I can not get for the sake of me how a facility can get away with doing so much wrong.

My husband's brother was in a Memory Care Unit four hours away. Due to my husband's own health issues, he was not able to visit ask often as he would like. I feel like it would be very beneficial for someone that is in a facility to be closer to family if possible. Therefore, my husband and I had him moved closer to home to another Memory Care.

Thus, my BIL was only there for a month and the Administrator at the facility "dumped" him at the hospital and refused to take him back. That is illegal. If a resident is sent to the ER for psch evaluation, if that patient is not exhibiting any out of the ordianary behaviors, by law, that facility is suppose to take the resident back. That is not what happened in my BIL case.

Also, if a resident is having any behavior issues, that facility is suppose to come up with a care plan to address these issues. This didn't happen either.

He was not hitting, yelling or cursing anyone. The administrator was tapering his medication and she was not approaching him appropriately. She was very demanding and fussed with him. Obviously, agitating him. So the Administrator feel it was ok for her to just dump him to the hospital.

My husband and I were "verbally" made aware of everything but we could not have anything in writing. She refused to provide a hard copy of anything.

I knew she was hiding something and I was determined to uncover it. Recently, I was able to get the "discharge notice" and she indicated on there that she was discharging him to another memory care unit.

So, she has done a lot wrong here but she got away with everything. Can anyone on here tell me how this happened.

By the way, BIL is doing so good. No behaviors, no falls and communicating very well. The hospital is now ready to find another placement but now this. Thanks you all.

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Shane 1124 Thank you so much for your kind words.
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Thanks you all.
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Whenever I visit these Memory Care Units, this is what I observe.

I always see residents sitting quietly in a wheelchair looking sad staring about. Looking like they are just there.

My BIL on the other hand, he is all over the place. He is in that wheelchair and he is going, going, going. Since he has been in the hospital, they have got him walking good.

BIL has an amazing personality. He loves to laugh, talk a lot to everybody and just busy body. If he can play and cut up he wants to do that too.

Maybe this has something to do with everything. Perhaps, they want him still and hush mouth.

I will say that I have had an Ombudsman and a director over another facility that says he does better if they keep him busy.
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Hi Haileybug! I am sorry this has happened again.

I understand your frustration as I am sure this places a lot of undue pressure on you and your husband on a day to day basis. It’s awful that the only way you get news of events at BIL facility are from third hand sources. You say you’ve seen him and he is the “best he has ever been” regarding his tendency to act out aggressively. You are fortunate to have seen him! Why don’t you give it a try and have him live at your home where his care will at least be consistent and he’ll be surrounded by family? He may do better with this instead for being transferred to several different centers. Are you hesitant due to the fact that his aggressive behavior may occur while at your house? Physically he sounds great, but unfortunately his psychiatric status is considered unstable. You can’t predict his behaviors whether he is with you or at any facility. The possibility exists BIL can lash out and really hurt somebody. You say *no*to that, but it sounds like his behavior over the years does not reflect that BIL has the ability to determine appropriate behavior from inappropriate behavior or control his impulses.
The administrator no longer wants to take that chance. As already stated I will bet in that month there is plenty of documentation. With the administrations decision and his documented history the decision has been made.

I’m afraid this will be the norm for your family. It’s very sad. But if there is one even small hint a resident may get hurt because of BIL, he is out. This has happened twice or so, yes? There is a documented history. Then please, Haileybug, realize there has to be some truth to his adverse behavior & the safety of all in that center is paramount to any one person’s needs.

No facility can be forced to take him either and can successfully cite his history.

Have you considered giving guardianship of BIL to the state? This will take a lot of pressure off your husband in that the state will determine his placement. You may lose control of where he ends up but you have already lost that control. If you can’t take him in to care for him guardianship is an option.

I don’t know why BIL’s mind has deteriorated but I do know having a family member with a mental illness is not easy. My own brother was schizophrenic but very very peaceful and gentle. He took care of my mother at home until she was 86. He had the patience of a saint with her. She did hit him once however in a fit of aggression and he called me very very upset feeling that he was violated by her physical abuse and wasn’t going to tolerate it. He had his limits. I then had to call APS in Ocean County NJ who responded quickly and provided regular oversight with frequent visits until that situation played out as she never hit him again. But that was the beginning of the end for my mom; her dementia & behaviors got worse where she refused to take her meds or bathe. She then broke her hip and had to go to a SNF because my brother could not adequately take care of her. She passed 14 months later from a stroke.

No one is making up incidents to get BIL removed from his last MC. The admin is protecting her staff and her patients/residents from what could be/is a patient with a documented long history of aggressive behavior toward staff.

I suppose I can suggest you and hubby take him in and care for him for a while so he gets consistent care as you’ve stated his bad behaviors are directed to staff and being at home with you may suit his needs better.

