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We're in the midst of trying to take the next best step but rather quickly. My MIL is in a rehab center and needs to transition permanently to a nursing home. She has dementia or Alzheimer's and is very violently hostile at times. If she weren't so hostile, my wife and I would try to care for her ourselves. But, we feel we have no option but to go with a nursing home.

Given her history of violence toward caregivers, including at the rehab center, on top of what's believed to be some form of dementia, we've wanted her to be more fully evaluated. The rehab center has not followed our direction to transfer her to a hospital with a psych unit. There's a possibility that her aortic valve stenosis is causing vascular dementia that might be treatable - but we haven't even had the conversation because we can't get her to the right doctor.

So the big question is what's our first step? What's the difference between a hospital with a behavioral health unit, a behavioral health center, and a nursing home with a behavioral unit?

Our hope is that if we can get her behaviors under control, more nursing homes would be willing to take her.

Thanks to all for your help! We're Runragged!

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You need a board certified psychiatrist, at the very least. Is there a teaching hospital anywhere near you?
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She was in the hospital for violent dementia behaviors then sent to rehab. The behaviors have been creeping in for almost a decade from what we can tell. She was never diagnosed with a mental illness but that doesn't mean one wasn't present.

She has been evaluated by a doctor who says he's a geriatric psychiatrist. He just hasn't done any good.

Sounds like a hospital with a psych unit may be the best bet. Even if she doesn't land in the lock down psych unit, there is a staff of psychiatrists who might be more available to the general wings/floors.
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Was she in the hospital and then sent to rehab? What was hospitalization for?

Are these behavioral issues new or longstanding? Is there previous history of mental illness?

In your place, I'd have her evaluated by a geriatric psychiatrist and see what can be done about the violent behaviors. It's going to be difficult to impossible to get a decent physical evaluation if she's violent and uncooperative.
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Have you tried your local Area Agency on Aging? Sometimes these offices are called Aging Services. They usually maintain lists of facilities and health care providers for different situations. They should be able to at least point you in the right direction.
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The rehab has been less than helpful, unfortunately, on all too many aspects of her care and future. Her PCPs, both in the community and in the rehab, are practically useless. We're pretty much on our own here.

In general, it's been suggested that she needs a behavioral unit at a nursing home. However, we'd like to see these behaviors properly addressed including any medical conditions that are making things worse, not just a bandaid solution.

Any advice?
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I am surprised that the social worker at rehab hasn't been more helpful. Let them know you cannot take her home and give her the proper care. Contact her primary care doctor for his assistance. Good luck!
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I don't have any experience with the various facilities you mentioned, but just wanted to suggest that simultaneously you try to locate a cardiac (or possibly vascular) specialist to address the aortic valve issue.

Her treating PCP, internist, or perhaps even the doctor who scripted for her current placement could probably recommend a doctor and get an appointment for you quicker than you can on your own.
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