She becomes agitated and wants to go home (she’s lived in her present home for 45 years)...trying to get out doors sometimes even attempting to break the glass or hit the caregiver. During these times she has energy that can keep her going for 24hours without any sleep. Her physician has prescribed Ativan and she’s been taking it for several years now. It doesn’t seem to help relax her. I’ve asked for more medication and her doctor does not think that would be a good idea. Her physician is concerned about falling.

My question is what would be the next step...change caregivers, skilled nursing facility???

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Mom needs supervision 24/7/365. It sounds like she is beyond medicating for this. No medication works forever and Mom may have developed a tolerance. If she has become combative and a fall and flight risk, she needs to be in a locked Memory Care Unit. You will have a difficult time finding new caregivers to take her on with these issues. And, there is always the chance she could fall or escape the house when their backs are turned. Frankly, it’s asking a lot of her caregivers to have them tolerate being hit or worse. I believe her doctor is telling you he/she thjnks Mom needs a facility. .
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She needs a more sympathetic doctor - a gerontologist or perhaps even a geriatric psychiatrist. It isn't just about the caregivers (although they are important too!), but her agitation has a negative impact on her own well being and quality of life.
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