Why do skilled nursing homes with memory care units claim they specialize in caring for patients with behavioral issues, then discharge them?

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Why do skilled nursing homes with memory care units claim they specialize in caring for patients with behavioral issues, then discharge them?

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If you are a Skilled Nursing Facility with a Memory Care unit and claim you are specialized in managing behavior issues, then why discharge a patient who has these issues?

I understand there are some facilities who may not handle this but those are not the ones I am referring to.

Dementia Behaviors Skilled Nursing Facility

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I assume the problems you are talking about involve violent behaviour since that is usually where facilities draw the line. Is this patient under the care of a geriatric psychiatrist and have they spent any time at a psychiatric facility? Nursing homes have to protect other frail, vulnerable people as well as their staff and unfortunately those whose outbursts can't be controlled may need a unit dedicated to violent patients.

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Yes, it is due to violent behavior. Actually, he was first in a psychiatric facility and got kicked out of there; which is very difficult to understand. Then of course has been discharged from two separate nursing facilities due to behavior. Others will not accept him.

The staff in charge at the facility where he is now, says he has to go because of violent behavior. That doctors have not been able to regulate his meds.

My concerns are, how can someone actually get kicked out of a psychiatric facility? Why can't this facility regulate his meds?

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So, what are you suppose to do, huh. You can't have them in your home. These people are very strong when violent. Yes, surprised a Psychiatric facility can't find the right combo even if it means the patient ends up being doped up.

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Tell me about it. He was in a Psychiatric facility and they could not do nothing for him and discharged him.

Now every nursing facility discharges him.

It makes them look bad. Like they don't know nothing.

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If he is a danger to himself or others, the state should bear the responsibility of his placement. Have you asked what they plan to do?

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The administrator says no other facility is will accept him due to his behaviors. She has discharged him to us. My husband is not able to care for him.

The ombudsman says she will try to locate placement for him. Hopefully.

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Is this your father, your grandfather? He has been in private pay places until now? Who has POA to make medical decisions on his behalf?

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I saw this when my Dad 97 was in a NH for five mos until he passed.As I went to the NH daily so I saw a lot of things as people do not visit daily...
especially when families work and they place the troubled dad or senior in a facilty..anyway this man was young compared to Dad..83..i watched as he
slowly became combative as initially he was so warm to dad,and everyone
wanting to chat and I thought why is this man here???long story made short he became combative ,throwing a phone at the staff...so police were called......he stayed in the home I spoke with the family...…...they simply drugged him up....shut him up...after the family approved of the Pshyc.
meds,...………..is he ill or just being kept against his will...administrator says that his family daughter,son or somebody moved into his home!!!!!
So all kinds of things go on in NH's my dads roommate was relatively young suffered a stroke and was around 69yrs...well he complained that his wife never visited...sad...he also wanted to get out..i carefully told him to speak with a social worker...some people are just dumped by families as they do not have the time or resourses to care for their husband or relatives...………...or Dads...…….snapping in and out of mental stability could be anger...at families...the combative man saw me coming in to retrieve dads clothing, as he was dying,and yelled to me in front of the staff
the same thing is going to happen to me???!!!!!IIs he crazy or pissed off at his family for throwing him in this NH...…………………..don't like what I saw..it looks like he may be being held against his will...…he was very lucid when I first met him...…………...you can go downhill in these places..i felt alzheimers coming on as things were so slow there and I felt sorry for everyone..former fast talking New Yorker...…………………………...

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Just my opinion but I think this industry is so regulated that they can no longer care for patients like your father. Restraints aren’t allowed, not even a bed rail. In the old days,
when Grandpa developed issues, he got locked in the attic. We can’t do that any longer.

Because there’s so much facilites cannot do, their only option is to release the patient. Knowingly housing a patient with violent tendencies could cost them their license if something tragic happens because of that patient. That doesn’t make it easy for the patient’s family. And it does sound like the doctors have washed their hands of your dad. Can he be re-evaluated by the psychiatric hospital? Like JoAnn writes, it may be to the point that to keep him and anyone he comes in contact with safe, he may need strong medications that zone him out. Not a happy solution, but it’s better than continually being kicked out of facilities.

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Did not understand why the NH would not put restraints or alarm on the bed or wheelchair as Dad was trying to get up or move, sliding fromhis chair so he needed to be watched constanly. also no cameras..this I understand could be privacy but the no alarm on the bed left my Dad on the floor below eye level from hallway monitoring for hours...at night due to no alarm...is this all legislation?...….using the alarm at least could call for help. looks like no one wants to be disturbed the staff?...it doesn't make sense to me to not employ the technologhy……..it looks like they expect the senior patient to behave..or they have lawsuits..a camera could tell immidiatly if someone has left their room in the long hallways I mean comeon!!!!!

