Possible elder abuse, don't know where to turn. Please advise.


My husband's mother is in the hospital, on the psych ward. She was in assisted living, was Baker Acted due to hearing voices and being paranoid and delusional. The hospital has just given her meds, none of which have helped and someone called and left a message with my husband that she's being discharged back to her ALF TODAY. No warning, no nothing. As of last night, she was lying in bed, drooling, could barely talk and could not stop crying. She was convinced she was going to be sent to an awful place, but there was a good place she could go to but she overslept and missed her chance. This is who they want to send back to Assisted Living where basically the workers give her medicine and not much else. Last Thursday, she was convinced an actress was going to interview her son (who lives over 1000 miles away) for TV. The same actress drove her (mother-in-law) granddaughter to visit. The granddaughter hasn't been anywhere near here, neither has her other son, or, as far as I know, the famous actress hasn't seen her, either. So, I've got a call in to an attorney and am waiting to hear back. Can the Council on Aging help in a case like this? The news media? My husband is going to take a camera with him if she is discharged and do whatever he can to let people know that this is who they think needs to be released. She might be hearing fewer voices or she might have just stopped talking about it because she was angry that we didn't believe her. Other than the fact that she MIGHT not be hearing as many voices, she's worse than when she went in. Please, if anyone has advice, please let me know.

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No, I haven't seen the discharge papers. The nearest geriatric psychiatrist we can find is probably 40 minutes away and I don't know how well she'd do on such a drive. There is a psychiatrist in our town and my daughter tried to call once and got no answer. She'll probably call again tomorrow.

And, no, I haven't seen any discharge papers, mother-in-law says she didn't get any. I put in a call for the doctor, no surprise, I haven't heard back from him.

I hate that she's suffering like this, too. I think I mentioned we had a CNA stay with her (or in the hallway, right outside her room) and she did try to get out of her room.
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Did the hospital suggest any medications for her? Have you seen the discharge papers yet?
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Something I didn't notice before is that there are a few common themes to her delusions (cf. your post of a day ago. There's death, assault by police, suicide, someone else arrested. There's a common theme here, and it's violence.

Perhaps her delusions are reflecting a deep fear for herself, in this stage of her life. And I suspect also that there's a lot of anxiety due to this fear. Perhaps any meds recommended by a geri psych could address this fear, anxiety and paranoia (as you mentioned).

It wouldn't surprise me if she's terrified of what's going to happen to her as she deteriorates mentally and physically, but isn't able to direct her fears other than in the methods she's displayed.

I really do feel sorry for someone who's this terrified of being injured and is lashing out in anticipation, if that's what's happening.
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Moppsy, sounds very similar to my situation. Dad, tho, has PD with dementia and lives in Memory Care. Early Nov he took a huge step down in his dementia and experienced the most disturbing (violent) hallucinations almost constantly. After blood work and UTI checks, it was determined to be a decline in his cognitive senses and reasoning; or simply put, the dementia worsened astronomically. This was almost overnight and continued until he was medicated recently and placed on hospice. (He's no longer eating much and has had a huge weight loss.) A psych eval was one possibility, but I didn't want to upset him further with a hospitalization. The hallucinations are still there, but the violent ones are no longer predominant. My heart goes out to you. It's so hard to watch a parent go thru this. I can no longer have a real conversation with Dad, and it breaks my heart.
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OK. She was threatening the neighbor who she thought was going to hurt her, so, she is a danger in our opinion. She also has yelled at my husband because she was convinced he was going to send her to a horrible place with criminals, where she would be raped. So, if she thinks a male nurse or CNA is about to rape her and she thinks she's defending herself she could be a danger.

She's not better because she is still talking to people who aren't there. She is considerably more frail than when she went in.

She was also there for more than 72 hours because the hospital said she wasn't ready to be released. Now, with no warning they decided she was ready and we have no idea who signed her discharge papers. If it was her, she's not in her right mind to be signing papers.

And, she had a UTI when she first started hearing things but when she went to the psych ward, it had cleared up but she was still delusional.

Just an example, 2 neighbors and a relative have died; another relative was beaten by a police officer; one was fired; one shot himself, came home to change his clothes and went back to work and another relative was arrested. None of this has happened. She also left her room at the ALF, pre psych ward, and was found outside, safe, but her ALF is on a very busy road. So, in that way she is a danger to herself.

