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I'm not sure if this is a side effect of an increase in dosage on her Exelon Patch, or if her dementia is getting worse. The facility has asked if I mind her seeing their on site psychologist/psychiatrist, not sure which he is. Of course I said I didn't mind. I have a feeling it is just mom, though. She had issues when I cared for her at home, and this is the 3rd incident since she has been in the nursing home. Just wondering if they can make her leave if the behavior continues.

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The short answer is, check your Rental or Admissions Contract. It should say in there what their Behavior Policy is, and what Procedure they will follow as far as notifying you there is a problem. I'm sure they have something like 30 days, or 3 episodes, before discharging someone. As far as providing "assistance" in finding another facility, if current one is private pay only, no, they will not provide help finding a new home, they have a waiting list of better-behaved customers who want to move in. Good luck with all of this. I have several friends whose parents have been asked to leave AL because of behavior, and in onne case, just because they were a lot older than the rest of residents, they wanted more active residents.
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Is sounds as though she might need some meds for anxiety or agitation. Is mom having delusions and paranoia. Have they checked for a uti? Is this new behavior or has mom been assultive in the past?
I would work closely with the facilty and their staff. If they frequenly work with dementia patients, they've seen this behavior before. Of course, if she needs more specialized psychiatric care, I'm sure they'll let you know that.
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Yes, she can be asked to leave, but the facility will need to assist in getting her placed elsewhere. Anyone injured by mom can sue her and her estate, as well, so it's urgent that you get to the bottom of the behaviour and get mom on the proper meds to help curb it immediately. Her doctor should be actively involved right now. If he or she is not, make that call this am and make it your priority to insure he or she takes action today.
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I am currently dealing with the exact same thing. When I read your post I thought I had written it. The place my mom is in told me three strikes and she will be asked to leave. They have sent her once already to the Hopspital ER when she was remanded to their Mental Unit for evaluation for 20 days. She came back with the exact same medication and they did nothing. She went last Thursday to the ER again, but this time they did find a UTI and sent her right back to the home and they said that since she did have an infection they would not count that one. My mother sundowns terrible and gets agressive and aggitated. I have been trying to work the physician also and are trying several medication options that none to this point have helped. I too may have to find a facility that is more in tune to my mothers actions.
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If she is incontinent there is a high probability of a UTI so having her assessed for one should be done immediately. Fecal matter reaching the urethra will cause infection. Since the body does not respond to the infection as they would in a healthy younger person such as burning during urination the infection, groin discomfort the infection can travel to the bladder and eventually to the kidneys and shut them down. The visual indication would be delusional behavior which would be a prompt for assessment of such.

The next probability is that she may be in the combative stage of her disease which will eventually pass. I suggest that you find a facility with a unit that deals with theses specific stages. Visit often so that everyone is kept on their toes. Bring familiar items she had at home to orientate her to the surroundings.

Residents at a skilled nursing facility have their days structured dressing bathing meals, activities and early evening entertainment including physical therapy is provided .The complete acclimation period is about 2 weeks until they adjust and become familiar with the environment and schedule. A structured environment tends to soothe and calm dementia patients.( READ WHAT IT'S LIKE TO HAVE ALTZHEIMERS) on this site.
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I didn't think of the uti. She has these frequently, and is supposed to be on daily Macrobid. I will have to check on that. When she was at home, delusions and paranoia were quite common, and she was often agitated and aggressive toward me. So it probably is the dementia. I am hoping they can calm her with some type of medication. The problem with these in the past was side effects, which were too much for me to deal with as her only caregiver. Hopefully now that she has all of this additional care, they can do something to help her.
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When nursing home patients become violent toward staff, which may or may not be a complication of Alzheimer's (in many cases it is, or some infection going on), they will have them Baker acted for medical evaluation. Ruling out physical causes, the facility will have their medications adjusted. Really, what else can they do.
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Yes, they may notify you that they want to discharge your mother. We went through this with my mom. She was in the Assisted Living community within a CACR that had a different level for "memory care." We were put on a 30-day notice and required to bring in personal daily assistants to help manage mom within the community. They adjusted meds too. However, I realized this was a wake up call that mom is not in the right facility for her needs. Assisted Living isn't memory care and the staff usually can't manage or always trained to meet those unique needs. The community geared toward memorycare was full with a waiting list and ended up being able to manage only those in the final stages.

We did a search for a new community and moved mom to a community geared to deal with individuals with dementia.

I know you are dealing with a lot, but it might be a signal that mom isn't in the community.
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Yes, they can make her leave if they feel she is a danger to other patients and staff, however, let's see what the doctor thinks. I have a feeling if you stop the Exelon her negative behaviors will cease. All of these "pretend" drugs to help dementia create more side effects than they help. I call them pretend because there is NO drug that will stop dementia nor cure it.
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I agree with ferris. If you look closely at the literature on these dementia drugs, you'll see that they are minimally effective at best and come with a host of quality-of-life altering side effects (diarrhea, headaches, drug interactions, etc). They may be worth trying for a younger person with early onset dementia, but for the elderly, there's more downside in taking them than upside in most cases.

The community can certainly ask her to leave. They have to protect their staff, other residents, and even visitors. They are telling you that they aren't equipped to handle aggressive behaviors and you should take that very seriously.

However, it sounds like they're willing to try to turn the situation around and you should work closely with them on that if you like the community and would prefer that she stay there. But, it may be time to look for a specialized dementia unit. Look specifically for one that claims it uses a "resident-led" style of care, where residents aren't forced to adhere to a rigid schedule. That can eliminate at least some of the situations that may incite your mom's aggression – no one forcing her to bathe, go to bed at a certain time, eat on a set schedule, etc. Also, dementia staff are trained and experienced (at least some are) in all the techniques of persuasion that mitigate negative behaviors.
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