My MIL is in a nursing home with dementia about a month now. She has always been nasty, argumentative and combative. Now she's at a whole new level. She is refusing her blood pressure medicine and it's sky high. So far, we've dealt with her throwing out her clothes nightly and not changing into her bed clothes. Now I find out she hasn't had a bath and will not allow a nurse to help her change. She throws the nurses out of her room.

The nursing home wants her to go to a Geriatric Psych Hospital where I am sure they will restrain and force her to do these things. They say that she needs 2 weeks in a psych hospital but the home may not necessarily be able to hold her bed 2 weeks. My husband and I are a wreck. The home makes it sound like there is liability for them because she won't co-operate. I get that the bathing problem is huge. Right now she has a fungal infection on both legs. Can the nursing home force her to go to the psych hospital? Can they become so fed up that they simply evict her? We've closed up her apartment. And what happens if the bed is gone in the nursing home at discharge? Does she stay in the psychiatric hospital or go to a different nursing home if her bed is no longer available? Can they evict her and send her to us? I have medical issues and won't be able to handle her. We are meeting with the social worker and nurses tomorrow. I just had to reach out to see if anyone else has dealt with Geriatric Psychiatric hospitals.

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I want to clarify-a psych unit in a hospital is different from a psych hospital. The nursing home told us that if Dad had too many incidents of dangerous behavior he would be transferred for a psych evaluation in a hospital for just a few days. Then have to go to a nursing home equipped to handle him. If the nursing home keeps a patient that keeps trying to leave, or is combative and they hurt another resident or staff member, they have to report it and go through investigations. They also may be liable for any injury caused.

It is so hard. I think of it this way:
My Dad lived for at least 80 years taking care of his personal hygiene.
with the onset of many little strokes causing vascular dementia, reasoning left town.

His recent evaluations, psych meds added and tinkered with have made it possible for him to live somewhere safe, where others are helping him be safe. He has gained 15 pounds because he is eating, he smiles more, and we can have a good conversation with him for at least 1/2 hour. He is not drugged, and he is not pulling fire extinguishers off the wall to protect himself now.
It is what is needed for some dementia patients so they can function with other people.
Our elder law attorney said, “No one can force you to take him into your home. Stop worrying about what might happen. Focus on what needs to happen now-one thing.”

I am glad you are meeting with the social worker at the NH. Just don’t allow them to tell you that you have to take your mother home. Let them tell you the options.

i want to add this. Even with dementia, delusions and aggressive behavior, I calmly talked to Dad about trying to walk out the door. I told him that if that happened, the sheriff would be called, and he would be taken to a behavioral unit for evaluation. And he might end up in a place with less freedom than he has now. He understood that, and has not left the building, although he did somehow remove his ankle alarm.
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Seroquel was a miracle drug for my mom when I was caring for her at home. But this changed when she was moved to a memory care facility.

Always remember meds will work differently on different people with the same diagnosis. Seroquel works great for some and will make some worse. My mom could not take ativan, it had the completely opposite effect as intended.
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The nursing home cannot force her to go to a psych hospital. But they must feel she is a danger to herself, their staff and perhaps other residents if they’re recommending she go. Yes, they can evict her. If her mental issues aren’t taken care of, no other nursing home will accept her, or if they do and she acts out again, they will evict her as well. Even in the lockdown units, they can’t keep patients who are combative and could put others in danger. Staff cannot spend endless time with her. They have other patients.

Take a breath. You say you cannot have her in your home. Has she been tested for a urinary tract infection? If she’s not bathing, that’s a possibility. My mom had chronic ones. She needs to go to the geriatric psych hospital to be evaluated and possibly have her meds changed. It’s not a pleasant thought, but seriously, what other choice do you have?
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My Mom being in a Geriatric Psych Unit was a positive experience.

No restraints were used. Her mood WAS stabilized with meds.

No, she was not an over medicated zombie.

