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Why do facilities have failure to comply when the issue is associated the the disease?


If the physician lists behavior disturbances on your chart, most facilities will deny you and suggest that your loved one go to a psych unit with a geriatric ward. Don't most Alzheimer's patients present with behavior disturbances and receive meds as an intervention?


Caregivers should be educated about how facilities accept patients in advance of placement.

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There r all kinds of Dementia that effect the patient in different ways. ALZ is ALZ. Both can have violent behaviours. Some can be controlled some can't. An AL is not equipped for these types of things. Their name says it all "assist". They have other residents to protect that are paying big money to stay there.

Then you come to NHs. They too are not equipped for violent behaviour. My daughter says too many times a patient is sent to her NH/rehab who isn't ready to be there and they get sent back. Nursing homes do not have pharmacies on the premises like hospitals. They don't have Psychiatrists on staff. My daughter is a good rehab/nursing home nurse but she isn't trained to handle someone who has violent tendancies. She just got punched in the head by a resident who has lewy body Dementia. Resident couldn't tell her why she did it.

NHs are just that, they nurse. They keep the resident clean, fed and safe. They administer meds, do woundcare, bath, clean up messes...but when a resident needs a hospital they are sent to one. Some NHs won't except residents with Tracheotomies because of the care needed and infection rate.

So if a Psych hospital is being recommended then that is where they need to go. According to my daughter, it takes a while to get the right combination of drugs for a particular patient. It can take 30 days to find out if a drug is going to work. If it doesn't another 30 days to try another one. Regular NHs are not set up for this kind of care or supervision and need to protect residents and staff. My GFs father got violent at his AL. He thru a computer. It was so bad that the staff locked themselves and the residents in a room. Police had to be called. Mr. S was in his mid 80s. They become very strong. He was sent to a Psychic facility.

The one thing I saw with my GFs father and I hear all the time is "I don't want my LO doped up". That is what these Psychic facilities try to do. Medicate without doping. Not easy. NH doctors are usually GPs, not schooled in psych meds.
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Reply to JoAnn29
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"Don't most Alzheimer's patients present with behavior disturbances and receive meds as an intervention?"

Er... this is a fair point and it would be unrealistic to dispute it. But it is increasingly frowned on, and best practice is trying to get away from it. Google "chemical cosh dementia" for related news items.

Also disturbances in behaviour do not always amount to "challenging behaviours," and it's the challenging part that turns a sweet little old lady into a heartsink patient. But hospitals, rehab centres and doctors pushing for an admission - "placement comes first" - will use every euphemism they can lay their hands on to get their patient accepted, and facilities know that they will, and so if the facility sees "disturbance" they're not going to investigate further as long as they've got another five applicants for the same bed.

I'm not quite sure what point you're making about educating caregivers about facilities' admission criteria. So, what would you recommend caregivers do?

I agree that psych units aren't appropriate either, though for now they are the safe option. What we need, and have needed for decades, and it's getting more urgent every day, is dementia care facilities dedicated to their purpose. Join a lobby group!
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Reply to Countrymouse
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Isthisrealyreal Nov 16, 2018
Not me, I'd rather just complain 😏

Just kidding, that is great advice.

We are living with issues that generations before us did not have to face. Why does it take so long to catch up to reality?

Maybe we should do a reality TV program so others get educated and bring to light how little care is really there for all these people that modern doctors are keeping alive. It could shift the research to how to have a quality life vs. quantity with no quality.
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It may be because the family does not disclose what the behaviors are at the intake interview. Other times may be because meds still need adjustment as disease progresses.
My mom was in a facility for several years when a new resident was accepted. He kept going in people's rooms because he was lost. This caused agitation to several residents that led to his moving to another ward.
At present now my mom is presenting with behaviors that are new. Gotta just stay one step ahead.
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Reply to MACinCT
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