Focus your energy on the future. Change what you can. But please realize what can’t be changed which is your BIL’s past behaviors. This will follow him everywhere.

I’ve been on the other side as a mgr who had to get rid of those pts I thought may cause serious harm to my staff/pts. Not hard to do.

Good luck Haileybug. You gets kudos from me for looking after your hubby. You are a very compassionate person. It’s hard for a person like you to cope with this
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haileybug Jun 2020
Shabe1124 Thank you so much for responding. You are always so smart and you are always having good insight on our current situation with my BIL. But please just let me add/clarify dear.

My husband and I would love to take BIL into our home and care for him. Nothing would soothe our hearts any better. The reason we can not is … I'm already a caregiver in the home to someone else and I have to do a lot for my husband as well because of his health issues. Therefore, we are just not able.

You may not believe me but honestly, my BIL is not as bad as they have made him out to be in the past. I could elaborate but that would take too much time. In short though, in the past, an Ombudsman actually went into the facility where my BIL was at before and she actually investigated to see what was really going on. Thank goodness that she was smart enough to listen and believe me and she went to see for her self. After investigating, she called me and stated that everything that I told her was correct. She told me that staff there was disrespecting him and that they were not giving him his medicines like they were supposed to do. The Ombudsman told me that after that facility hired a new administrator and all new staffed that she was so impressed with my BIL behaviors.

BIL actually did not do anything at all that was bad enough to move him out. If he punched someone, then yes. If staff agitated him then, NO.

The Administrator as the last facility saw his history and done an assessment of his needs before she accepted him at her facility. It should be her responsibility to take care of him. If these facilities can address such minate behaviors, then they need to shut down.

I'm just thankful he is doing well at the hospital and they are good to him and they really show that they care for him. I just hope wherever he is transferred, they can carry on.
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This, you need to be very clear about.

You say, for example: "... the Admin tapering his meds and being so commanding, I assume it contributed to his agitation. Thus, this is not behavior that causes a threat to anyone."

No. Not so. The *cause* of a person's agitation is not relevant to whether or not that agitation is a threat. Even if BIL lashed out only because his medication had been too abruptly altered, he still lashed out. He is still a threat.

If he punches a worker because the worker did something careless or stupid, he still punched the worker; or if, God forbid, he threatened or assaulted another resident then all the more so.

If the adjustment in his meds caused him to become fearful or paranoid, he still was fearful and paranoid, and may have expressed that through aggressive behaviour. Any such incidents ought to have been documented; and the documentation ought to be available to authorised persons. Have you (or has DH) seen any, or asked for any?

I agree that the *solution* is to address the medications issue; and that, by the way, will not have been done by the administrator. These are tightly regulated prescription medications, and the px can only be altered by a licensed practitioner.

Hmm.... I wonder... It's not impossible that a keen young psychiatrist was eager to reduce BIL's medication and the care staff were not convinced. I even wonder if some of the incident reports might have said something like "told you so." Only speculation, of course, but it would fit.

So. What now? BIL is in hospital - is the referral to the next Memory Care Unit going ahead? Are you happy with it?

But back to the administrator - bear in mind that she was talking to you about conclusions that had been reached by a whole team of people, and make sure you're not just wanting to shoot the messenger.
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haileybug Jun 2020
Countrymouse Thank you for responding. A Memory Care Unit is suppose to specialize in behaviors. If they can not then they need to shut the doors.

Do not get me wrong, I am not talking about a resident punching someone in the face, slapping someone or cursing. Absolutely not.

I'm talking about agitation. You know? Like we all get at times, especially when someone is bothering us.

My husband and I were told of the events she documented and there was nothing in there indicating he was a threat so anyone.

Example : My niece and myself bought him 2 new coats. Dark green and black. He by chance had put on a dark blue coat. The admin asked for him to give her the coat. BIL told her it was his coat. Instead of Admin waiting for BIL to just put down the coat and then get it from him, she kept insisting he give her the coat.

Example: BIL was being nice by trying to help feed another resident beside him at the dinner table and the Admin told him to stop. Instead of staff just politely getting next to BIL and help feed the resident themselves, she told BIL to stop.

Now do you get the picture. When BIL thought he was doing the right thing, she was approaching him inappropriately.

If she was not covering anything up, why was she refusing to give my husband any documentation although he signed the admissions paperwork as responsible party? However, now that she feels she got away with everything, she is willing to give him the documents now.

Thank you though. You do have a lot of good insight.
Haileybug, I'd be baffled too.

WHY would the administrator suddenly take against your BIL and decide she was going to engineer his rejection by this facility?

Here you have (going on your description) a perfectly peaceable, easy to manage, fee-paying resident with no behavioural issues, no significant problems. By anyone's standards, a complete pussycat.

For what earthly reason would she decide he had to go?

