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Reluctantly agreed to try dad (91, late stage Alzheimer’s and Parkinson’s) in memory care. I am POA. He was admitted as respite resident on Oct. 1st. I added additional month in view of recent events. When admitted he made comments about going home. Within first few days he fell unwitnessed. Dad fell 3 wks prior at home left unattended by caregiver. We stressed as soon as meds are given put him to bed because he gets anxious. Fell on his back with no injuries. Figured accidents happen. He appeared to be somewhat relaxed after asking to come home. Gave me peace of mind. Now last two wks, everything seemed to come to forefront. I received a phone call 3 days in a row, he tore his skin (like tissue paper on low dose aspirin), bruises on right arm, touching aides inappropriately. Spit out food so he’s isolated. Now sits by himself because he may spit on a resident. (Given puréed foods, sure way to tick him off. He loves to eat.) One day I’m being told he eats by himself, others he is fed by aides. If forcing food he doesn’t like, guaranteed to be spit out.
My dad remains combative on meds. Presently taking Depakote and Seroquel (which is also a high risk for fall med.) He takes Depakote 125 mg and Seroquel 50 mg. Both in AM and PM. At night Trazodone 50 mg. added to help with sleep. Seroquel was added to his meds approx 3 months ago. Low dose, increased dose after a month but not much of change shown to help combativeness in AM. At home slept through the night all under control except for combativeness in morning only. Now I’m told by some it’s all day (lunch, dinner time) and others say he sleeps most of the day???
Morning care is where the underlying problem lies. Dad does not want to get out of bed in the morning to get cleaned up for the day. Started at home when Hospice aides bathed him in bed. He was used to getting up to go to bathroom to get cleaned up. Dad was never morning person and asked to be bathed in afternoon. I thought Parkinson’s may be getting worse. I was trying to get to root of problem but since my sibling had to come to help me he suggested too much to handle at home and as stated above I reluctantly agreed to try respite residency. That’s when MC came to home to see dad’s combativeness in bed. Assurance given it can be handled and their facility is the place for him. Facility reported fall, tears to skin, when things occurred. Everything seemed to be copacetic first few weeks. Then phone calls “dad is fighting tooth and nail with two hospice aids so we are bringing in a psychiatrist”. A psychiatric nurse practitioner PNP evaluated him via telehealth. First the director of MC advised psych. came at lunchtime to evaluate morning care routine??? Director advised PNP that my dad is impulsive. Without actually seeing him in action PNP suggested Ativan Gel to rub on his wrist and/or behind ears. Claims this will calm him down enough for them to get him up and running but needed my approval. I advised her that I would need to talk to my nephew (recently completed residency for Psychiatry) and research.
I’m ok w/medications if they help, however dad already takes enough meds. He sleeps most of the time I visit and aides tell me he loves to sleep. Hmmm.?( I asked for a phy. clinical review of meds prior to admittance and nothing done).
Before approving I asked for zoom meeting to work together as a team. I was my dad’s primary caregiver alone and with help of aides (when good one stayed). I wanted to help with strategies I know worked at home and brainstorm to address triggers. The best they could do a phone call. No knowledge of what interventions used or how deescalated matters.
I asked to view my father’s medical records, where I discovered they gave him meds as early as 2/3wks prior without approval. I spoke with Hospice director a few days ago who advised no change in meds? MC notes noted I said their facility “may not be the one for my father.” It was said by Director of MC, not me!

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I'm wondering if you think it's good for your Dad to be in a constant state of agitation? What type of quality of life is that? Many elders who have dementia and other issues need meds to keep them more relaxed and peaceful because there are no other solutions. It does take time to work out which meds and in what dosages. Why are you concerned about him taking meds? Or is it more that it's happening without your knowledge/approval? If you're not his MPoA or legal guardian, it's not in your legal authority to know or control.
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What is it you want them to work with you on for his combativeness?

What is your plan for dad when he is kicked out of MC for hitting another resident/staff member?

Did you know that an eviction for these types of behaviors make it difficult to find a facility that will accept him without time spent in a psych ward to get his combativeness under control and then there is still no guarantee that he will find a facility?

I would encourage you to work with them and listen to what they are saying. Sometimes meds are temporary to help residents adjust to their new home.

