Mom hit the health care aide repeatedly during an escape attempt. What to do?

Don't accept her back

It sounds to me like her Alzheimer's may have advanced beyond what an assisted living can handle. She may be at stage 6 which requires a secure caregiving situation like a memory care unit.

https://www.agingcare.com/articles/Stages-of-Alzheimers-disease-118964.htm

Medication for depression and schizophrenia changed my mthr's outlook so much, I wish she'd had this 40 years before! Yes, it does raise the risk of falling and other things which lead to an earlier demise, BUT- now I've seen the ladies who have advanced dementia, who are curled into a ball, who have to be shifted every 2 hours. I would prefer to go earlier rather than later if I have dementia, so improving the quality of life and making me happy is a greater concern to me at that stage than keeping me healthy so my non-functioning brain is kept alive. It's a quality of life issue, really.

You don't mention your mom's age or if she has dementia? Often when the elderly are moved to a new place they are out of their comfort zone and act out inappropriately. They often say they want to go home - but home is something their mind has created where they can be comfortable. My mom couldn't find words to say what she wanted or needed. I remember my mom saying she wanted to go home 10 times a day when she was in the home where she lived with my dad for 35 years. Although my dad was deceased we did change anything in the home to keep her feeling comfortable. As Alzheimer's progressed her home of 35 years was not her home or comfort place in her mind. She would try to escape by hitting and slipping out the front door to wander the neighborhood until we put locks she couldn't open on the doors. A few times I would say okay let's go home and you show me where that is when we get in the car - We would drive around and it would calm her a bit but then one time she just started crying and said I don't know where home is. It's devastating to have a loved one with dementia. Later when she was in the last part of life and was still hitting out and being hard to deal with and trying to figure out what could be causing this behavior - one doctor just wanted to up her medication and add other medications - that just made it worse. One day we saw her sleeping and she had her face all scrunched up like she was in pain. The doctor stopped all the other medication and began giving her pain medication under the tongue and right away the behavior stopped. I am sure this isn't the solution for everyone.

I see from your profile that your mother is 90 and has Alzheimer's. Has she been seen by her doctor recently? If not, I think she should.

Sophe, you call the Head Nurse at Assisted Living and get mom sent to the ER as a psychiatric case, ASAP. NOW. If you don't you can be sued by the people she is whacking. Personal Injury lawyers would have a field day with this case.

She should also be tested for a UTI in the ER.

Great ideas. I really get great help from you-all. Pagstegman, I was wondering about legal ramifications...excellent point. I visited today and she has been given some Xanax finally to calm her down. But I will leave instructions with the head nurse to have her transported to the ER the next flip-out session she has. Good idea.
Sjolley2, you make a good point about the pain...I know she has complained about her knee in the past....I wonder if it's hurting her and she doesn't mention it...maybe an X-ray is in order...interesting idea to address pain behaviors. She does make a hissing sound when sitting down or rising from seated position. She has vascular dementia. Her short term memory is completely gone, not 15 seconds of recall but she can carry on a normal sounding conversation for brief periods. She is very paranoid, suspicious, delusional and says I'm evil and she's in prison, to the point that staff warned me to expect another resident's family member may call the adult protective services to investigate. They report she is fixated on me stealing her money (not true, I hired a forensic accountant to keep track of her money). But she can't remember the answers I give her about her money. It's all so depressing and discouraging. Yah, word to the wise, don't change environments unless you have to because it's very disruptive, moreso than I expected. Even for a 25% price cut and better care.

Mom is in AL? correct? Probably totally wrong place for someone at the point of oversight & caregiving that your mom is at……and for everybody's sake, the staff, other residents, you and most importantly your mom. Please read the link that CMagnum posted for you.

If this keeps up, the facility will have no choice but to send you a "30 Day Notice" on mom and she will have to move. Be proactive in this and have a clear talk with the social worker at the AL as to what they suggest as to either a NH or specialized AL for mom to go to. If the $ is not there to continue with private pay, then going into a NH and applying for Medicaid will have to be there route to go. It will be good that you have an accountant dealing with her $ as it will make the Medicaid application easier.

You do have DPOA & MPOA for her, don't you?

Generally nursing home staff is trained to deal with agressive or abusive clients.
They do not sue the family when they are hit, bitten or otherwise attacked as it comes with territory.
They are professionals trained and paid to handle these situations without causing injury or additional distress to the client.
I suspect your mother is in an "assisted living" facility?
They will not keep a client that acts out, continuously upsets / disturbs other residents, need extensive memory care, prompting or skilled ongoing nursing or LPN attendants.
Usually these conditions are made clear to the family and client before acceptance.
Always read the fine print in a contract.