It seems so very improbable, is the thing.

What usually turns out to have happened is a failure in communication. I will give you a parallel example.

We have a client who requires 2:1 support four times a day in his own home. He is unable to stand independently, he is catheterised, and he is incontinent. The care plan covers personal care but also encouraging engagement in PT and regular mobilisation. There's all kinds of heavy duty equipment involved, including a stand-aid which believe me you don't want to run over your foot; but anyway -

This gentleman lives with his (scarcely more mobile) wife, and his large, strong, adult son who has a marked learning disability.

Now, I don't know what happened during the assessment. All I know is that when we workers got sent the scant details we usually receive before visiting a client, there were warnings in red block capitals: MAKE SURE SON HAS LEFT THE ROOM. DO NOT ALLOW SON TO BE PRESENT. DO NOT ENGAGE WITH SON.

"Oh Lordy," we all naturally tended to think.

I am happy to report that things have settled down very nicely indeed. Son is a sweet man who is perfectly able to grasp that his assistance during personal care routines is not necessary now that we are there, but who likes to be helpful. So we ask him to bring us supplies, or to take out bagged-up waste items, and everybody's happy (especially our client, who is protective of his child and sore at heart when people misunderstand him). But the information is still there on the briefing form. It could just say "remind son to leave the room if necessary," but no. Still the dire warnings. Sigh.

Now. The administrator in your question had responsibilities not only to individual residents but also to the resident body overall, and to employees. She wouldn't, in the normal course of things, have had enough contact with your BIL to have wound him up; my guess is that she received reports from staff on the ground and reacted to them. What reports, is the question.

I have already learned that, as a support worker, you have to be very careful what you report and to whom, if you are not going to land your client in trouble. There are seniors I trust with information (there's one I would trust with my life) and there are one or two I don't - they can sometimes get hold of the wrong end of the stick and overreact disastrously. If a client makes inappropriate remarks I have to report it, but I'll generally do so by saying how I stopped him rather than complaining that he made them. If I didn't report it at all, and he did the same thing to a young pretty worker - well, you can imagine. If I reported the remarks alone, the result could also be very negative.

Then again, you see, I am older than most of my co-workers, much less prone to be upset by anything a client might do or say, and perhaps less likely to trigger undesirable behaviours in the first place.

This is ALL about communication. Your response to how this administrator behaved is to decide that what she's done must be illegal. But when you've asked for reasons, and she's cited behavioural issues, have you asked for examples?

There's another key point but no room - I'll have to rabbit on in another post!
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haileybug Jun 2020
Countrymouse Thank you so much for responding dear. I appreciate it so much.
Anybody will get aggressive if you pressure them the wrong way.

And that is all that needs to be.... expressed.....

Nobody nowadays needs to be aggressive.. so therefore, the facility or their employees do not need to be subjected to aggressiveness in any degree.

Didn't quite read the whole issue... but being aggressive in any mental capacity is not warranted, from what I have experienced...... ??
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haileybug Jun 2020
MayDay Thank you. He has not been aggressive but agitated.
Sometime you have to laugh

What does your state say about admissions and discharges from AL and NH?

Unfortunately, if the adminstrator followed the rules and guidelines for the discharge, then you won't have a case.

It is interesting the Administrator would be involved. Usually in places like this administration is far enough from the residents they have little to no contact with them. There are even entry and exit door (s) near them that they can come and go without having to go by any resident.
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haileybug Jun 2020
Shad250 What is funny?

How did the Administrator follow the guidelines?

He was not a threat to himself or anyone else.
He was only there 30 days. No interventions were made.
Was not given a 30 eviction notice.
Lied on discharge notice about where she was discharging him to.
Agree but why did an Administer pick on your BIL. Its not their job to get involved with residents. This really baffles me. The State does oversee them To an extent. Not sure if the Ombudsman can do anything but no harm in trying. If there is a corporate office you could call them and put in a complaint concerning the Administrator. Maybe someone can override Administrators decision.

Like I said, this post sounds so familiar. Maybe there is another poster who had the same problem and was able to get answers. BIL maybe better off in another facility.
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Anybody will get aggressive if you pressure them the wrong way. That does not mean they will be violent or harmful. Doesn't mean they need a pych evaluation either. js
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This post sounds familiar. The Administrator part and all.

ALs residents usually still have their own doctors or use the doctor associated with the facility. Those doctors are responsible for the residents prescriptions and what kind of care is needed. Not the RN in the facility. The RN cannot tapper meds without an order from the doctor. She can't order therapy without a doctors order. An Administrator cannot do this either. Not even sure why an Administrator would get that involved with a resident. I can see him/her having the ability to refuse to take the resident back. In my Moms AL, the RN was responsible to see prescriptions were refilled. She may even suggest that a resident may need a certain med but the doctor needs to prescribe it. An AL cannot monitor someone who is having aggression problems to see if a med is working or not. This needs to be done by people trained in this which means usually a psychic eval in a facility where a person is closely watched. An RN in an AL cannot be expected to do this. Not even an LTC. They too will send someone aggressive to a psychic facility.

