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My Dad is becoming increasingly aggressive and an in home caregiver was mildly injured by him pushing a table against the wall in his anger. (Her finger was jammed from him pushing the table.) I get calls and texts all throughout each caregivers shift and other than commiserating, and offering various solutions —most of which are redundant because they’ve already tried them—I’m at a loss as to how to help or what to say. That’s the job, the very difficult job of dealing with my dad who has mental illness, advanced dementia, lives at home in a rural area far from services , too poor for memory care, on Medi Cal with In Home Support Services, too physically healthy for a nursing home to take him on. He’s 6’3”. I’m his conservator living 8 hours away. There are not many caregivers in his remote location, I fear that we will burn out the few that are willing to come.

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I think your are justified in your fear that you will burn through your caregivers. To me the constant updates are a way of giving you notice that they can't handle it and things need to change, once it becomes clear that you are essentially throwing up your hands and telling them it's par for the course I wouldn't blame them if they walk.
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Darlin Jan 25, 2020
I’m definitely not throwing up my hands, nor have I given her that indication. Aggressive behavior and paranoia are part of the disease. I’m looking for resources and ideas to keep him calm.
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You have been given good advice. However you seem to not want to believe it. The caregiver, if serious incident occurs, should call police to attend. This will very likely involved a hospital stay in adult mental health ward where he will be evaluated. You father cannot stay at home anymore. Is it his dementia that is the problem or his other issues.
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You need to address the issue of your dads behavior. He’s on medi-cal So he’s eligible for financial assistance for AL living or memory care. Has he had psych evaluation recently to see what’s going on? If he’s on medication, maybe it needs to be tweaked. If he’s not on medication, perhaps there is a medication that will with his behavior. Because the truth is, you either need to get his behavior under control or get him placed in a facility. He cannot be having violent outbursts with the IHSS workers. They will refuse to work for him. These workers are not trained professionals and they aren’t paid nearly enough to deal with this type of work environment.
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NeedHelpWithMom Jan 24, 2020
It’s not fair to these workers to be placed at risk for being harmed from his outburst.

Cali, I wholeheartedly agree with your post. He needs an experienced professional staff caring for him.
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My tiny well mannered mom became violent and used swear words I didn’t know she knew. The dr suggested she go into a psychiatric unit to try different meds and do some diagnostic tests. They found her vision and hearing had declined. Her medication has been changed to mellow her out and the cares givers have been trained how to approach her. I do believe she was scared and startled with the caregivers.
It might be worth a try
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Darlin Jan 25, 2020
This has been the most helpful answer— thank you!! Someone that has dealt with this is what I was hoping to find.

My dad would have to be tied down to be in a hospital. This was our experience 4 years ago. The courts demand I keep him in the least restrictive setting.

If this continues or worsens I imagine this it what his doctors may suggest.
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With advanced dementia and mental illness, seems he would be a perfect candidate for a nursing home. Or better, in a memory care unit, usually a subset of a nursing home or assisted living facility.

As others said, he either needs to be medicated to get his anger under control or moved into a facility where they will most likely do the same thing with fixing his meds to control unacceptable behavior.

This is a very difficult situation but it does need to be dealt with somehow.
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The category does not matter. We all see every post.

YOU need to find the solution to the problems dad is having. That is not the caregiver's job. She lets you know what is going on because she is screaming out for adequate assistance for your dad. She is not qualified or authorized to do that. She needs YOU to help your dad.

Rural areas are awful for finding necessary medical services. You need to get dad out of there and into adequate care. Yes, this will mean you have to put in some effort to get dad the care he needs. You will have to dedicate some time to do this, or hire a geriatric care manager.

Before you say "MediCal does not pay for assisted living or memory care", it does not sound like you have checked into your dad's situation specifically. Are you relying on hearsay? Every state, including California, has a waiver program tlas part of Medicaid to get people like your father the care they need.

You need to be more assertive and inquiring about getting the services dad needs. Are you in denial that it could be as bad as the caregiver says? You need to tackle this problem head on to get it solved. Yes, you will need to spend some of your time to do that. And best get it done before someone is seriously injured. When finally setup then you can sit back knowing dad has the care he needs.

Sorry you do not like the answers you are receiving here. You are getting reality. Yes, it is inconvenient for now to have these problems. They will continue and will worsen with time. How long are you going to wait?

Who is the Power of Attorney? Conservator takes care of money most places, not POA decisions such as where someone will reside.
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Darlin Jan 25, 2020
Wow! Seriously?!
You clearly do not have have any clue what a conservator is?!!! Look it up! I spend several hours every single day on managing my dads care, and every detail of the many agencies involved.
The waiver is for just a few counties and neither of us are in those.

I was just there last weekend. I go up every two months.

I appreciate you taking time to add the links. I’ll check out the ones I haven’t previously.

But....Your words are harsh and lack compassion. That is NOT helpful. Assuming I am uninvolved and not putting in effort is a stab in the heart. Ask my husband how much effort I am putting in!

This forum is too support each other not shit on each other.
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I had a similar thing with my father. Turns out he had ALZ. He too would become physical to the point of punching the nurses. At some point he actually was able to overturn both my mom and himself over in the walkers they were using. I called 911 for help, and they took him to a psychiatric facility. There they were able to change medications for the better. After that they tried to move him to a rehab center, but instead he went walking out of the place in his PJs. It was quite the journey. Next time something happens and someone gets hurt, call 911.
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Has he been diagnosed with a particular type of dementia?
Some dementia there can be more violent episodes. This can be very dangerous for caregivers. Are caregivers with him 24/7/365?
At any point one of the caregivers may decide to call 911 due to a violent outburst.
Is your dad a Veteran? If so the VA might be able to help with either in home help or placing him in a VA facility if he qualifies. (it would depend on where and when he served)
Is his doctor aware of the violent outbursts?
Has medication been an option?
(the reason I asked about the diagnosis is LBD (Lewy Body Dementia, it has Parkinson's type effects as well) can be difficult to medicate)

On a side note please make sure that no weapons of any type are in the house and lock up any knives or any tool that could be used as a weapon.
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He needs to have a thorough evaluation for his behavior. I agree with Cali that his situation must be addressed. Yes, caregiving is a tough job but the requirements shouldn’t be that they accept abuse due to his behavior.

You will regret it one day when they file a report one day of abuse to the police. Wouldn’t you become frustrated if you were in the caregiver’s situation? It isn’t fair to them.

Has your dad seen a geriatric psychiatrist? There may be medication that could control his behavior.

I personally feel he should be in a nursing home with a professional staff. Do you have any power of attorney regarding his welfare? If you do, why aren’t you advocating for a solution to his needs?

How long has this been going on? You are right to be concerned about his caregivers burning out. I would be just as concerned about their safety. No one deserves to be at risk for being harmed.
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Reply to NeedHelpWithMom
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Exactly...if you fear losing them, they are calling out for you as next of kin to help. I'm sorry for the remote location, but clearly you need to connect with some better resources and possibly consider a move where he can be monitored and better taken care of.
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