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There is a lot of discussion in the long term care industry about this, and legislation around it too. There are fewer things people can be involuntarily discharged for, but harming other residents is one of them. My husband had this issue, which was clearly a dementia behavior, but they didn’t care and kicked him out. I filed a complaint with the state of Michigan and the nursing home still got away with it.

I would suggest contacting your your state ombudsman, who may be able to help. This is a very difficult position for you to be in, so get some help as soon as possible. I am in my 50’s, know how to navigate the system, and still did not win this battle. My husband ended up in a facility 60 miles from home, where they also tried to evict him. He started declining and the behavior stopped, so he stayed there until he died 2 weeks ago.

Hoping this gets better for you soon, and that you all find some peace.

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Oh, what a challenging road you’ve been down. I’m sorry to hear you’ve lost him, god bless.

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I have read articles in our paper (and not recently) about this very issue. They followed a few families who had this problem.

Just what are the families supposed to do?!?! Take the elder into their home?

It is so unfair to the families!

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Exactly

I thought they were the ones who were suppose to give them the help they need.

We received a lot of phones calls about family member falling due to weakness. Then we got the last call that he has become violent and that the doctor could not regulate his meds. Therefore, the administrator has discharged him to us. Oh, wow.

It is my husband's brother and he is sick. He can not care for him.

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This is what it has become due to lawsuits. I had relatives who had a father with dementia and he became very violent in the evenings when he started sun downing. Beat the H out of all of them regularly. They never put him in a nursing home until he became an invalid. It completely wore out everyone involved in his care.

If I'm ever faced with this situation and have to care for the person at home, there WILL be heavy sedation and restraints.

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I understand exactly what you are saying. In our situation, we got a lot of phone calls that our family member was falling due to weakness. Then to get the call he has become violent and has to be discharged, confusing.

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Sunshine45, my heart goes out to you. Other then sedation, I’m not sure what other options there are to have your loved one in a place that’s safe for all parties. Looking at it from both sides, facilities need to be safe for patients and staff. Families need a place for loved ones that is safe for them as well. Since this disease seems to give people super human strength at times, it is an issue where there may be no other choice but to subdue one person rather then risk multiple injuries to others. How awful it is to add yet another challenge to you. I’m so sorry.

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Yes, I agree. Safety is most definately top priority for everyone. Especially in such vulnerable places as these.

Just thought these facilities would regulate much stronger protocols for individuals facing such illnesses. I'm certain mental facilities have protocols in place for such behavior to protect everyone around, why don't these nursing facilities have the same?

In a mental facility they deal with the issues accordingly. In a nursing facility, they just discharge them.

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There are probably two reasons: some of them do what used to be called lying, and others are probably so bound by regulations that they are unable to use any common sense measures to deal with the problem.

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I agree

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I just spent another night with spurts of confusion and violence with my husband. He is on seroquel and valproic acid for behaviors but he still moves through being docile at bedtime, then sleeping briefly and then the behaviors kick in and last anywhere from 9 p-2 am. The strengthe his exhibits for a 150 lb 84 year old man is stunning. I am almost always alone, and have had to call 911 4x in the last 2 months. Doing this is so, and the last one I refused to take him home as he repeatedly was released because he did not meet the criteria for admission. After five days and three nights of haldol, he was released to go home with 30 days of home health. It seemed that he was better with the new meds, but that is changing again. His PC referred us to a geriatric psychiatrist who is actually very close to us. I had seen a presentation by her in the Sr. Community we just moved out of, so I was excited. But when we began to make the appointment for the eval., I was told that though the initial appt is covered by insurance, all future appts., have a monthly fee of $80. I know that sounds reasonable, but we simply don have it. I have begun the whole Medi-cal process and am waiting now to be denied because we probably have too much income. Where we go from here, well, right now I do not know. I am certainly willing to place him in a facility, but again, there is no money for it. And I am so fearful of what his care would be like at most of them. But my 24/7 caregiver burnout is,honestly, On the brink of threatening my own psychological and medical wellbeing. He is my husband and has been a funny, handsome, good one who cared for me during my times of medical need. He deserves the best care now and I am no longer able to give that. Our future seems very bleak right now.

