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I'm full time caregiver with rapidly declining health faced with ongoing struggles to care for husband that is beginning to destroy my quality and husbands quality of life to the point that I no longer want to be here. He is in the hospital with possible pneumonia right now and had to be strapped down due to combativeness. He is very strong, 6ft 3 in tall. Over the last 4 years it has been getting harder each day.

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True, true, and so true!!!! Get the psych eval and yes, there are meds to help with the agressive behavior. I am not a fan of poly-pharmacy or over medication but sometimes circumstances require more immediate measures.
Be an advocate for your husband and yourself. A safe discharge should always be a priority and a legal responsibility for any social worker/case manager. I work in a SNF and we deal with a variety of dementia patients. Let them know in no uncertain terms that you are unable to care for him and that it is no longer safe for him to come home. Do NOT feel guilty. You are doing what is in the best interest for the person you love. Contact your local Ombudsman who will also help you through this. Visit local facilities on your own. There are places that will take your husband and who are able to handle his behaviors. It may require a short stay at a psych center to get his mental state under control. His cognitive state of mind is out of his or your control and that is why there are professionals to help. If you are not getting the satisfaction you need do not hesitate to ask to speak to the head administrator.
Above all else do not take him home under the same conditions. Once you do you are again responsible for him. There is no shame or guilt in saying this is beyond my ability to continue. The gift to yourself and your husband is to do what you know is in the best interest of both of you. Be strong.
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It can be frustrating, but im sure theyve got their hands really full. We all do.
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Drive me NUTS! When posters don't come back to update on what is going on!
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I thought I would add that the reason some posters indicated that the husband had dementia is that Marianne1244 says on her profile that her husband has alzheimers/dementia.
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The skilled nursing unit is also where they place you when you go in for rehab. There is more monitoring in this section. My uncle went into skilled nursing from rehab and we chose to keep him there after rehab (as a private pay not medicare) to have the cataracts removed from both eyes. After that was done he agreed to sell his house and stay in this facility, however, he really did not need skilled nursing but liked the nurses and aids and wanted to stay right where he was. He had the funds to continue the private pay so the nursing home agreed to let him stay. He lived there about 5 years. Some people in this unit needed more supervision, help with all daily activities, some were loud and combative, others wete bed ridden, some on hospice, but they had the staff to take care of everyone's needs.
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That is what skilled is. Who ever told you that, it is false. My father is in a nursing home in a skilled unit. He was transferred from memory care to this unit when he was having problems. He has dementia and sometimes is uncooperative and combative and skilled was where he needed to be. Hope this helps.
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Maybe I am missing something, but I am not sure the husband has dementia or even needs skilled nursing when he is back to baseline. Lots of decompensation happens when an older man has pneumonia and is in the hospital, and often its temporary. No hospital prefers physical restraints to chemical restraints when the right ones can be found. Maybe the issue is that the wife who has posted is failing in health, so a placement could be done based on that plus what the baseline is once that happens again.
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WOW!!! HOW SAD. PLEASE LET US KNOW THE OUTCOME...AND WHAT HELP YOU WERE GIVEN!! PRAYERS FOR YOU!
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Just an additional note, Marianne, you are going to have to stand firm. Some hospitals will try everything to pressure you into taking him home. Including guilt, do not fall for it!
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Respite care is only covered under Medicare if the person is on hospice.
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A patient being combative can be the symptom of many things some as simple as a UTI, to a major brain injury or mental illness. Because you question is one with many answers let e just say, first get your diagnosed with what the problem combative is not an illness it is a symptom of something.

Once you have that you will be able to best determine what your options are. One thing is certain, when a doctor, facility or a (paid private person or company) caregiver says he is 'combative' the options for placement have decreased by well over one half.

In other words, get s diagnosis and work on fixing the symptom. This is not to say he cannot be placed. This is to say you will have a harder time with placement. If the problem is mental illness work closely with the medical staff to find a treatment best fitting his needs.

There is frequently a mental health specialist for the elderly or disabled working the community. Sometimes they work out of the mental health resource in the community and/or out of the county aging and adult services. They have your back so to speak. Work with them to have a placement whether it is for Respite or long-term living situation.

As the caregiver you are in need of a break. Take full advantage of a break. Go somewhere that will allow you to relax and breath without fear of the next day (this is not to say you are fearful, it is to say the endorphins for anger, fear and overworked can be the same). To be of the best use and to make the best decisions for both of them you need to be at your best. 'Rest' is the most important one thing you can do for yourself.
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Your response to whomever told you that a nursing home will not accept your husband should be, "Then where will you place him?"

