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My dad has dementia which has progressed rapidly. He fell in the home 3 times last week. He is in the hospital and has been referred by social worker for nursing home care. He is swearing and not being very cooperative with hospital staff. He has since been denied entry to most of the local nursing homes. My mother is not able to care for him in the home if it comes to that. What can we do?

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If your dad has already been referred by the social worker for nursing home care, she is not going to send your dad home with your mom. She is saying, he needs more care than can be given at home.
Therefore, the social worker must keep trying until she finds the placement he needs.

No worries there.

I have been through this more than once with a family member.
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There could be a lot going on here so this is just my opinion. I do work in a nursing home so it could be the nurses notes. If the nurses notes show a lot of violence sometimes he could be seen as not yet stable and pose a threat to other residents therefore they would deny him. It could also be that he is a huge fall risk and they may not be able to assure he don’t fall more this is risky for a nursing home as there are some pretty big reprocussions for the nursing home if he continues to fall. . Or it could be his payer source what does his insurance cover and are they in network with the nursing homes he may not meet the requirements to come based on his level of care it could still be to high and his insurance could be unwilling to pay for many days. Could also be his meds they do a cost breakdown is he on a costly medication that the nursing home considers to high. But likely it’s his notes you will have to show stability maybe a stay in a senior behavior unit then after he is stable they can try again. Check to see what his insurance approves him for and call yourself to the nursing home. He still may not meet long term qualifications but he may get some rehab time that will give a respite and a paper trail for more approval time. And if you tell him he only is going to a rehab facility for a short period of time to get better then he may calm down. Best wishes. There is no longer as much resources available for dementia as there use to be due to the demon I think is managed care. Insurance just does not want to pay until they absolutely think there’s no choice left. Make sure your social worker is sending info to certified dementia units also those that are just locked units are not the best place for him.
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Dvinsant123 Jul 2020
Also don’t forget that regardless you want the best care for him sometimes that means building a relationship with a nursing home yourself. Reach out to one off the beaten path a lot of them do not get many referrals due to there rural location but still provide good care there more likely to accept a patient that the family has spoken to them to tell things the medical record don’t tell. Also you said this was a rapid onset and 3 falls in a week this could be something else all together often times they will go with dementia getting worse when in fact yes they have dementia but it’s exaggerated by a secondary condition such as UTI you must advocate for him and let them know that yes he has dementia but you think something medically else is going on. A lot of people who have this diagnosis are discriminated against in my opinion and other causes for behaviors and falls are not even considered they just assume it is the dementia easy for staff to do I’ve seen it for years so be a strong advocate for your dad. Don’t listen to others who tell you unsafe discharge that will be hard to prove since he lives home with your mom and has you. So that is a ploy that rarely works you want what is best for both of your parents you will definitely get more help and better placement with that stance then screaming unsafe discharge I’ve seen poor people sent to other states because desperate social workers have ran out of time to find a place and family is unwilling to help with that. It’s very sad when that happens there support is cut off. No one should be telling you to do that nonsense call around yourself talk to the admissions or director of nursing explain that your dad is just very confused but that if he could go somewhere with a routine and activity that you think he would calm down. He’s likely agitated because they won’t let him walk so some of that behavior could be caused by staff and there approach to him.
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Tell them to send him to the psych hospital to get his aggression under control.

Keep telling them and tell mom to tell them that it is an UNSAFE DISCHARGE.

He is going to have to be medicated to stop the aggression because no place wants a resident that is angry and noncompliant. It will take time to find the right combination of meds, so be prepared.

Best of luck finding a solution that doesn't make him a zombie.
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Some nursing homes have a special care unit for Memory Care. Some ALs do as well. I’d inquire what level of care he needs. You might also ask for a geriatric psychiatric referral as well. I’d explore medication if he’s overly anxious or having mental anguish.
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The first and most important thing you do is refuse to allow the hospital to send him home if there is any hint of that coming from the hospital. They need to keep him until they are able to find a bed for him. They will eventually, but it may be miles away. If it is, so be it, let them send him there.
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Just be certain you do not allow him into the home. You will not get him out if you do not. You are lucky that he is in hospital or rehab, because this means it is in the hands of the Social Workers. You will begin to get all sort of threats such as "We cannot place him close to you or in your area" and in all truth may be more than a thre1at, but believe they will try. Do not open it to the possibility of his coming home or you are sunk. Let them work it out. Give them all the information they ask you for. And yes, nursing homes are in hard times with covid-19. They can refuse patients they believe they cannot care for.
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Maybe your dad needs Memory Care. Either way, since the social worker says he needs care by a facility, it will be her responsibility to find him placement.

The Social Worker is going to do all that she can do to keep him as close to his "residence" as she can.
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