put up with crap from no one, especially not a bully
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Bullying is an extremely common problem in senior living situations. According to research I saw by ProMatura (behind a paywall, because it was done for a trade organization), the researchers concluded that practically all Independent Living Senior Residences have bullying. All residents are entitled to 'quiet enjoyment' of the residence.

Here's what I would do: first get educated about the problem. Go to http://www.stopbullyingcoalition.org/resources. Start with the Essentials page and watch all the videos/webinars and read all the sites. Once finished with that, you'll know about 95% of what there is out there on this topic. Then, go to the Comprehensive Resources list and check out links that might be of interest. Right now, the links pages are current, but the person who developed them butted heads with the man who owns the web site so it's unlikely that the links pages will be diligently maintained. Pay particular attention to the training manual developed by Marsha Frankl and her colleagues at the Jewish Community Housing for the Elderly--this discusses how a very good housing provider manages elderly residents who bully, who appear to have psychiatric problems and are creating problems for other residents and staff.

This is important: you want to keep *very* good notes. You definitely want the staff at the assisted living to help tackle this problem. Your sister does need to know that bullying behavior will not be tolerated here, and there are serious consequences. You definitely want your sister to get both a full medical and psychiatric workup--with the medical workup coming first. In a well-run assisted living, when management knows that you want to see your sister's behavior back under control and the bullying stopped, the staff is much more likely to do right by your sister and the other residents, that they are less likely to threaten to evict her while experts are trying to figure out what's going on and get her behavior under control. Because, after doing your homework, you might be able to suggest ways to help calm the situation down, using established best practices. Why do you need good notes? Your sister is probably in danger of being evicted--and you might need to get a lawyer to stave off an eviction so that you can get her admitted to a more appropriate place. Also, your observations and notes will be very useful to medical and psychiatric staff who are trying to treat her and get to the bottom of the situation. Keep a log book--document every interaction you have with her and if you think she bullied, you really want to document what she said or did to someone. You will want to keep notes at all meetings you attend on her behalf. If it comes to getting Adult Protection Services involved, the case worker will be glad that you kept good notes.

Good luck. I hope that helps.
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Just to highlight the very unusual factor here: the person needing care in this post is only 61 years old, and her family has been struggling with her physical and behavioural challenges for ten years.

I don't like to pry, but has anyone ever put a name to your sister's difficulties?
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My sister was admitted today to what we believe to be a very good geriatric psychiatric facility. They have assured us the first step they take is to evaluate all her meds through lab/blood tests as well as observe her in individual and group therapies. She signed herself in, but was very angry as she feels everyone is lying about her behavior. That everywhere she has ever lived she has never had any "issues" behavioral or otherwise. Thank you to DoN. I will be sure to have our family read your recommendations. Step one in process!!
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