If you pull the legal card with them, they will evict your dad. They don't want legal fights.
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I assume the meds were prescribed by an MD or APRN?

Do you have guardianship? Unless you do, your dad is "his own person".
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IMO if he is on Hospice then that doctor is in charge. No problem in consulting with th MC doctor but the Hospice Dr has the last say.

MC is one step up from an AL.they don't do skilled nursing. Maybe a few more aides but the person should still be able to do things for themselves, like feed themselves. The difference between an AL and MC is that MC is a lockdown unit.

I think you Dad needs more care than a MC is capable of giving.
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JayCee11 Nov 2021
Good point. Thanks.
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My mother was also not a morning person.

When she was admitted to a NH, we were assured that she would be able to eat breakfast in bed, in her nightgown until a reasonable hour (9.30-10 am). Residents have the right to determine what time they are gotten up and prepped for bed. It is explicitly noted in the "Patient's Bill of Rights".

Please tell them to respect those preferences. HiS wishes, not their schedule is what applies here.
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JayCee11 Nov 2021
BarbBrooklyn, thanks for the advice. I’m learning more and more places do things for their convenience and not what the person wants despite the shift in change to “person centered.”
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[We stressed as soon as meds are given put him to bed because he gets anxious.]
Is he getting anxious about going to bed or could he be getting anxious after being given meds that are not agreeing with him but he can’t express this? I’m just wondering.
 
[My dad remains combative on meds?]
So has hospice thought to reevaluate his meds?
 
My dad’s body did not agree with Trazodone at all. It really turned him into an s.o.b from day one and I told hospice he would not try the second dose. I thought Seroquel would be liked, but now I’m ? starting to not be certain because I’m seeing a bit of edgy/make me type attitude breakthrough here or there when given, again yesterday morning. So came late afternoon, I pulled out old reliable (nortriptyline 25 mg) and he was no longer edgy/make me the rest of the day and that’s what he will be taking today. The Seroquel has also been hit or miss with sleep. So in the emergency room, he got prescribed Ramelteon 8mg. When it comes in next week, we will be trying that one for sleep.
 
[Morning care is where the underlying problem lies. Dad does not want to get out of bed in the morning to get cleaned up for the day. Started at home when Hospice aides bathed him in bed. He was used to getting up to go to bathroom to get cleaned up.]
Do you think them changing how he is cleaned up will help? Worth asking.
 
And finally, is there another hospice provider you can bring in if the one you are using is not addressing your concerns or take him off of hospice to be reevaluated by a geriatric doctor/team. Not sure if this is possible just wondering.
 
Constant agitation as Geaton777 mentioned is absolutely not a good thing.
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My husband is also combative and is taking depakote, seroquel and trazadone plus ativan gel. He will not sit down he walks MC all day long I would love to get a report that he is resting, he's non-compliant walks around kissing female res. very aggressive when approached and am trying to move him into a medicaid facility but with this report I am going to have to continue to pay private care. He has been there for 2 1/2 months I just wish they could get him under control. I am 61 and he is 62 I feel I will be out of money very soon. Hang in there it is good that he is resting during the day.
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Just wanted to give an update here. With the help of dad's primary care doctor, we have made another change to his meds to help him find comfort. Hoping this will help someone.

Remember, I was saying looks like when he was on the Seroquel (generic form) he would have an edgy/make me type attitude here or there. Well, I tried a few more times and know for certain with him it was not working not even for sleep (his max dose was 100). Maybe it needed to be higher but the primary was not willing to go higher.

What my doctor is trying now since Nov. 19 is escitalopram which is generic for Lexapro. Knock on wood so far so good. And I'm trying CBD Gummies as some have suggested on here except this one does not have the THC.

The regimen right now looks like mornings he gets his sugar pill. Then around noon with lunch or a bit before noon (depending on disposition), he gets half of a 300 mg Full Spectrum CBD Gummy. Then an hour or so before dinner, he would get his escitalopram. I can't say it makes him sleep soundly but the doc refuses to prescribe a sleep aid. At least for now. I'll also add during the night if I happen to wake and see him tossing a 5 or 10mg melatonin gummy.

Fingers crossed this will carry him for a while.
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