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

This happened to my mother from a trip to the hospital. It's how I came to be here. Glad it's right. It takes time. My mom was 3 weeks in the psych. Hospital until they got her fixed up. She has dementia (mid stage). She also had a UTI and picked up Mersa in the hospital. Please hang in there. It gets better I promise!

(((((((erica)))))) sometimes there aren't great options, and it looks like your mum is in that space. I am so sorry. Perhaps it is time for just comfort care. Nothing else seems to be working. Things can happen very fast. It is beyond our understanding. Prayers for you and your mum for peace.

Update: her medical doctor called me (never a good sign). Mom has continued to rip out her IV. She’s either sleeping or agitated and yelling for the little bit of time she is awake. Her swallowing has become so bad that she really isn’t eating or drinking at this point. The doctor recommended doing palliative care and keeping her comfortable and stop trying to do the IV. They will still allow her to drink and eat if she can but does not recommend a feeding tube as her quality of life is very poor. I have to agree at this point. Maybe my mom is trying to tell me something by ripping out the IV and I should let her go in peace. Her BP has been elevated. Dr. Says she is strong right now but as she continues to lose nutrients and dehydration sets in (which was already an issue) she will become more lethargic. She is giving her about 2 weeks (obviously a estimate). I don’t think I’ll ever understand how this declines so fast. If my mom passes this month, it means I’d have lost both my parents in February, 2 years apart. I’m starting to hate this month.

Erica,
The fact that they are getting her to take Ativan is a positive. I am assuming then that she’s still being treated for the UTI. When they get the UTI cleared up they will be more able to see what they are dealing with.

Hope you get a little clarification or explanation from the Doctor.

Lizzy as of right now the nurse I spoke to says she’s still yelling out even when he’s right next to her. The psychiatrist is now recommending Ativan on a daily basis instead of as needed. I put in a call to the psychiatrist office to get a call back to I can ask why she’s declined mentally so fast, what his thought process is and what the plan of care is. So she’s still in the hospital for now.

Erica,
Any news about your Mom?

Erica,
Yes, I would consider no news, good news. I hope the nurses are keeping you in the loop when you call.

Being able to keep the IV in so that the UTI can be treated is definitely good news.

Enjoy the mental break.

erica ((((hugs)))))) that is good news. Hope you can relax a little now.

Thank you all! She is in Ativan knocking her out pretty well so they can keep the IV in for the antibiotics.
To be honest no one has even called me from the hospital! I call and get to speak to the nurses and check up on her but no doctors, no social workers have spoken to me! Frustrating. I will admit though there are days i just need a mental break and am glad I haven’t gotten a call yet.

EricaMagoo83: I feel for you. This is so draining on you. I hope they get her meds under control because one thing is for certain-this is too much for you to handle. Big Hugs ((( ))).

Erica, My Dad walked all night and they said he kept the patients up. My phone call was that they had taken him to the ER and that we had to find another place for him to go, they wouldn't take him back. This was 10 years ago but, things haven't changed much. I was lucky enough to have a friend at the hospital in Social Services and she talked me through getting another place. Ask the hospital for help, they should have someone there that can give you peace of mind.

If this is not her baseline self, it could be delirium caused by the infection. Delirium is a common with UTIs in an older person. This can be reversed if the infection is properly treated. If you mom can't tolerate an IV, maybe a good old fashioned shot of antibiotics should be given. And push fluids.

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.

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.

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?

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.

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

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.

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.

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......

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))

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 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🙏

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.

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.

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

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.

(((((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.

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

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!).