What happens if the hospital can’t calm a combative dementia patient down?

How long has mom been in the Geri psych facility? It takes time.

Is she in a regular hospital or a geriatric psychiatric hospital or unit?

Your poor mom! Just imagine how panicked one would be if you thought they were keeping you from your baby! Have you talked to mom on the phone?

I am here to visit when she was transfers. The first day all she did was scream at me & moan and be nasty. Yesterday they finally got Ativan in her but enough so they could try replacing the IV so she mostly just kept her eyes shut and didn’t talk unless she was cursin at the nurse for putting in the IV. She is in a hospital with geriatric psych because her NH doctor said it was better and has a good program. I know it takes time but if they can’t get the meds in her, how does this help?

If they got the ativan into her and it's helping, they will be able to get more meds in with time, don't you think?

Hopefully she is starting to turn around. Sometimes not much can be done. I have a friend whose wife was like this. The only option in that case was the state psychiatric hospital. She received excellent care there and it was a very nice, well reputed facility.

She did great there for 2.5 years and passed.

I honestly hope so. I hate to see her doped up but I also hate to see her so confused and angry and in pain. She’s told the doctors before she just wants to die. I can’t be here to take care of her and I’m trying to do the best I can.

GladImhere, thank you. I feel like I’m alone. I’d hate to see her in a psychiatric hospital but if that’s the last resort at least then I know there is one.

Erica, she will be well taken care of. The docs will figure out what she needs. My mom became like this. She had been in a memory care facility for almost two years when her behavior became impossible. Hitting, screaming, biting, kicking. Mom was on hospice at that time. Hospice recommended a much smaller facility, a care home. Every resident. There had been kicked out of their previous facilities. Can you imagine?!

Mom did well there until she passed four months later. Yes she was medicated. But you need to remember that the impossible behaviors are even worse for your mom.

GladImhere, thank you. I know it’s scary for her. It’s scary for me too because I feel helpless & it’s so hard to see her like this. My mom has always been strong willed but this is beyond anything I’ve seen. I’m trusting our medical system but they have failed me in the past. I also don’t think social workers do everything they are suppose to do. I’m just feeling overwhelmed with everything and it’s taking its toll on me, and my marriage.

When Mom went into an assisted nursing home/memory care facility, my husband and I had already witnessed and experienced months of her stress, fear and delusions since she lived with us for more than 5 years. We had a way to calm her down, offering understanding and patience and letting her know that everything would be okay. It was not easy but doable most of the time.

After the first month in the facility, the nursing staff was not able to calm her down - talk her down - and they would call me as they did not know what to do when she stood by the elevator door letting them know I was downstairs waiting for her to take her home. (I was not there, and she was in a secured floor at that time.)

They suggested I talk to her immediately by phone to see if I could help, as they had no clue. And although by the time I was called, Mom had already been in that anxious state for an hour or 2, we all found out that by reconnecting to me or my husband - voices which she knew cared and loved her - she accepted the new reality that she was now in a nursing home. She would then calm down and ask me, "Then, should I go back to my room?' and, although it broke my heart, I would say, 'Yes, mom. That is right. Return to your room and I can call you there to say hello.'

l learned early on that Mom continued to need our voice when she 'lost it.' Seemingly, we calmed her fears most of the time as she trusted us.

After this first event at the facility, the nurses gladly called me immediately so that Mom did not have to suffer hours of anxiety. They then knew what worked for her, and I gave them permission not to wait so long to call me or my husband when it happened next time. Little by little, mom adjusted to her new reality. Now she just asks me, 'when can I come home?' without the emotional outbursts. (Thought it still breaks my heart to answer her.)

I realized then that between the nursing staff, CNAs, social worker and us, we made up Mom's support team. And, we all welcomed each other's help without having to give her calming meds....as I knew she did not want them.

This way of resolving that issue may not work for all, and certainly it takes time and patience. But if you have that, and have an open nursing staff who will work with you for the best of the resident, then you are lucky and so is your loved one.

