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My mother-in-law (diagnosed with ALZ in 2012) is now incontinent and my father-in-law is at the point he cannot adequately care for her at home. we just found out she is in the hospital, because the home health care nurse and the aide could barely get her bathed and back in bed today. My father-in-law's ultimate plan is that she go into skilled nursing to see if her strength can be built back up so she can come home. If not, he is prepared for her to be a resident at a nursing home in their town. My father-in-law said their local hospital is full, so she was admitted to the psychiatric ward! All the general restrictions of a psych ward must be followed, including visiting only between 4:30 pm and 6 pm. She is not at all agitated! She is very pleasant and does not argue with anyone! No one is there to be with her, especially her own husband! When he is not with her, she begins to ask where he is - pleasantly, but I can tell that him being away from her for a long time might actually cause her distress! In the past few weeks, my husband and his brothers have been questioning their dad's soundness of mind due to various decisions. What in the world can we do???????

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Your doing the best you can. I am a RN and worked on a Geri psych unit. Every patient that came to our psych facility ( only 1 of 4 locked units was for Geri-psych) if the addition was over 65 years old they were admitted to Geri Psych. A lot of patients would have a "change in mental status" due to a UTI or something and would be admitted to the unit. The good thing is your MIL will have a social worker assigned to her case to find proper placement when ready for discharge. It sounds like your FIL is a very loving spouse, but unfortunately his spouse is requiring more assistance with ADL's. It may be helpful if you can arrange a family meeting with MIL psychiatrist/social worker, FIL, and you and your husband to discuss options of where MIL to be transferred after discharge.
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BlackHole... yes, that unit is a much better place for my MIL rather than a regular room... we are very glad for that. Since my FIL called it a psychiatric ward, it threw us for a loop.
The main nurse today has visited at length with my FIL and husband. She has verified what I've known... MIL is at the early part of stage 6, definitely needing specialized care. The nurse actually told my husband and FIL that the best place for my MIL would be a memory care facility, not a regular nursing home. However, she will be at the hospital at least several days to tend to some acute health issues, plus thorough evaluations. My FIL's health has been sketchy this year, with four separate surgeries due to his putting off his own health needs. We've wanted him to move in next to us - there is a nice house that has been available a couple of times in the last few years and is currently for sale. But now, the best place for him would be assisted living.

pamstegma... Oh, it's definitely too much for my FIL, and has been for at least a year or so. Bless his heart, he is a very stubborn man, and desperate to keep his wife with him. We are praying that he will listen and act upon the medical staff's recommendations to place her in a memory care facility.
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I don't think there was a shortage of beds, that was a fib that Dad told you to avoid any embarrassment. Plan on mom moving to a secure facility or memory care unit and not going back home. This is too much for Dad.
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A "Senior Behaioral Unit" can assess a dementia patient much better than a typical ER and whichever Doctor Du Jour is making rounds in the main hospital. However MIL got there, count your blessings. Many dementia sufferers get no skilled analysis and no specialized care plan. Tell hubby to keep an open mnd whn he meets with the team. It's difficult to hear things about a parent that deviate from the outline we all keep in our heads.

The incontinence alone will probably be a game-changer. MIL will be incontinent all the time; not just when the aides are at the house. Is FIL up for diaper duty? Probably not. And there's no shame in that. If MIL ends goes to facility care, you can keep up the "til she gets her strength back" ruse while the real plans are underway.

How's FIL's health? Physical, cognitive and mental? He is under a lot of stress. And his wife is not the woman she used to be. Is there a way -- without angering or patronizing FIL -- that hubby's visit can be an opportunity to assess FIL's needs? He is undoubtedly burning the candle at both ends. He may also be dismissing his own health issues because he is consumed by MIL's needs.

Good luck to you all. And be sure to research the fnancial implications of residential care. Consider meeting with an elder care attorney -- to chart the best course.
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Not sure if she has a health directive, but I will pass that along to my husband. I think the POA in place covers everything - health and finances.
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Does your MIL have a healthcare directive or other document that specifically names a healthcare decision-maker? Are those the same people as the financial POA?

Your husband's plan to speak to the doctor sounds like a good start.

This is so hard! Hang in there!
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My MIL has been weakening physically in the past couple of months. I used to be able to help her walk just by guiding her elbow, but now two people can barely get her out of bed and into a wheelchair or onto the shower seat. Just found out from my FIL that she has become incontinent. Behaviorally, she seems to not be able to do things for my FIL or me, but then is more willing/able to do things for the nurse and aide. But she is always, always sweet with all of us.
She has always been relaxed and pleasant. I asked my FIL about this, and she said other than being a little worried about being too heavy for the nurse and aide, she was the same kind person today... no screaming, no violence or anything of the sort.
We live about 2 hours away and have done everything we can to get my FIL to move them close to us, and get my MIL in a memory care center - he is extremely stubborn and would not move.
Anyway, my husband drove to their town tonight... went directly to the hospital and spoke with the nursing staff. My MIL is in a "Senior Behavioral Unit." He found out when her doctor will be visiting tomorrow morning, and plans to be there to meet with him and find out if indeed there were no open beds in the regular rooms, or if the dr thought this unit was better for her evaluation. POA lineup is FIL, brother Chris, my husband, then the youngest brother.
Cognitively, my MIL is at the point where she doesn't recognize my FIL about half the time. Mostly, she seems to realize we are loved ones, although she doesn't use our names and asks us all how our families are doing (very generic questions, like one might ask an acquaintance). She does light up when her three sons are around. She is back in the 1970s... wants to take us to meet her mother and grandmother, and wonders when her boys are going to come in from playing. She does not remember things from moment to moment.
Of the seven stages of ALZ, I think she has been at stage 6 for at least a month or so.
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If she truly is just there because the hospital is full, I would expect her to be moved to a regular bed as soon as one becomes available. Seems odd to me, though, that they wouldn't just send her to the nearest regular hospital.

What trouble did the nurse and aid have in bathing her and getting her into bed? Was she physically weak? Unable to stand or cooperate? Belligerent? Did she try to hit them? Was she screaming? If they called for transport to the hospital and reported violent, irrational behavior that could be the reason she is where she is. That is not necessarily a bad thing. Often in that setting they can come up with a drug plan while carefully monitoring her reactions.

Have you talked to the nurse? Has her experience of MIL also been of a pleasant, cooperative person? Or has she seen agitation and belligerence? It doesn't sound like your FIL's observations can necessarily be relied on. He said the hospital was full -- but that could be how he explains it to himself rather than how it was explained to him.

It sounds like going from the hospital to a nursing home would be the best thing. They can both think of it as "until she gets her strength back" but if her husband is becoming cognitively impaired she may not ever be back under his care. They don't have to face that reality immediately, though.

What can you do? Is your husband or one of his sibling by any chance medical proxy / Healthcare POA? That would give him the best chance to talk directly with the medical staff. Finding out the true circumstances of her hospitalization would be a starting point.

Remember that she has had a progressive, fatal disease for four years. As the disease progresses lots of things can change. Start by finding out in detail just what her cognitive and behavioral status is right now.
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