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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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My Mom is in the Geriatric Psych Behavioral Unit as we speak. She was just moved into a memory care unit around the 1 st. Of Aug. She made it 3 weeks there before being sent away. This is her 2 nd. time in a behavioral unit. Last time was a year before when she broke her pelvis and back. She popped somebody on the hand and said "get away from me," and off she went. She was a Sunday School teacher for 50 years. I realize this is all just the dementia/Alzheimer's like they say, but it doesn't make it any easier! We are on day 7 today. She is fine until Sundowners kicks in every single day they said. I have taken care of her in her home for 6 1/2 years almost 7. I brought her to work with me at our family store. We are private pay and Memory care is holding her bed. This isn't even our 1 st. Rodeo, but it is still hard. I want to know what happened with Faith!
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Geriatric psych units are not all bad. Some are very nice and people may live there for varying periods of time.

Psychotropic drugs work differently on different people. And initial results may chang. Dosages may need to be adjusted or medication changed completely. It sometimes takes awhile to get everything adjusted.

A nursing home cannot keep a patient who becomes a danger to themselves or to others in the nursing home community.
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Please get the medical cleared before taking further actions. She may have a
UTI (urinary tract infection) as well as the fungal infection on her legs? Did she arrive at the NH with her legs infected?

If this is the case, the NH is liable for neglect medically, so they might be taking
the best route to cover their xxx.

Is this the first you have heard of this? (One month, behaviors, refusing meds, leg infection?).
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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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Yep, if she is deemed a danger to herself, the staff, or other NH patients! If her condition is really bad, she could be in a psychiatric facility for a long time.
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I can only go by previous a family member. I would first look at the paperwor or contract very closely of nursing home. I would try to see on why and what conditions she has presented to them and came up
their opinion came to release/discharge her to a particular type of nursing facility with routine observation. Is it legal, I don’t know.
If she ends up their, look at what type of services they going to provide that the other couldn’t. Did she present such symptoms or maybe they just didn’t want to deal with it any more . All I know is my uncle got discharged once; I call it booted from a nursing facility once. He ended up at another nursing facility and appeared to get along well there well with people and management. Try to look at it from all angles kind of like the 5W’s and a H: Who, What, Where, Why, When. The H is for How you are you going to come with your best decision based on the criteria given to you now resting on your shoulders. Hopefully you will come up with rationale decision that you feel good about given the circumstances.
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Yes they can discharge a patient for various reasons.

One being they do not have a lockdown unit to deal with combative patients or those who wander off.

They likely need the psych evaluation to have her placed in an appropriate, properly equipped facility.
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The issue is the insurance paying for two facilities.
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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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I’m confused by some answers. Can a NH force a patient to go to a geriatric Psych Hospital? Some answers say “YES” and some “NO.” It would seem that if the resident is combative and non compliant they cannot allow them to remain in the facility. Also, it was stated that if the person receives Medicaid they will be placed in another facility if their room is not held, but if they are private pay the family will be on their own to find another facility. Is there a concrete answer to these questions or does it vary from state to state or facility to facility?
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suiee7005 Aug 2018
Check with medicaid in your state because the nursing home may be required to hold a bed in theither facility for a period if time due to hospitalization
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Yes I know someone who’s husband was in nursing home for several years & got very combative w CNAs so they had to send him to Bklyn psych ward ...he got medication adjustments & then came back to same nursing home much calmer! Unless you want to deal w this at home, Seroquel is the answer . Hugs & blessings to you
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Babs75 Aug 2018
Seroquel got my dad so calmed down. We didn't know what we were going to do and there were no beds at the psych hospital (very limited where I live). He's still gets worked up about stuff but his level of anxiety has dropped drastically.
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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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They will try but you have to stand up to them. My husband is a lawyer and he has had to push back against nursing homes that have tried this. They’d keep calling and he would keep refusing. Hire a lawyer if necessary. The psyc hospitals are useless in my opinion for seniors. they either don’t follow up with the medical instructions going forward plus it’s almost impossible to find a nursing home to take you once you’re in one.
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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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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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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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Faith,
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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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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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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