Thank you Balance, unfortunately I wish it was as easy as hearing my voice to calm her but usually she just yelled and screamed at me. When i didn’t do what she wanted I was a callous b**ch like “these people” (the nurses). I’m trying my best but we haven’t always had the best relationship because of her narcissism & mental health issues in the past. I’m all she has left though. Some nurses and social workers are better than others and I pray I have a team that can understand my situation with not living here and help me help her.

I liked that you acknowledge that you are trying your best. That is all required of you. After that, have some kindness towards yourself. Sometimes, there are situations which have no easy solution. Some of our parents have created their own karmic situations and no one can take away what they need to go through. Hard to realize, but never the less true.

So, acknowledge that you are doing all that is possible, and return to your own life and peace within.....and that, takes real effort for many of us as it is where our own growth hides.

Urinary tract infections are just famous for making people crazy. Paranoia most of all. As the antibiotics kick in and the tranquilizers, she'll calm down and later not remember and refuse to believe it if you try to tell her what she was doing. In dementia there's a combative stage that's awful for the caregivers. Hopefully she's not there full-time yet. For the doctors and nurses, she's not their first combative patient. They will know what to do. You might also ask for some calming medication for yourself. Now is the time to relax a bit while Mom is getting great care and full-time attention (believe it or not!).

Thank you Sophe, I just landed back home in Canada. I’m trying to have faith they will get the antibiotics in her for the UTI and this will help along with trying to regulate meds to keep her calm. I feel like when i get a couple days break then the calls start coming and I have immense decisions to make. I’m afraid the nursing home won’t take her back. I also get myself worked up if she gets denied Medicaid however This trip to the hospital throws a wrench into the mix as spend down was suppose to be on the nursing home! Then again I’m not really sure where she will end up. My mom has expressed her wishes to die, and I feel guilty that I wish she’d go peacefully and not be in pain & confusion anymore.
I will try to relax but life just never seems to let me do that

(((((hugs))))) erica. This is a hard time for you and your mum. Hope they get her settled down. Please try to let the guilt go. We hate to see our LO in such a bad condition. You are only wanting peace for her.

If mom is in the US, they will figure out how to place her. If she's not able to return to the NH, they'll have to find an alternate place. There are also long term care hospitals that house those with severe mental illness and/or hard to control dementia related behavior. Do you still want to be responsible for making all the decisions? I'd consider if you wish to do that and what options there are to transfer it to someone else. There's no shame in that, especially with you being in another country.

Geri psych admissions are usually for 2-3 weeks. It takes that long to get a geri patient stabilized.

Thank you all. Sunnygirl, there is no one else. We literally have no one so I’m the one who has to make the decisions. I hired a lawyer for Medicaid application & liquidating assets, and making decisions about her health care.
Sunny, she is in the states, she’s in New Jersey. I just hope I get some help placing her if need be, I’ve heard horrible stories of social workers who basically just handle people a list to call and say good luck! She’s only been in geriatric psych 3 or 4 days.

There r ways they can get meds in her. At Moms NH it was in applesauce. Not too many ALs or NHs will take combatant patients. It's not fair to other residents or the staff who take care of them. She is better where she is at this point.

I think that you have the option of saying, I can't do this and there is no one else. The state will make her their ward, making all decisions and taking all of her assets to pay for her care, they will use that 1st then she goes on to state funded aid. This might be the best solution for all involved, it is terribly hard to make decisions for our parents as I am learning, walking away from their abusive behavior is really and truly an option, granted it's not easy but, none the less it is an option. Good luck to you and may you find peace on this journey. I take mine one minute at a time and am so grateful for each one🙏

I don't have any magic words, but I feel like I could easily be in your shoes, Mom has been in a combative stage and I too worry about what happens when the Memory Care Home can't calm her down.

(((hugs)))

I'm so sorry JJ. I'm very scared. I just hope they can stabilize her in the hospital enough to allow for her to go back to NH. I'm honestly not sure how much more I can take. Be brave JJ, we will some how get through this.

((hugs))

Erica, I don’t have any wise words for you. But just wishing you the best. Take some breaths,take a walk, tell hubby things are bad enough without him making you feel worse. Guess I did have some wise words......

