My mom is quite a handful and the director at her ALF has suggested that I consider her having some inpatient behavioral therapy at a nearby Oceans Behavioral Hospital. She has Alzheimer's, but she is also narcissistic. In recent weeks, she has gone and dug cigarette butts out of the smoking area behind the perimeter fence then, found staff members who smoke back there and threw the butts at them. She's also thrown panties at staff because she said they weren't hers. She went and ripped a blanket off someone's bed because she thought it was hers. She laughed at the director when they were in a panic searching for my mom because she forgot to check out. Mom told her she needed the exercise. These are examples, not all inclusive.
I (and they) recognize that ALZ is driving this, but there seems to be an added component of explosive behavior that I can't tell if it is her NPD or her ALZ (these are all things I could easily see her doing when I was a kid, well before ALZ).
I'm just wondering what I could honestly expect from behavioral therapy. ALZ is not behavioral, and NPD is so deeply ingrained that I can't imagine it is fixable at this late stage in her life. Is behavioral therapy really gonna help? Is it gonna be worth uprooting her and sending her off somewhere for a couple weeks? If it is, I'm all for it, but I just don't know.
I have no reason to doubt the quality of care my mother receives - I know family members of several other residents as well as healthcare professionals who are in and out of there and all agree with my opinion that her place is top-notch. I'd like to leave her there as long as possible, but I'm beginning to wonder if suggesting this therapy is code for, "Your mom is too much for us to handle."
You said: "In recent weeks"....... I missed that because the question was more about a certain recommended facility and I did not focus on her symptoms.
In the elderly, a UTI (urinary tract infection) can actually cause her behaviors, have her checked right away. Any change in cognition and behaviors could be an emergency. Get more than a dipstick urine.
Get her checked for dehydration also.
REPEAT: A change in cognition and behaviors could be an EMERGENCY.
And, JoAnn is correct:
Even if you transfer her to MC, she will need to be evaluated and properly medicated for them to keep her.
So things went from not so great to pretty bad yesterday. Day before yesterday, the intake person for the hospital approached her and got her to agree to go. The AL Admin and I were SHOCKED, but pleased. They had a bed open up yesterday so they came and got her. She packed her own bag and everything. Got in the van willingly. Got to the hospital, realized what it was, and threw a wall-eyed fit, tore up paperwork, and stormed out. They had to catch her. Now why they weren't prepared for that - I don't know. I can't believe that was the first time that ever happened. Anyway, she said "Nope. Not going." And since she voluntarily committed herself, they could not hold her, so they put her back in the van and took her back. The intake person called me and told me that they were trying to get a mental health warrant to force her to go and they wanted to have that in place by the time the van arrived back at the AL and they wanted to know that I would be behind them if they needed my signature or anything. I had misgivings by then and I told them I would want to get more details, but that I would if needed. By the time they arrived at AL, she was fine. She had completely forgotten what happened. When I talked to Kim, the AL Admin, she said they wanted to wait and see. She texted me and apologized for what happened. I'm thinking she wanted to see about getting Mom help but she didn't want to see it rise to the level of mental health warrant. Of course, this was winding down at 4:45 yesterday afternoon. Mom is safe for now, so I'm gonna let Kim have her weekend off and talk to her on Monday to get her opinion of what happened.
I think the hospital escalated this a little beyond what is merited, but I'm sitting back and doing some thinking and researching this weekend.
Will her insurance cover the in-patient at the psychiatric hospital?
You need to ask her doctor for the order and recommendation for psychiatric assessment. The top-notch director may know a top-notch program to refer her to for mental health issues, but the hospital could be designed as one of the fancy substance abuse rehabs and expensive. Find out. See if an M.D, psychiatrist will come to her facility and interview her for either medication or placement into their behavioral hospital.
The director's motives may not be code for anything, because what you describe is already too much for them to handle. So not giving up on your mother at age 83 is a good idea. It is usual and customary to seek treatment at a behavioral facility for seniors when this happens. There she will be evaluated and perhaps medicated that might miraculously change her behaviors for the better. It takes a few weeks to adjust her meds while they watch her. It has less to do with behavioral therapy helping her, but time and attention may help her, with the right medications. So, off she goes to the hospital recommended by her doctor.
Whether or not she qualifies to return to to the ALF, keep in mind that she could be discharged from their care if nothing is done. So, maybe it will be worth it. She may need to go to a memory care facility after the behavioral hospital, but surely they will recommend a good placement for her.
When she returns to the ALF, you might want to hire a private caregiver to watch her more closely, be a companion, and monitor (or administer) her medications.
That helped my loved one stay longer in Assisted Living.
So sorry that you are working with a difficult NPD mother. The admission to the behavioral unit will coincide with a time of more professional care and less visits from you due to the need for her to trust her caregivers more and comply.
See it as getting the proper help, and a short respite for yourself.
Proceed without doubting the director's motives, imo.
We are finding out about the insurance right now. After a night to sleep on this, I've developed a plan of action:
I'm going to call the director and ask her what outcomes she would hope to see from this. I'm hoping her insight will give a little more clarity. If this is a last ditch effort to find a way to be able to work with her, maybe I'm better off finding a MC facility and moving Mom there. Or maybe it would be better to send her to the psych hospital and return her to a MC.
I'm going to send an email to her neuropsych and her doc asking them for their opinions. I'm not sure I understand why med adjustments would need to be made inpatient, but I'm open.
I've never walked this path before. I have the above three professionals who have stood us in good stead thus far so it makes more sense to rely on their judgments with their knowledge of my mother than for me to make decisions blind. Throw in the wisdom and experience of this group, and I am so grateful for all the resources I have.
Upon research, the hospital is a bona fide mental health facility, not a substance abuse facility (unless that fact is deeply hidden). It's a 24 bed hospital that specializes in bipolar, schizophrenia, and depression, but also treats those disorders with relation to ALZ and dementia as well as generalized anxiety in the elderly. At this point, I think I'm okay with the facility itself.
I am surprised that the Assisted Living facility hadn't mentioned it is time to move Mom into Memory Care. Your Mom needs to be in Memory Care where the Staff is experienced with behaviors caused by Alzheimer's/Dementia.