My mother pulled an epic stunt back in the summer. She tried to elope (escape), hit people with her walker, got outside, hit the building and yelled at it for 90 minutes before the EMTs could hog tie and sedate her. They didn't really hog tie her, but they should have. She raged for over 24 hours in an ER room before she could be placed in a geriatric-psych unit for 5 days. This kind of behavior is not new for my mom, but it was new in that setting, so it really shocked everyone. Mom's been a holy pistol her whole life and dementia isn't helping.

She had to go into a locked memory care/geri-psych unit after. She could not return to the nursing home unit she had been in. She is now on high doses of Prozac and Risperidone. It has helped a lot. She has to be supervised 24/7 in a unit where she can't elope. She has an ankle bracelet that stops doors from opening.

This doctor you describe is NOT giving you good advice. They have to weigh the pros & cons of medication, and sometimes the side effects are totally worth it because of the benefit. It is not good for a patient to be in a constant state of upset, fear, and combativeness. If that were me, load me up with the meds please, so people can take care of me!

You should have a social worker coordinating with you on where to put mom. The place my mom is at has a social worker in their employ who does this. She was wonderful.

You have some great responses here. I had to move my loved one from a regular Assisted Living facility to a Secure Memory Unit for much less behavior than you describe by your mother. Once they get to that point, it's not something the regular staff can handle.

You may ask for a meeting with the AL director and department heads to come up with a plan of care, but in the meantime, I would get her proper medical attention and find another place for her that is more suited to her needs. In an emergency or if she tries to leave the facility, you might not get 30 days notice.

I learned that sometimes with dementia patients, they can't verbalize when they are in pain. They often act out. You have to read what they are trying to tell you as others here have pointed out.

My cousin was recovering from a spine fracture and it must have been causing her a lot of pain. Plus, she wanted to lay in bed a lot. Soon after she went on Cymbalta, it was like a miracle. It works on pain and depression. It really helped her. I would discuss this with her doctor or a new doctor.

I know it is a nightmare when you are so frightened that you loved one will be ousted from a facility. You will see a huge difference in your stress level, once you get her behavior more stable and she is in a place that can really assist her needs better.

I will add that when my loved one was placed with residents who were similar to her, she seemed much more at peace.

My mom took a few swings at people with her purse and she got a prompt trip to the ER and diagnosed with cellulitis. Some people will get crazy(er) with any kind of infection or pain; it may be too mild to call it delirium but it can be a real issue and can settle down to baseline once the problem is treated.

Igloo572, yes she is in assisted living. Highly rated, recommended, thoroughly investigated, etc. The staff have been understanding and polite. They are trained in redirection and management of assaultive behaviors. What the nurse expressed concern over was if Mom threatens or assaults other residents... apparently she has done something to make them think that's on her list.
There is an unrelated memory care unit nearby that is a possibility...I will investigate it soon on a proactive basis as Igloo and Olaandme suggest.
We are changing health care providers to one who will come to her apartment to provide care, but it takes a little time to do that.
I found her escape outfit...a heavy jacket packed full of mixed nuts and little notebooks. I'm so sad she is so delusional and distressed. I so wish I could make it better.
Yes, I'm the one legally empowered to manage her finances and medical care.
I'm very grateful for the forensic accountant...this is an accountant that specializes in fraud and criminal behavior detection. Helps me keep everything neat and proper. I can recommend finding one of these specialists when you know your relative is going to go down the paranoia rabbit hole.

1. A Senior Behavioral Clinic can get her meds straightened out. It took ten days for my mom and she is a different person. Take her to a geriatric psychiatrist for referral.

2. I believe that people in her condition should not have a phone. Who are they going to call? And why? It is better if you communicate directly with the staff.

I would take the staff's concerns about lawsuits if she should assault another resident very seriously. Sounds like she needs a different level/type of care than assisted living. I'd start looking so as not to get blindsided and forced to act in an emergency.

Sophe you are showing a good pro-active and realistic approach to this. The forensic accountant idea is outstanding. Your mom is in good hands-yours.

Thanks Pam, I really appreciate the attaboy...it is such a sad path, your comment helped me be happy. :-)

Update: One month has passed since she attacked the technician. Mom has been increased on a couple psych meds by the substitute doctor. She is doing better. She has not attacked anybody or anything recently. Things are doing better. I think it was a combination of adjustment and inherit aggression. Thanks for your suggestions. I now have a better idea what to do if she acts out again.