We've recently moved our mother into a memory care facility. Everything happened exceedingly fast. She went into a fast decline within 3 months of living independently to a two-day hospital admission to a two-week rehab stint for PT where she was "combative" as in physically violent then transferred to a geriatric psychiatric facility for 2.5 weeks for further evaluation (UTI was discovered) and medication adjustments (she's now on four meds for dementia/depression) where we just now moved her into a memory care facility. We were told by the Ger. Psych she was non-combative and med compliant though she sometimes didn't want to eat and did not like attending therapy (but went) and had suicidal ideations stemming from depression but talked about them. Two social workers at the facility felt she was an excellent fit for memory care despite these issues as memory care would definitely help. Two days after arriving at the memory care facility, the director contacted us as we had major concerns about her previous red flagged behaviors at rehab and she assured us that our mother was compliant and sweet though confused and suffering from another UTI so she wasn't eating as well. My mother did visit with several other residents for the first two days but as since opted out of a therapy group and has isolated in her room likely from UTI symptoms. A doctor just called my sister to tell she has serious concerns about our mother's behaviors and mentioned she had all sorts of red flags on her geriatric psych evaluation and wasn't sure about her ability to stay as a resident because she's so combative. You can imagine we were both all kinds of confused since none of her behaviors at the psych facility were described as "combative" and had been assured by her doctors, nurses and social workers at the ger psych facility she was doing well and there were things to work on that memory care could help improve including depression and isolation. She's only been there three days and is settling in but is expected in the midst of a UTI to attend a group therapy when she hasn't even started medications antibiotics. And UTI's tend to impact her appetite. So, is the term "combative" a catch-all phrase to describe not only aggressive and violent behaviors but also if she says not to attending therapy one day or eats less? My sister is sobbing because she's terrified they're going to kick her out and she's not even been there a week. She said the doctor was extremely pessimistic about my mother's chances. The only thing we got out of it was a promise to get a urologist on the books to see if we can find the cause of her recurring UTIs.

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As long as she is suffering from these recurrent and apparently NOT FIXED UTIs she is going to be this way. Meanwhile she should be in skilled nursing. No one can know WHAT she will be like in memory care with these infections.
As to the doctors assessment of pessimism, what exactly does he mean by pessimistic "about Mother's chances". Chances of WHAT? Recovering from UTI, being OK for memory care? If she is going to need placement in psychiatric facility this is not going to be something you can do on your own. Just tell them you don't know WHERE they can place her, but she has no home to come home to. They are going to have to get a discharge/transfer plan together, or a treatment program.
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Thank you everyone for your replies.

She's been transferred three times because everything fell apart so quickly and we had not setup for her care as she was living in a house by herself until late December. It's such a long story of how we got here and trying to play catch up to the fallout. The UTI was diagnosed Thursday a day after her arrival because one of the nurses noticed she was walking lopsided and sitting funny and also wasn't eating much. So they had her tested and started antibiotics today. She's had three UTIs in the span of 6 weeks though she's likely had quite a few this year. She's been lucid enough most of this year to resist any and all efforts at seeing a doctor. She never saw doctors while she was well - never. Only in emergencies.

My sister emailed the director at the mc facility who has reiterated my mother is not being combative but is isolating and upset about the UTI which has apparently contributed to an incontinence issue (she hasn't had this prior). Because I am out of state, my sister is dealing with the doctor but has clearly reached her limit with everything that's happened in the last six weeks which doesn't account for the last three months of hell of trying to get my mom help which she has refused and lashed out at my sister and brother-in-law. So, I insisted when the doctor calls back to conference me in asap and I will get on the phone with them and make sure we have better answers and clarification (what is this "therapy") and will take everything everyone has said into account going forward especially the preventive measures for UTI. So very grateful.
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Take with a giant grain of salt the words of any doctor who doesn't know your mother well. I've had more problems with doctors who know everything about my mother after being with her for five minutes.

1. Her new PCP at Kaiser said she needed more exercise when she was ghostly white and had no energy. Turned out she was severely anemic and ended up in the ER later that day and was admitted for five days and five pints of blood was transfused into her.

2. Her most recent hospitalization was for a high fever due to a leg wound that had gone septic. The doctor there diagnosed her with pneumonia and it miraculously disappeared 24 hours later. (She was nonetheless hospitalized for an additional 10 days for the leg infection.)

3. A cardiologist who hadn't seen her in four years was brusque with her and didn't understand why she wasn't more upbeat and answering his questions. I pointed out to him FIRMLY that she was a widow of two weeks and had dementia, both of which were written in her chart.

4. The only exception to the five minute rule was my mom's PCP of 30 years who was way beyond her time to retire. She told my mother she had terminal cancer because she'd had pleural effusion that couldn't be explained any other way as far as she was concerned. She did no tests to come to that conclusion, and my mother spent 24 hours feeling suicidal that she was going to have to go through another bout of cancer 20 years after the first one until she had a simple sonogram exam that completely ruled it out.