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I’m so sad to hear about your troubles with your husband.
Seroquel was given to my father to help him sleep, it worked for awhile then it didn’t. I started giving him an Ativan at night which seems to help a lot, he gets a half one in the morning to help him remain calm. I guess we here been lucky so far.
I have have discovered that when I try to make him stop doing something or to do something he doesn’t want to do gets him very aggressive in telling me that he wants to hit me, thank goodness it’s only been telling me! When I try to distract him with a snack or something it usually works and no anger. Getting him to do something he doesn’t want to do I will use bribes of something he likes to do after we are done with the thing he doesn’t want to do, I have to constantly talk about what we are going to do when we are done. Tiring but usually works.
The best to you and your husband, I will put you in my prayers.

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Hospitals use restraints, both medicinal and physical to protect patients from harming themselves or others. Nursing homes used to do the same thing, but from what I have been reading lawsuits from care workers and other patients/families, have caused the nursing homes to stop taking or even kick out anyone who might have a behavior that could possibly cause them litigation in the future. That seems to more and more often mean that if someone in a care-home develops violent behavior, sexually inappropriate or deviant behaviors they get kicked out. They end up homeless, in jail, or in the care of families who too often lack the skills to properly care for them. When pops became violent I was advised to have him arrested, jailed and then ask for psyche eval at his first hearing. The cruelty involved in a system that requires someone with a conginitive impairment to spend time in the justice system for behaviors they can't control and then have to beg for help from a judge rather than having our senior care system step up with a solution, is itself insane. We had to go outside the system and find a doctor willing to take cash in order to find the right medication to help pops. Wiped out my savings to do so but now he's manageable at home as long as he takes his meds and the doctor helped us get the proof we needed to make workers compensation pay for his meds since his injuries from a work accident are what caused all of this.

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I agree with you all the way.

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The treatment that works does not work forever. It will always need tweaking

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I agree

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I know this may sound terrible, but if you cannot take care of him at home, please do not take him out of the facility. It then will become their job to place him. They cannot or at least should not dump him on the street. It’s heart breaking but you need to remember to take care of yourself.

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The administrator sent my husband a discharge notice that she was sending him to our home. We can not take care of him.

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Like Faerifiles, I also have experience of the criminal system being used because the medical system won’t or can’t. Many many people of middle age or older end up in jail because of mental health issues when there is nowhere else to place them. The best you can hope for is that they are in a specialist unit in a jail which has more options to control the behaviour in the best interests of all concerned. In a nursing home, family members see the results of the behaviour (of their own elder or another resident) and are appalled. The nursing home has no magic wand, just the same as the family. A jail has less constraints. Jail is also usually much more expensive, but it is a hidden cost paid for by the taxpayer. There should be a middle ground.

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The sad truth is just because they are not qualified or do not know how to take care of someone's medical condition, they just throw them around from here to there.

The administrator is discharging him because the doctors can not regulate his medicines and hospital will not evaluate him. Just sad. So sad.

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It is just ridiculous. A family member just gets thrown out everywhere because they do not know how to regulate his medicines and because they do not have proper protocols to deal with these behaviors.

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Yoy can send a letter back to the administrator and tell them that there is no way you can have him in your home, it is not safe and do not send him. These bully tactics are just that, what would they do if he was all alone in this world? That's what they need to do.

Stay strong and keep saying no, address the medication control in the letter but do not accept delivery and send it certified mail so they can't say they didn't get it.

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Thanks for the advice. I am going to try this. I already asked the administrator about having him re evaluated so they can get his meds regulated but she says the hospital will not admit him again because he is "good as gold" when he gets there.

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Not all SNFs are what they appear. The one my late mother was in said to her "Ma'am, you're too well to stay here." Unfortunately they were dead wrong as less than 48 hours later, my mother suffered a stroke there and died days later at the hospital.

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I am so sorry that happened.

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I have a similar situation. My husband had 2 serious falls, the 2nd put him in the hospital. They used restraints at times, camera, alarms on bed or chair that went off if he got up. He went to Medicare Rehab after which he was put into Memory Care. He was never violent but got anxious, nervous, talked about killing himself. After 2 weeks they did an involuntary transfer to a hospital Behavior Center (without consulting me). They told me it was to adjust his meds. Without even talking to the dr. there they informed me they were giving me a 30 day notice that they did not want him back.

When I asked what would happen if I couldn't find a new place what would happen and was told they would have to take him back. The Memory Care social worker called me today to urge me to find a new location so he doesn't have the confusion of being back there and then relocating. They don't care about him, they only want patients that are docile and submissive.

I am in the process of trying to find a new location.

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The nursing facility was suppose to notify you when they did a transfer with your husband to a hospital.

Also, if the staff there are not able to provide the care he needs, it is the responsibility of the administrator to find him placement. They must have an acceptable/safe discharge plan for your husband.

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Sunshine45: Thank you for your kind words.

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Why do skilled nursing homes with memory care units claim they specialize in caring for patients with behavioral issues, then discharge them?

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