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My Father lives in a Nursing Home in South Alabama, has been there a year. He has Dementia, is blind, confined to a wheelchair. He is a Medicaid recipent. Today he became aggressive with a male Nurse. It is my understanding that he was “fighting” with him. They have had a nice relationship before. An ambulance was called to take my Dad to the hospital for his behavior, no injury.


I saw him earlier in the day, his behavior was different.


He has been admitted, maybe a stoke caused behavior. I will know more tomorrow.


Can the Nursing Home not let him return?

I wouldn't quite put it like that, can the NH not let him return.

A nursing home can have very good reasons for refusing to continue services for somebody who needs more care than they are able to provide, or different care from what their staff are trained in. So if something has changed in your father's condition which means that they cannot keep both him and their employees safe, wouldn't you agree that they would be right to say so?

But I also wouldn't get ahead of yourself. What can't happen is that your father is kicked out of the hospital with nowhere safe to go. If the hospital can find out what caused this isolated incident and get on top of it, well and good and the NH should be content to welcome him back; but if he needs a step up to a specialist memory care or dementia care unit they'll work with you to find one.

As your father's advocate, it is only reasonable that you should be given a detailed report of what exactly happened. Sudden aggression could have a clinical cause (uti, stroke) but it could also be that something freaked him out or that he's in pain. You know that the nurse wasn't a stranger to him and that they had a good relationship, so that wasn't the issue; but it would be really helpful if the nurse could describe what was going on - all clues welcome!
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Reply to Countrymouse
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There could be a medical reason your dad was aggressive. It can also be that something changed or happened to make him that way. If he is blind, I would think he could startle easy. And the nursing staff could be abrupt changing his clothes, shaving him etc because they were in a hurry. Either scenario is possible.
My dad got upset when the one cna was assigned to him. He got very agitated when she walked in the room. This happened sev times. At first I thought thats odd, he is fine with everyone else. One time she walked straight into the room and shoved a hamburger in his face and told him to eat. No hand washing. Nothing. That shocked me! She threw bedding on the floor. Nursing homes get fined for that. Other times his face was bleeding quite a lot from being shaved. These were big long scrapes down the side of his face. Like someone pushed down on the razor very hard. This went on for a while. Long story short she was fired I believe. So there could be a valid reason he is aggitated. Not every cna is a good one. My dad got along with everyone else. So there was a real problem.

I would see what is going on with your dad's work up in the hospital first. You can always go to the hospital/that floor's social worker and talk to them. They will help you. You can set up an appt with them too. They can discuss options when he is ready for d/c. Discharge. They are very nice.
A nursing home can say he needs a different facility. There are medical ways to deal with his agitation if it is caused by dementia. He wont get thrown out into the street. The hospital Social worker can help with your concerns and where to put him if he needs another facility. Good luck.
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Reply to Jasmina
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If there is an adjustment to medication made or an infection found (like a UTI which can cause this type acting out) then perhaps the NH would consider it a one off event. If it is something that has been occurring and continues in the hospital, they might feel he needs a different level care. A blind man in a wheel chair sounds helpless but I know seniors can be amazingly strong at times.
I hope they sort his issue out soon. It doesn’t matter to them that he is on Medicaid.
I know this must be very upsetting for both of you.
If he has an infection then he’ll need a little time for the antibiotic to help. Let us know how he is doing.
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Reply to 97yroldmom
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The correct answer is READ YOUR TERMS AND AGREEMENTS. Like any contract of carriage or residency there is certain behavior that is allowed and disallowed based on operational needs(Remember it's a business and NOT your or their home).

When a behavior interrupts the daily operations, causes concern for the well being and safety of employees and other occupants of the place of business a company may take action. AGAIN please read your terms and agreements. Too often we speed through the contract and don't really get to read the small print.
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Reply to donkeehote
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Tillie69 Jan 14, 2019
Just want to say that when a person is in the nursing that is considered their home - not the people who work there but the person who lives there.
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Nnccbb57 - My dad had dementia and was in a nursing home for about 4 months when he became violent toward a male CNA.  (He punched him from his wheelchair.  CNA wasn't hurt)  The NH called an ambulance and they took my father for an 'evalutation' at the hospital.  Then they sent him to a geriatric psychiatric unit for further evaluation and they switched his meds there.  