Erica, do you think your mother might like a baby doll? Life size and properly weighted to feel like a real baby. SOME persons with dementia are soothed by the nurturing act of holding such a doll. I recently gave my mom's to an adult day health program. The social worker/director said, "Oh my goodness! I know exactly the person in our advanced dementia section who will love this!"

I'm not offering this idea as a solution to your mother's mental illness or dementia, or what her next housing will be. Just that it could possibly calm her down sometimes. Ask the staff there whether you might try this approach.

Thank you for your idea Jean. I’m not sure what will help her at this point. Her delusions seem to change day by day. I am back up in Canada and spoke to the nurse as I check in everyday. They told me she’s yelling for people to get out of her room yet no one is even in her room. She yells for help but can’t seem to articulate what she wants or needs. I just hate seeing her like this. I don’t know how it got so bad so fast. Sometimes I wonder is she angry that she’s there, if the meds are making it worse or if it will get better. I’m trying to have faith.

I feel for you...they will stabilize her eventually & find the right meds...My mother takes seroquel & she also says she’s pregnant...she’s 90 yo ...that would certainly be a new Guinness book of record..She was in nursing home but I took her home due to private pay too expensive...Medicaid would not be available for a long penalty period...I have private Aides that work w me at home..it’s not easy but it works...good luck

It’s so tough doing it long distance. I’m 600 miles away but home right now dealing with all the STUFF and visiting the folks in AL each day while I’m here.

We had one bad episode with Dad, swinging at staff while trying to find his car. He went to physc ward for a night, got on meds and calmed down.

The only thing that keeps me sane is knowing they are supervised and cared for. Sometimes that’s just all we can do. I still freak when I see the AL number pop up on my phone, a fall, dads on the loose, but nothing I could really do even if I was on site.

I hate to hear that you’re going through this. Hopefully they will find the right med combo for mom soon.

Erica,
(((Hugs)))
My Mom was in a Geriatric Psych Unit for 10 days. It was certainly scary for me at first. I know you are scared and worried. Try to relax. Do something you enjoy.

If the Unit can find anything your Mom likes, applesauce, ice cream, sherbert, etc, they will get the meds in her. Be patient. They will find the right combo and get her stabilized. It may take some time.

She is where she needs to be.

Has the NH led you to believe they won’t take her back?

Lizzy, My moms social worker at the NH is an idiot and so not empathetic! Asked me to get my moms stuff the day after she was placed in the hospital!! I literally cannot stand this woman who knows nothing and can’t seem to help worth a lick! I spoke to the NH MD who i have email contact with frequently and he said his goal was to get mom stabilized and have her back. I told them since they can store her stuff for a month then that’s what they will do!
CaregiverL, I couldn’t care for her on my best day! I give you credit. I’m trying for Medicaid with a lawyer and hope there is no penalty otherwise she’s screwed! So just another stresser on me besides where she will go if she doesn’t calm down! My emotions are all over the place.
Windy, I’m glad you’re back visiting. I was visiting mom but she’s so angry or so doped ya it was the most unproductive visit ever. For the first time I really missed my mom even though she’s right in front of me.
My mom was always a strong person and to see her down to this is hard. I’ve had my moments with her and she’s been difficult and we haven’t always had the best relationship but she’s still my mom.

Dear Erica,
The urinary tract infection and infection in her leg will make mom feel like she is completely out of control. It may be necessary to sedate her until she has enough antibiotic treatment and hydration to resolve the infection. That is the only way intravenous treatment can be done without her pulling the lines out. As the infections resolves they will be able to ween her off of the sedating medications. There most be some things that she likes that can distract her. Is she catholic? If she has used a rosary this can calming. Does she like animals. Looking at pictures of animals, or petting a stuffed animal can be comforting. Music, aromas, going through a box of familiar things can be helpful. Talk to the discharge planner who is in charge of your mom's case and discuss options with her. Ativan can be helpful, however, in some sensitive cases, there is a rebound effect creating a cycle of anxiety.
You are doing everything that you can. The discharge planner which might be a social worker should help you with all your concerns.
You are good daughter.