We are looking for other options but the hospital discharged her to a place that is not suitable, but it's our best option for now. We're not down on the ALF at all, it's mainly the hospital.
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Gosh, I'm so sorry for what your MIL and your family is going through! Do you know if the hospital checked her for a urinary tract infection, or any mother infection for that matter, as sometimes infection can make the elderly act out in unusual ways. It sounds like her Schizophrenic symptoms have been going on for 6 months or longer, but its possible that her sx could have ramped up with signs of infection. Did they scan her head to rule bout any tumors or any other organic possibilities? Were changes made to her current regime of medications? Hopefully soon, your husband will have the chance to review her discharge papers, and get her in to see her usual Dr, for a referral to a Geriatric Psychiatric, to see if other things need addressing, and how getter to stabilize her condition, and then you will have a better understanding on where she might need to be placed for the best possible care necessary. Have you considered placing her into a smaller private assisted living place, where her care would be more hands on, like a home type setting?

I sure hope that you can get this sorted quickly, as it is so incredibly stressful for all involved! Good Luck, and please let us know how this turns out for you, as we all learn from others experiences!
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Moppsy, my heart goes out to your family. This is a nightmare for you.

Depriving someone of their rights by committing them to a medical facility is taken very, very seriously here. Very specific criteria must be met for it to be used. A pysch facility can keep the patient for up to 72 hours. One of the criteria for holding the person is that they are likely to hurt themselves or other in the immediate future.

We don't know what happened for the AL to Baker Act your MIL. Being paranoid and delusional is not the same as being in imminent danger of harming others or oneself. Did the voices tell her to kill herself? Did she threaten to get back at certain people she was paranoid about? We don't know. Do you or your husband? Was this explained in the first call?

Trying medications is pretty much what psych wards do. This is a relatively safe environment for the necessary experimentation, under constant medical supervision. How do you know that none of them helped? Was she discharged with any additions or changes to her medications?

Not being able to stop crying is very distressing, but it is not grounds for holding someone against their will. Having delusions about interacting with an actress is also not grounds for holding someone.

It sounds like the psych ward tried things during the 72 hours they could hold her but had no authority to keep her longer. What kind of psychiatric help has your poor MIL had before this incident? Has she been diagnosed with dementia? Has she been seen by a geriatric psychiatrist?

She's been given a tentative diagnosis of schizoaffective disorder. That is something to start with as you seek further treatment for her.

Memory care units, as the name implies, are designed to care for people with memory problems -- mostly dementia. Schizoaffective disorder is not a memory disorder. Whether the memory care unit associated with her AL can deal with it needs to be determined. She may need more specialized care.

I guess what I would do is have her seen by a geriatric psychiatrist as soon as possible. I'd put any legal action on the back burner, simply because of the time and attention it will take to get MIL's residence decisions made.
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The ALF took her back, because the hospital dumped her pretty much at the door. My husband was in contact with them while his mother was hospitalized.

My concern is a hospital discharging a patient who was absolutely not cognizant enough to sign her own discharge papers and my husband with POA wasn't even consulted, just informed, via a voicemail that she was being discharged back to the ALF.
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Moppsy, I've worked for med mal attorneys, both plaintiff and defense. If you're serious about filing a lawsuit, you should be aware that you'll need to identify specific instances of malpractice which don't conform to the standard of care for specific medical conditions, including how the situation should have been handled, what should have been done and what actions should have been taken, and what the damages are.

Med mal attorneys would first order the medical records of both hospital and AL, then have them reviewed by a doctor or nurse practitioner in the related fields, and rely on those professional opinions as to whether or not abuse existed and there's a potential case.

This is not a criticism, but a lot of people feel that they can just file a malpractice suit if they believe that abuse or malpractice occurred.

It's not that easy. Attorneys aren't going to spend time and advance funds for document procurement if there isn't a violation of care standard and damages and a likelihood of recovery, let alone success at a trial.

It's been some time since I did an med mal work, but if I remember correctly, one of the legislative motivations for tightening malpractice suit restrictions was the proliferation of suits alleging abuse, and the astronomical costs to the medical profession to defend unfounded allegations.

I do think the AL isn't very reliable or responsible in handling the situation, but I'm not sure it rises to the level of malpractice. That doesn't justify it though, however, be aware as you've written that your husband essentially "told them to handle it because he couldn't do anything long distance. " The AL facility will use that to assert that your husband literally "washed his hands" of the immediate situation and that they acted in what THEY thought was your MIL's best interest.

Be prepared for some "blowback" if they're put on the spot. They may NOT take her back.

Please discuss this with a med mal attorney, not an elder law attorney, before you make any conclusions on how to proceed.
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This sounds like a bad, very bad movie and I promise it's not. She was basically dumped back at her ALF, we have a CNA coming to sit with her tonight and the next few nights and if the lawyer ever calls me back I'm going to ask about a lawsuit against the hospital for elder abuse or medical malpractice or both. Thanks to everyone who responded.
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