The social worker at the Geriatric Psych Unit told me that the NH cannot refuse to take my dad back.  After 2 weeks my dad went back to the NH; sadly, my dad passed away about 3 months later in September from dementia.  We are in CT - not sure if laws differ per state

I hate this disease.   Best of luck to you and your dad.
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Reply to LindainCT
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Nncbb57 Jan 14, 2019
Thank you! This pretty much the way it has been explained to me today. Everyone seems willing to try to get him to a place (meds) where he will be calmer. He is healthy, no UTI, blood work good. This awful disease is just progressing, that simple.
I’m sorry about your Dad.
It is a terrible disease.
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There is always the option of geriatric psych ward, if necessary, but beds are hard to come by. (The hospital my dad went to could not even get a patient into a bed directly from their hospital! )
It seems as if there’s medications to calm people down. Have they tried anything? Unfortunately, if he’s a danger to the staff, they might try to transfer him, but they would need to prove that they tried different strategies to alleviate the problem first. In this case, information is power. Read the contract carefully, so you are armed with information if and when the time comes.
Best of luck!
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Reply to Dadsakid
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I do believe a private nursing home, like a private school, can evict a resident for behavior issues. I ran into this problem myself. My father, with only mild dementia but confined to a wheelchair, was creating quite a ruckus because his assisted living fired his favorite nurse. He drew up a petition for residents to sign, yelled and complained. Eventually, during a resident meeting, he slammed a door so a staff member could not leave and then said he would rather die than live without the nurse that was fired. This admonition that he would rather die was their excuse to have him committed. I was called and told I could take him or they would call an ambulance. I took him. He was in the psychiatric unit over night. The next day he threw a fit on me about being in the "looney bin". I concluded that it definitely was not the place for him, but doctors there did not immediately agree so I took him out Against Medical Advice. That may have been good for him, but it sure was not for me. The AL would not take him back without a written release from the psychiatric unit and the psychiatric unit would not write one, nor take him back, because I took him out AMA. I then took him to our local hospital who would not admit him to their psychiatric unit because he did not meet the criteria! After a week of Hell caring for my demanding father and on the phone trying to figure out a way to get my Dad back into the AL they agreed to sit down with us and discuss it. They were very firm with my Dad and spoke to him for an hour or more. I think they kept him out just long enough to make a point with him and to let the other residents settle down from the chaos he had created. That was 2 years ago. He has been there a total of 7 years. As long as it is a private institution I believe they have every right to evict them. That may not be true of a facility that accepts Medicaid.
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Reply to kmichmom
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Unless this has been ongoing I would doubt they would evict him.
Once he has been evaluated and the reason for the incident resolved I would think there would be no problem letting him return.
It could be anything from a UTI, the Nurse could have surprised him and grabbed him and he was not expecting it. It could have been a stroke...
The balancing act is they have to keep residents safe as well as the staff.
By now you have the evaluation.
I am sure if it was anxiety an adjustment on medication could resolve the problem. If this was the first incident I doubt that they would evict someone based on that. There must be written policies about behavior problems and what they do to correct the problem before a resident is evicted.
Please let us know how this was resolved.
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Reply to Grandma1954
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My understanding is they can not make him leave unless there is another facility for him to go to. I know of a person who is terribly disruptive and they have asked his caregiver to find another facility - it has been 3 years and he is still there - still causing problems - I would advise reading the contract and seeking senior legal services. It appears that his behavior will follow him to where ever you place him. Do they have a psych person at the facility that can evaluate medications that may help calm him down? Have you talked to the doctor about his behavior and what steps they can take to modify it? Good luck - Hold strong
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Reply to montanacmm
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IsntEasy Jan 14, 2019
He's already out of the SNF. It's the hospital that can't release him until he has somewhere to go.
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Yes, it is possible that they would refuse to allow him to return. However, since he's been there a year and they know him to be normally non-violent, they will likely give him another chance, particularly if he gets a diagnosis that explains his change in behavior.

But, they cannot endanger their staff nor their other residents. If he has had more subtle incidents and this was an escalation, they may not let him return. He would have to be admitted to a specialized unit. The hospital or his SNF can refer.
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