Dad has bipolar and dementia. Has been on hospital hold for one week with restraints. Psych units won't accept him because of dementia?

Hello!

I've learned so much the last few hours perusing these forums. My dad has a long history of mental health issues, his worst being bipolar. He was admitted in June for two weeks on a hospital hold after a psychotic break where they diagnosed him with dementia and changed all his meds. He was home for a few months before it became too difficult for my mom to care for him- unable to walk, incontinent, falling, confused, thinking he was held hostage by women, violent outbursts, etc.

We moved him into an assisted living facility. Within two days he was moved to the lockdown memory care unit. Within one week the police were called because he was aggressive, punched a worker, damaged property, etc. After the police left and he calmed down he quickly became agitated and threatening again which is when they took him to the emergency room.

He's been in the emergency room for one week on and off physical restraints. They say he can't be transferred to a psych unit at a different hospital until he is off restraints for four hours which he has never been able to do. They say the normal chemical restraints aren't working as expected and he's in physical restraints with sitters. When I asked them what the plan was because he can't live in restraints in an emergency department they say they've tried calling all the psych units at hospitals within a few hundred miles and they decline him because of the dementia diagnosis (including the hospital he that he was on a hospital hold in and diagnosed him with dementia just months earlier). They called hospice who evaluated him but they wouldn't take him because of his violence and restraints.

What are our options? I find it hard to believe psych units can decline patients who are clearly having a psych issue even if they have a dementia diagnosis. It seems the emergency department and adult protective services that we're dealing with have no clue what to do with him. He's refusing to eat, drink and take his meds. I'm sure he wants to die because he's spoken that way before. He has signed a DNR and my mom is power of attorney. Would medicating him to a comfortable level and then trying to send him to hospice be an option? I'm sure he has less then 6 months to live.

Also who pays for this emergency room bill? He has Medicare.

Anyone have a similar situation? Bipolar, dementia, psych units and memory care unit declining him? He surely can't come home!

Thank you,

C.