Hello!
I've learned so much the last few hours perusing these forums. My dad has a long history of mental health issues, his worst being bipolar. He was admitted in June for two weeks on a hospital hold after a psychotic break where they diagnosed him with dementia and changed all his meds. He was home for a few months before it became too difficult for my mom to care for him- unable to walk, incontinent, falling, confused, thinking he was held hostage by women, violent outbursts, etc.
We moved him into an assisted living facility. Within two days he was moved to the lockdown memory care unit. Within one week the police were called because he was aggressive, punched a worker, damaged property, etc. After the police left and he calmed down he quickly became agitated and threatening again which is when they took him to the emergency room.
He's been in the emergency room for one week on and off physical restraints. They say he can't be transferred to a psych unit at a different hospital until he is off restraints for four hours which he has never been able to do. They say the normal chemical restraints aren't working as expected and he's in physical restraints with sitters. When I asked them what the plan was because he can't live in restraints in an emergency department they say they've tried calling all the psych units at hospitals within a few hundred miles and they decline him because of the dementia diagnosis (including the hospital he that he was on a hospital hold in and diagnosed him with dementia just months earlier). They called hospice who evaluated him but they wouldn't take him because of his violence and restraints.
What are our options? I find it hard to believe psych units can decline patients who are clearly having a psych issue even if they have a dementia diagnosis. It seems the emergency department and adult protective services that we're dealing with have no clue what to do with him. He's refusing to eat, drink and take his meds. I'm sure he wants to die because he's spoken that way before. He has signed a DNR and my mom is power of attorney. Would medicating him to a comfortable level and then trying to send him to hospice be an option? I'm sure he has less then 6 months to live.
Also who pays for this emergency room bill? He has Medicare.
Anyone have a similar situation? Bipolar, dementia, psych units and memory care unit declining him? He surely can't come home!
Thank you,
C.
Get angry. Be your father's voice here. He's been given the bums rush and now needs a REAL doctor to take a REAL look into what's happening here so he can get the REAL help he needs.
Good luck!
The emergency MD is who called hospice. I plan on asking today if they think he's nearing end of life. I've checked the criteria and I think he meets it. He's rapidly deteriorating. We were together over Labor Day and he was still able to walk and talk/make jokes. Then I saw him at the end of September and he shuffles, can't sit up, moans all night long, wanders, doesn't know who we are, wants us to call work and say he's not coming in (he's been retired for almost 10 years). During his lucid moments he goes from confusion to paranoia/rage. The memory care facility and the county APS worker have been supportive that he can't come home.
Thank you for your response!
They say Ativan is the only thing that's calmed him down a little, when it wears off he is agitated again.
He doesn't have a neurologist. He was diagnosed with dementia in June. His primary doctor was just a family medicine doctor who was prescribing him what the psych doctor over the computer (tele psych) recommended. Prior to his inpatient hold in June he abusing ritalin and oxycodone which they were prescribing him. When they took these meds away is when the rage escalated and they gave him a dementia diagnosis.
We have a county social worker who is with Adult Protective Services we are in touch with but I'm learning the questions I need to answer from this site.
Thank you for your advice!
Is he on medicaid? I would get an emergency appointment with an elder law attorney to help with this situation.
My mom was one of the extremely agitated. While she was never diagnosed bipolar that I am aware of, I think she probably was. Since I was a kid she had incredible highs and lows, attempted suicide a few times during/after these outbursts. She was kicked out of memory care because of her behaviors. The hospice she was on recommended a care home. She was on chemical restraints. Care home worked out much better from the care perspective and seemed better able to care for her, more prepared for anything mom would throw at them. She passed about four months there.
Beyond that, I have no idea what to say that may help. Hope you find an answer soon. Stand firm, no he is not coming home. It would not be a safe discharge for anybody. Best wishes in finding a solution.