Dad had incident at his memory care where he essentially had a lengthy tantrum during which he was combative and could not be distracted or deterred by staff. Apparently, he was having a delusion, and this happened in a common area where a lot of other residents were about. No one was hurt, but the potential was certainly there. The combative behavior isn't new, but this incident was a whole different level than we'd seen before.
The facility called 911 to have him taken in for evaluation for a possible physical cause for the behavior. There was no physical cause, and he was cleared for return to the memory care facility after a few hours and a bunch of tests at the ER, but the memory care was unwilling to take him back on the same day, so he was admitted to hospital for a couple of days because there wasn't an alternative (and unfortunately this extended into the weekend, when you can't reach doctors, facility administrators, or anyone with decision-making authority).
The hospital transferred him to an SNF for rehab (several SNFs declined to take him before one was found) since his physical condition declined after about 3 days in a hospital bed. Then began the long process of trying to get him readmitted to his memory care. I called the administrator right after the weekend and was told that behavior modification was a condition for him to return. It wasn't an eviction, but it was a barrier to re-entry. This was just verbal - nothing written. Should we have insisted on that?
We pursued a change in his medication, but that took time. We basically ran down the clock on the 20 days of Medicare as we bounced between the SNF rehab's doctor, my dad's primary care doctor (who referred the issue to the neurologist) and the neurologist, who was out of town for the first half of this ordeal, so we were really in limbo here. With a medication change, the SNF said they would have to monitor behavior for 3 days afterward to document any problems and get the 602A form done before they'd discharge him.
All of this is new territory for us, stressful and caostly at every turn. Should we have done anything differently?
That the MC did not send you something specifically as to your dads needing behavior mod, is, imo, is, in a way to your dads best interest. If MC were to send you a letter it will have details on the incident that was the tipping point and any other past behavior concerns (combative behavior wasn’t new) and it will go into his file. Should he need to find a other MC facility or even a SNF, and they review his file, he will be toast on being admitted. They way they have handled it to me show that they like your dad. They are wanting to work with him & you to find a path for him to be able to come back. I’m guessing he’s been there a while so staff know him and 90% of the time he’s a lovely resident.
it’s a fine line for the MC as they have the safety & security of all the other residents and the staff to safeguard. it’s probably going to be that he goes onto a new medications and will be on a 8-10 week evaluation as to their effectiveness and if work well enough to quell or manage his agressiveness. If he’s still at the rehab/SNF try to have him do a week on new meds there and then get him returned to the old MC with the understanding that the medication management needs a full 2-3 months. So he gets to stay there for sure for that period of time. And every 3 weeks you have a care plan meeting so no surprises or if he does have to move to a higher level of care you have time to find.
also the family member who feels everything (or almost everything) the MC did was wrong, have them stay away or have them always with a other more “nice” fam. If they show up and start haranguing staff and administration, it makes it look like the whole fam is crazy. Again I think the MC likes your dad, don’t give them a reason not too. Let us know how it goes,
Dad is back at the MC and he's a lot weaker after his 20-day stay at the SNF. Short term, he's less likely to injure or get injured. We hope the most recent change in medication will help with the aggressive behavior. We stay in close contact with the staff to monitor the affectiveness.
We might have to move Dad anyway, but we have the gift of a little more time right now, and I agree that antagonizing the administration or staff will not benefit our situation(!)
To be clear, if the tables were turned, I would *not* be comfortable with a combative resident returning within hours of an incident, and I can easily understand the MC facility's point of view. A family member disagrees with most of the decisions the MC facility made: sending my dad out for evaluation, refusing to take him back that day and putting conditions on his return, etc. This family member thinks the MC facility overreacted, and this was the equivalent of "patient dumping." IMO, we were lucky not to have been given notice.
Good suggestion, @Geaton777, to review the contract. I think we'll need to research our options now so we're not caught totally unprepared if this happens again and the MC decides dad needs to leave.
My mother's MC had a couple of residents who got violent, including one huge man who was like a wild animal when he went off. He was punching walls and windows(!), and the aides were almost helpless against his strength. Fortunately, I was there visiting my mom and got her out of the line of fire, so to speak. That man was gone within minutes and never was allowed to return, thank goodness.
There were a couple others who deteriorated to the point where their behavior was problematic, so they were removed as well. I don't know where they went, but that's behavior that requires more medical care than MC gives.
When my mother's dementia advanced to the end stage, she was acting angry and aggressive herself most days. Hospice gave her Ativan which helped a lot, fortunately, so we were lucky in that regard.
Good luck to you and to dad. I hope he finds peace soon and that the MC takes him back in short order.
You may have to place him into LTC but he will need to be medicated.