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My step-mom keeps getting major sun-downing delusions and as a result has created major problems at the places she has been staying. We are at the point where jt seems we aren’t going to be able to make it work at any memory care what would be the next step from here? Nursing home?

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OP, you say “it almost always happens when one particular employee is working the evenings”. Have you met this particular employee and looked at them? Is it someone who looks frightening in your mother’s eyes? If so it’s a difficult problem to fix without being discriminatory, but it might help to explain things. If it's made worse by the 'walkie talkie guns', is there some way they could be kept out of sight around your mother?
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OP have you tried to work out WHY she didn’t have problems in ER or the psychiatric hospital. Double check that the meds were the same, and administered at the same times (particularly if the effects might have worn off in late afternoon). Ask them if they can suggest any reason why it was less of a problem with them.

Double check the light levels in the rooms she was in. It’s called ‘sundowning’ because of late afternoon, but perhaps it really is related to light levels?

Sympathy and best wishes, Margaret
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JWBoosh Sep 27, 2023
I have tried to figure it out and have no answers, I talked to the staff at the psych hospital and the nurses and they didn’t really have any answers. I was hoping the answer was meds at different times but they were being given at the same time.

We are moving her somewhere on Thursday so will have to see how she does there. I’m wondering if part of the reason she did better in the ER and psych hospital is because they are actual hospitals and maybe she realizes that and thinks she is there for some reason - but the memory care is a bit more like a hotel or home and she seems to think she is just in the wrong home. I really don’t know, will have more
idea based on what happens at the new place we bring her to on Thursday.
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I would definitely get her on whatever meds are recommended for calming down someone with sundowners. It's such a sad and horrible thing and I imagine how scared and confused she must feel. Please talk to her doctor ASAP.

Best of luck.
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JWBoosh Sep 26, 2023
She was put on 4 psych meds by the memory care doctor and they haven’t helped.
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NHs will not take psychiatric residents till they are controlled by meds. Did you try taking her to the ER when she has these episodes? The key words here is that she and the people around her are not safe and she needs a psychiatric eval. You can mention that she may be kicked out of her place.
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JWBoosh Sep 26, 2023
She has been sent to the ER twice and a psychiatric hospital for 2 weeks. She had no issues at any of those places so they never adjusted her meds any differently than how they were at the memory care. She just went back after the 2 week stay and it’s right back to how it was before she got shipped out to the hospital trying to break out every evening once the sun goes down yelling, screaming convinced they are all trying to kill her
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Time to search out a geriatric behavioral psychiatrist or someone with similar training.

My LO was seen by a wonderful therapist APPROPRIATELY medicated with small doses of medication(s), and the staff received pertinent recommendations for managing her “conduct”.

She was literally NEVER overdosed, and I was kept “in the loop” as to her behavioral issues, so that I could support her progress during my frequent visits.

Memory care might WELL be best for more supervision and attention.

Good luck- there may be a better solution than “bouncing”.
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It's my understanding that the only way most facilities deal with aggressive behaviors is by heavily medicating the ones causing them.
Is your step-mom being medicated enough during her sun-downing episodes?
If not I would be speaking to her doctor to see what can be done.
And like Geaton said below, memory care facilities are more than used to these behaviors and should be the ones guiding you with what needs to be done to help her.
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JWBoosh Sep 26, 2023
Maybe we just ended up with a terrible facility because they seem completely clueless as to what to do with her, they just call us almost every night to calm her down when she is already in full hysteria mode in the background trying to smash things, yelling and screaming, etc.
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Can you please clarify where your stepmom is exactly? Where are "the places she has been staying"? You mention MC (which is a facility/NH) and then you wonder if she should go to a NH? Isn't she in one already? She's already been bounced from one and now may be bounced from her current place?

The facility/staff should be experienced with this behavior and know how to deal with it. It's possible she needs medication to help. What do they say at the care conferences? They should be providing input and solutions to you, not kicking her out.

What are the exact behaviors that they say are problematic?
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JWBoosh Sep 26, 2023
So we moved my step-mom to a big memory care facility about 2 months ago. At first it seemed to be going okay and then after about 2 weeks in the evening when the sun went down she started having episodes of trying to escape because she didn’t know where she was or why she was there, and she was convinced the people there were outlaws or robbers trying to kill her. We never experienced anything like this before she was moved to the facility.

A few nights after she started doing this they shipped her off to the ER. I got a call
from ER social worker who said she’s fine here, we are just going to send her back to the facility. The next day the facility said we are going to have one of our mobile doctors visit and this doctor put her on Ativan, Buspar, Risperidone and Sertraline.

It seemed she had a few good days then it went back to nightly episodes when the sun went down of her trying to smash her way out of the facility convinced they were trying to kill her. One episode we went down there to calm her down and we realized she was convinced that their walkie talkies were guns. I am still not sure if they did anything to try and keep her from getting to these hysterical states - it almost always happens when one particular employee is working the evenings.

After a few nights of this she was sent to the ER again and the head of the facility asked us for permission to have her sent to a psych hospital for a couple weeks to have her evaluated and get her meds adjusted. We agreed to this. However, they didn’t adjust her meds at all for the whole 2 weeks because they said she had no behavioral issues at all for the whole time. This left us baffled.

She was brought back to the memory care from the psych hospital about a week ago and after 1 or 2 days it’s been back to the same routine again. For the last 4 nights we get a call from the same employee and in the background my step mom
is going ballistic convinced they are trying to kill her with guns (their walkie talkies). She’s yelling and screaming and banging on things. We calm her down and then she is okay for the night. they have tried to adjust her meds some to give at different times and it hasn’t helped.

During the 2 week stay my dad and I started looking for another place and did find one which we are moving her to on Thursday. We told them about her sundowning and what’s been going on and are to being her on Thursday but am very nervous about how she will do. And her current medication regimen does
not seem to be working at all.

I can’t explain the stress this has been on my dad and I the last few months. He is dying of cancer and I moved in to caretake him, and all this is going on with my stepmom at the same time. I feel so helpless and hopeless and am barely hanging on.
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