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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.

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Your dad needs a neurologist to really look into what's going on here! Based on what you've said, he's only seen a GP who conferred with an online psych doctor who prescribed meds via computer???? Then given a dementia diagnosis, based on no medical evidence, and after coming off of Oxycodone and Ritalin when the rage episodes exploded? Is that right? If it is, your father hasn't gotten ANY sound medical attention to date! Medical diagnoses coming from unqualified people, dangerous medications being prescribed in conjunction and possibly causing psychotic issues THEMSELVES, especially since they were abused and/ or discontinued abruptly! WHO really knows WHAT'S going on with the poor soul who is in desperate need of real medical help! Insist on having him seen by a neurologist who needs to hear ALL of his history to date, including this "dementia" diagnosis that was issued 5 months ago. He can order tests and scans and such and make a SOUND medical diagnosis based on evidence he collects. Not coming from Cracker Jack boxes or online psych doctors similar to online psychics who charge by the minute!

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!
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So sorry for what your father is going through and the stress it is creating for you and your mother. I don't have any advice, but the sun is just beginning to rise here on the east coast and I'm sure someone will answer with more practical solutions soon. Hang in there.
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Are they looking for psych or geriatric psych placement? A geri psych unit should be able to handle both. Sometimes it takes a while to get a bed, but this seems long. Can you ask the social worker/case worker where they are trying for placement? My husband was very agitated in the psych ER. The chemical restraint was Ativan and Haldol. This seemed to make things worse after it wore off. With the Haldol, he would lose his ability to walk without support. When I asked what else he could get as haldol is not recommended for folks with dementia, the nurse said Ativan and Benadryl. They did not give him another chemical restraint after I asked about the haldol. Can his neurologist help out with trying to secure a placement? Or trying some state agencies for elders or mental health? In my state, beds are so tight you just had to wait until one opened up and he was accepted. I’m sorry you’re going through this - it is a nightmare while it is happening. Prayers for you and your dad.
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nursemom Nov 2019
They seem to be just looking for psych placement. I'll have to ask if and where there are geriatric psych beds available. I know there are psychiatric hospitals that are about four hours away. I plan to ask today which hospitals they've tried to get to accept him and why they are declining.

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!
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They were trying to discharge him to a memory care facility at about 48 hours. They felt he was on all the wrong meds and they changed his psych meds and felt he should be given another "chance to prove himself" before needing a psych admit. Shortly after, he became agitated and needed restraints and since then haven't been trying to send him home. They say it's a difficult case and they don't know where he will end up. My gut feeling is they are trying to stabilize his meds in the ED so they can DC him back to memory care.

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!
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My dad was in hospital ER for about a week while they tried to find him a Geri-psych bed due to his aggression in his memory care facility. He actually ended up getting deathly ill with a fever, nonverbal, unable to stand...it was a uti. He has Alzheimer’s. This is his third time in the hospital due to aggression. The first two times he ended up in a psych ward at a small hospital they really did a great job with him. They also had other dementia patients there...this is in North Carolina. With this last episode it has been a nightmare. I am literally sitting outside of a memory care facility waiting to go in and see if they would except my dad as a resident once he finishes rehab (currently can not find rehab that will take him either due to his behavior so he is still in the hospital and my nerves are shot as usual). There is a huge gap in our system when it comes to mental illness/behavior issues with dementia. I have felt lost. I also wonder what side effects these meds cause. My dad seems to be looking at me like HELP ME and it breaks my heart because I don’t know what to do and it’s hard seeing them be treated almost like a criminal at times. Be aggressive for him. I’m trying to do that for my dad but all doors seem to be closing in my face. You are not alone.
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C, how difficult! You are right, he must not come home. Make that clear to the hospital and APS that is not an option. Have they pressed at all for him to go home? If so, again refuse. Is there a hospital social worker involved? I find it hard to believe that a psych unit will not accept him because of the dementia. I have no idea what your options would be. Hospice won't accept him? Has he been diagnosed by a doctor that he is end of life? Have you checked nursing homes? Maybe they would accept him with chemical and physical restraints.

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.
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Nurse mom- when my husband was given Ativan as a prn when agitated he also seemed worse when it wore off. My therapist said it feels like you have a hangover. This could be happening to your dad. Unfortunately it seems like a guessing game with the drugs sometimes.
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