Mom stayed in the unit for 10 days. It was a very peaceful place. Mom actually wanted to stay longer.
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Its serious when they suggest this. It all has to do with her being on the correct meds. Easier to determine what works and doesn't work. I doubt they would discharge Mom without you having a place for her. My daughter works in a NH as an RN. She says there is a point where its quality over quantity. Wouldn't it be better for her to be calm than fighting all the time. Anxiety is not good for them either.
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The same type of thing happened to my mother. She was screaming, yelling, pulling nurses' hair, "I'm in jail, help", and refusing meds. They sent her to a geri psych unit for 10 days. I, too was a wreck that they would not hold her bed, but they told me "this is her home, she'll have a bed". Got over that hurdle, then had to drive two hours one way to see her. If you've never been in a geri psych unit (I had not) it's not pleasant. There are a lot of folks there a whole lot worse than what I was dealing with. I hated her having to be there, I hated the atmosphere and I hated everything about it. That being said, they did a WONDERFUL job with her! They took her off all meds and slowly introduced a few back. This happened in June of 2017 and she's been great ever since. The psychiatrist who worked with her was one of the best doctors I've ever met (I work in a hospital!); kind, genuine, and more than willing to talk at any time. So, if it ends up that your MIL has to go, try to keep an open mind and know that they really do have her best interests in mind. Good luck!
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In short, they CAN force her to go to inpatient psyche unit. They can do so by having their doc “certify” that she needs it. Having said that, she probably does, based on what you’ve said. But it would be a good thing for her, most likely. They are very skilled in managing people with dementia and associated difficult behavior.

Regarding not holding her bed, they may not. It depends on several factors, such as insurance and money. If she’s private pay, maybe they would hold the bed because they don’t want to lose that income. If she’s on Medicaid they are obligated to hold it a certain number of days. However, if they just don’t want her there, they can get away with not letting her back in. That happened to my husband, and we had to scramble to find a suitable facility.

So so sorry you’re going through this, these are very tough waters to navigate. Whether she stays there or goes to a different facility, the in patient geriatric psyche stay would most likely benefit her and you. Good luck!
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It is unlawful to restrain any patient and doc's are hesitant to prescribe it. MIL is a danger to herself and others, my mom was too. The Geri psych hospital will monitor her closely and work with her to determine what combo of meds will relieve her agitation and anxiety. Through that process MIL will become less agitated and more cooperative. For some additional psych assessments are necessary.

They will request that you not visit for everyone's safety. It is a process to figure out what will help her. With right meds the pros will be able to adjust them as needed, usually without a second psych assessment.

Yes they can evict MIL. My mom was. She was on hospice at the time and they recommended a smaller care home, less institutional and much more comfortable for mom. She did better there and died after about six months there. Mom was heavily medicated, but she had to be for her own comfort and safety. The care home mom was in was a bit cheaper each month and had a better staff patient ratio. And ALL of the residents there had been evicted from previous facilities due to behaviors. Maybe you do not want MIL to return to the place she is now. Maybe there is a better facility that will be able to better provide for her needs.

My mom also had to have a sitter with her on and off over the three years that she was living in facilities. The facilities also can demand that if it turns out that the meds do not have the desired effect. The sitters are private pay so care can get very expensive. Just a heads up.

This is very hard on our folks and the families. Sometimes it just has to be done. Call your Area Agency on Aging to find out about care homes in your area.
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My brother became aggressive and violent in his Memory Care unit and was eventually transferred to a geriatric psychiatric hospital for his own safety and that of the staff and other patients. The goal of this temporary placement was to adjust his medications to alleviate the negative behaviors. They did not use physical restraints there as the new medications acted as a chemical restraint. He was eventually able to return to his former Residence. He was pretty well zonked on the medications but the staff were able to provide his care without fear. If your MIL is as aggressive as described, there is no way that you could care for her at home. I doubt that the professionals would suggest this, but if they do, just refuse! Good luck.
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She needs to go to the psych hospital for meds to be trialed, not to force her to do things. Start there.
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