An AL is just that. It assists with ADLs. When the care becomes more than an AL is capable of handling, they can then have the family transfer the resident to a facility better able to care for them.

Most ALs are privately owned. Not under the same rules that a LTC facility is.
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haileybug Jun 2020
JoAnn29 Thanks Ms. Joann29
How it happened, likely was this.... and please realize It wasn’t “dumping” per se.... Like he wasn’t pushed out of a car at the entry of the ER. That would be a serious liability issue for the place.

What likely happened was that there was an event that occurred that triggered a call to EMS or ambulance service to come to the MC to pick him up and safely transport him to the ER to see what the problem is.

I’d hazard a guess it was either
- he came across a threat to his own safety & security. & it’s going to be in his chart at the MC. To take him back their gonna want a psych workout to ever even consider this. And they know these are never ever done overnight and the psych work up will take days to do and will show a problem(s) that need to be done outside of the hospital.
- he appears to have had a TIA. TIAs are real subjective.... so slurring, vacant look, more than usual confusion, favoring 1 side of your body, or other mini stroke symptoms.... all could be an effect of a TIA & in an abundance of caution, they are sent off to the ER where they go onto observation, get nice and rehydrated, lots of 1 on 1 care, and then presto! all better in 48 -60 hrs. So ready to go back.

The discharge planner at the hospital calls the old facility that they are ready to send him back..... Then the facility tell the discharge planner that “we cannot meet the level of care he needs” so discharge planner needs to find another facility, like one that deals with stoke recovery or geriatric psych issues and medication management for it.

Total legit play by the facility. Not pretty but legit.
Tha ER run and hospital notes will show something the MC can use to not have him return. “We cannot meet the level of care needed”.

Arguing about it, imho, is a total waste of your time and energy.
What is it that you want? Want to b*itch and vent? This is a safe place to do that as we’ve all been in some way that others have found our elder to be a buttrash. Do you want the administrator to apologize to you? Yeah that would be nice but she doesn’t have to be gracious.

if his old place has an opening, you may want to ask discharge planner to call about having him go back there. If he was doing well there & was there for years (so they know him & his moods) and it wasn’t a care issue that was behind the move, maybe see if he can move back.
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sunshine45 Jun 2020
igloo572  Thank you for responding.  That is not how it went, actually.  He was only there 30 days.  In short to your response, between the Admin tapering his meds and being so commanding, I assume it contributed to his agitation.

Thus, this is not behavior that causes a threat to anyone.  Admin called an said "He has to go and can't come back."  That to me, is a clear indication that she doesn't have a heart.

After 4 evaluations by 3 different doctors, it was determined he was not having any behaviors and the hospital called the facility to discharge him back but of course, She Said NO.

What do I want?  No, I do not want an apology and no, I definitely would not want BIL to go back there.  Lord knows, I would not.  What I do want, however, is for the Admin to be held accountable for her actions.  Her actions are what I call "neglect and abuse."  That is my opinion.

Thank you for responding though.
Sorry - I can't post. The site is glitching and won't allow any corrects, revisions, and won't function properly.

I'll try later.
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shad250 Jun 2020
It is so hard for me to move forward. If my BIL had been given a fair chance and everything went the way it should have on the Administrator's part, I would just get over it.

I'm having a hard time in accepting how the Administrator "played dirty." Then covered things up on her end. It hurts knowing someone so vulnerable can be treated so wrong.

I do have some comfort knowing that the hospital he has been at have some Amazing doctors. I mean they are the best. My BIL is doing so very well. Better than I have ever seen him. For that, I am very thankful.

His Case Manager/SW is working on finding him placement. She too is very impressed with his outcome. She is actually requesting that these Marketing Directors come at look at him for themselves.

Hopefully, he will get placed again soon.
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AlvaDeer Thank you for responding. I appreciate your feedback.
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All facilities vary in their rules and regulations, and upon signing in the person responsible for the person enrolling is usually given a list of things that can result in "discharging". States all have regulations, and regulations vary according to what the designation is. That is to say in some states a "nursing home" is highly regulated while an assisted living is regulated very little if at all.
All of these facilities are "businesses". That is to say they are not hospitals. They all vary in staffing, in training of staffing, and etc. And of course they all would rather have a "placid" and easy person to care for rather than a more difficult one. Those who have elder loved ones with dementias that have a lot of acting out are really up against the wall in what to do. So sorry you are having to deal with this, but yes, there will be little way to prove any wrong doing here, so best to move on.
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