I know you didn't want a list of anecdotes, but if I can come up with four examples right off the top of my head, trust me -- doctors have a tendency to do these snap diagnoses with very little evidence. As others have said, really grill this guy and get very specific examples of what he's talking about. Point out the contradictions with the other staff. **Ask him how many times he's seen your mom.**

I guarantee you, he'll start backing off.
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notgoodenough Feb 2021
"I've had more problems with doctors who know everything about my mother after being with her for five minutes."

Ain't that the truth!

I work with a man who came to work one day and told us he had pancreatic cancer! After talking to his wife, however, we found out he was diagnosed by Rheumologist, who, after running some tests couldn't find out what was wrong, and said "it must be pancreatic cancer." No tests, no scans, nothing like that - just a hunch on the doctor's part.

Needless to say, after seeking a second opinion, it wasn't pancreatic cancer.
You know, I have the utmost respect for doctors. I think the majority are really trying their best to help their patients, while slogging through the quagmire of our health care system.

But then, every once in a while you find one that is, how shall I put it - less attentive to details than their comrades.

So, in dealing with this particular doctor - I agree with SendHelp. Question everything. But ask for specifics. "Doc, you say she's combative. Give me an example. What was she doing before she became combative? What was she being asked to do when she became combative? Combative how, exactly?"
There's a great scene near the end of "Look Who's Talking" where Abe Vigoda is playing a resident in a care facility, who was mistakenly given too much chocolate, which made him combative. Could it be a similar situation with your mom?

I would also "name drop" to the doctor. "You say she's combative? That's strange, when I spoke to the director yesterday, she told me mom was compliant, sweet and suffering from another UTI. Do you think, Dr. so-and-so that maybe it's the UTI that's making her behave the way she is? I have heard that is often the case, as I'm sure you must know, being a doctor who works with elderly patients..." and so on.

This is what others here talk about, when LO's have been moved into care facilities - being an advocate for you mom. It's as much a calling as providing at-home care!

Could it be, perhaps, this doctor doesn't want to take the time needed with his/her patients, and hopes by suggesting mom "might need" to be moved you will be proactive and move mom out?

If you can't get any sort of specifics from this doctor, I would not hesitate to bring in the director and ask them to get clarification from this doctor.

Good luck!
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Question everything at this point.

5 places, in 3 months?

You can do this. Sorry this time seems so chaotic and difficult.

Following a UTI and treatment with antibiotics, it is common for a yeast infection to occur. So check that out too. There are treatments for that too.
Some are over the counter.

I agree with JoAnn, probiotics, cranberry juice to prevent another UTI. Another treatment to prevent is D-Mannose, over the counter.

What is the delay in having her medicated with antibiotics? Cannot let this go even 3 days, dangers of sepsis. I am going to assume she is being treated by now?
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When Mom was in an AL they suspected a UTI. You know why, she hit the aide with her toothbrush. Out of character for my Mom. Wonder if this Doctor would consider Mom combative.
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What kind of therapy session? Mental or physical. With Dementia a mental therapy session will not work. Anything discussed will be forgotten at least by the next day. Physical? They cannot make her do anything she does not want to. Is she being "combative" because they are trying to force the issue. I am pretty sure that forcing her is against the law in all 50 states. And this is why, she is a resident. This is now her home and because of that she can't be made to do anything she doesn't want to.

The UTI, it needs antibiotics. It does not clear up without them. She will become combative if its not cleared up. I would suggest that you ask that she get a probiotic and cranberry tablets to help prevent them.

This doctor needs to talk to the doctor who released her to the MC.
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This is the doctor you want controlling your mother's care?
" She said the doctor was extremely pessimistic about my mother's chances."

Hold on a did really well to get a urologist for your Mom.
You do not say her age. But that she was living independently.

Can you have her seen by the previous Ger. Psych? A rapid decline due to an UTI.....there is hope after the UTI has cleared.

Do not give up hope. And focus on getting her a proper doctor maybe?
Learn all you can about UTI behaviors in the elderly. They cannot describe their symptoms I understand. And there could be delirium. And she was just transferred, how many times? (Take someone with Dementia and move them, there will be confusion.) She may not be able to return to her previous independent self, but improvement(s) can come and go. Each case can be different.

As far as the term "Combative", it can mean different things, and behaviors can be changeable.

It can mean uncooperative, swearing, verbal only, or include kicking, biting, spitting, aggressive to staff, pushing, resistant to care. Find out by asking the director to explain what the behavior is that is combative.

Can you visit? Can you take her out to a doctor's appointment? Does she know you or your sister?

There will be help for you here. Keep talking to the caregivers here. I do not have actual experience with a loved one in memory care, but was surprised to hear the term 'group therapy'. Really?

There are patient advocates for anyone in a facility. There are Ombudsmen.
By law, the facility must provide the contact information. You might need to do this for your Mom. One can get lost in the system with such a rapid decline.

It is good you have your sister in this with you, so ban together at this time.
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