State clearly and without waffling that you cannot take care of your husband's needs. Don't enter into discussions or arguments about it or even long explanations of why you can't. It is simply a fact and the hospital's social worker or discharge coordinator will deal with it as such.

If your husband's behavior truly puts him beyond the scope of care for a nursing home, then he needs a psych evaluation and, again, it's up to the professional at the hospital to determine that and put a plan in place. There are facilities for even the most dangerous behaviors, but for your husband's sake, dealing with the root cause of his behaviors and mitigating them will open the doors to less restrictive facilities where he'll have a better quality of life.
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All these answers are great! I'll add my 2 cents. In order for your husband to be released from the hospital, the discharge coordinator must be sure he can be adequately cared for at home. He cannot, so they must find other arrangements. There are hospitals with wonderful geriatric psych units where you stay for two weeks while they determine the right combination of meds for you. There are some hospitals that are entirely dedicated to that. The people there can find him an appropriate nursing home after his meds are regulated. What you might want to do is contact nursing homes in your area now and start looking into which ones would be acceptable to you. When you call, tell them you need a nursing home with a secure dementia unit for your husband who ambulates. They will tell you whether or not they have such a unit. If they do, schedule a tour. Ask every question you have and pay close attention to the feeling you get from the person giving the tour. I've found that's a great indicator of how you will be treated going forward. Pay attention to the way the residents are treated and ask about the staff to resident ratio. If you're considering nursing home, you probably want to schedule a consult with an elder law attorney to protect your assets if your husband should need medicaid. A great short-term option while this is all happening is "respite care." Respite is when a person goes into nursing home care for 3-30 days while their caregiver gets respite. It's covered by insurance. Ask the admissions person at a nh you like for information. It sounds like a month off to get your ducks in a row would be wonderful for you.
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When my uncle needed placement from the hospital, the social worker gave me one choice in a neighborhood that was not so good and far from my home. She told me that she made one call and they had a bed available so she made no other calls. I chose to tour (drop in unexpected) on 3 places near my home. Went back to social worker the next day and requested that she call my first choice for bed availability. She wasn't too happy but I insisted. I was fortunate that they had a bed available and the place was 10 mins from my home and much nicer then the one and only option that was presented to me.
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Ill echo everyone else. You can refuse to take him home, and you should especially since your own health is in jeapordy. Hopefully that will force them to do a psych eval so they can place him appropriately and get him the medication he needs. Good luck to you, take care of yourself.
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I totally agree. Refuse to take him home. If you are at the point where you want to take your life ( and that is what I hear in your post ) then you MUST insist on a change. Tell the case manager at the hospital you cannot do it anymore. You have done your best now its time to allow others who are trained for this to take over. The doctors can give him something to calm him down and there are homes that will and do take people in his condition. Big hug to you. Hang in there it will get better once you get him settled. Stay in touch with us we will be here for you.
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Mariann, what is happening with your husband? You need the geriatric psych consult mentioned above! You CAN and MUST refuse to take him home because his necessary level of care is more than you are able to provide. The hospital and the staff then become responsible for finding suitable care for him. It may be a geriatric psychiatric hospital.
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The previous posts are exactly right. When my 90 year old mom was combative, argumentative, resistant and belligerent, we finally found a wonderful geriatric psychiatrist (in-network!) who put mom on a regimen of different meds and now mom is more social and calm than I remember her when I was a child. She's much more engaged and willingly cooperative with none of the "zombie-like" qualities some people are afraid will result. She has severe vascular dementia with no past or present memory but she now can enjoy the company of her family and friends. Please find a geriatric psychiatrist - MD - as soon as you can!
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Marianne - now is a perfect opportunity to address his combativeness. I'm quite surprised that the hospital has not already done so including a geriatric psych Eval. They usually are against any type of restraint unless potential danger to himself or others. I too recommend a psych consultation, a medication review, and discussion w social worker and case manager. Skilled nursing facilities are supposed to be able to handle all patients but they are not all created equal. Again the social worker can help find one that does accept what is termed "challenging behaviors". But those can be medically managed. Good luck you deserve and need a break. Also there are smaller residential homes specific for behaviors. But again manage the behavior first. -Brian
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Who is telling you he can't go to skiled nursing care? INSIST on a consult from a geriatric psychiatrist while he's in the hospital. Understand that you do not have to accept him to be discharged back home if you can't care for him.

If they say " oh, then he'll become e a ward of the state" reply, " that's great, that's exactly who needs to figure out his care".

Sometimes a little hardball is in order.
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At the hospital there is a discharge coordinator and a social worker. Tell both of them you just can't do this anymore. They will help you get him to a safe place, possibly in memory care with good medications.
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Have you spoken to your husband's Dr. about it? There are medications available that can help with combativeness.
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