Moved Mom from ALF in OR to Memory Care in FL - less than a week; now in Geri Psych and unable to return to memory care; what’s next?
We moved her into memory care Mon 9/30. Sent my son & daughter in law during the day and I went to visit from 5:30p - 9:30p T, W, Th - she started to spiral Wed. Took her to ER for med adjustment on Friday because she became combative and hit care staff and another resident. Meds adjusted and took her back to memory care Friday night. Went to pick her up Saturday morning to bring her to my house for the day - she was already in rare form when I got there. Got her calmed down; took her for a walk with my daughter and granddaughter; basked in the sun by the pool. Set up laundry and Tupperware for her to wash (an ocd habit of hers). She snapped at my house; hitting me; breaking glass and throwing things. I had to have her Baker Acted and she was admitted to Geri Psych.
Before we took her to ER on Friday - I had facility print me her med sheet - I noticed her serequel was only once a day a bedtime. Her script when she arrived 4 days prior was twice a day (noon and bedtime). It was an “Ah-ha” moment of this explains a few things. When I took her back to facility - I asked the med tech to pull up - she said her medication was dc’d two days prior - excuse me? By who? At the time the rounding physician hadn’t seen mom yet so she wasn’t a patient. She said she couldn’t see that a doctor dc’d it. Houston, we have a problem!
This not only explains the spiral out of control starting Wednesday, professing Thursday and exploding Friday and Saturday. I was so upset. My sister and I worked so hard to coordinate this transition and make sure things didn’t fall through the cracks in regards to paperwork, meds, setting up her new place. My mom has bruises on her hands and wrists where I was just trying to hold her hands down from hitting and throwing. She has been at Geri psych for 5 days. Each day we visit and talk to her nurses - Mom is still yelling and frustrated saying “I want to go home. I want to go to my home”. Heartbreaking and so far impossible to explain to her that memory care is her new place.
They have been doing med increases and changes to try and stabilize - although she has been yelling; she’s pounding on desks etc - she hasn’t hit anyone - baby steps!! Yesterday on day 4 - a male patient in Geri psych pushed my Mom - she fell backwards and hit her head. She was sent to ER to be checked out. She didn’t return to the Geri psych unit about 10pm. The memory care facility picked today to send the DON to assess Mom to see if she could come back to memory care - she said no. I feel deflated. I spent a good chunk of my day at work - creating picture papers for my mom - to show her pictures of her apartment, the screened in porch w/ record player, the Dairy Queen around the corner that she loved. I figured she’d only been at memory care for a week and all this change and commotion - figured the pictures would help her focus and remember - my hope that instead of saying I want to go home - she would say I want to go here - to my apartment. I feel like it was a rush decision by memory care to say No; when it was the staff there that recommended Geri psych and said most people are there 2-4 weeks and come back thriving! Overwhelmed tonight wondering what’s next.
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I think you need to have a sit down with the director of the facility and play a little hardball. It was THEIR medical mistake (decreasing the Seroquel) that led to this situation, right? How about they take some responsibility for that? Or would they like to talk to mom's lawyer?
I'm hoping that the geripsych facility will get mom stabilized and that discharge planning THERE will come up with a good scenario as to a place that your mom will thrive. Keep us updated; we all learn from each other here!
Something you should be aware of...facilities are under tremendous pressure from regulators to reduce the amount of psych meds that patients are on. These are considered a "chemical restrait". I thought of them as a Godsend; there was NOTHING...N.O.T.H.I.N.G on God's green earth that assuaged my mother's anxiety; not one of us being with her 24/7, not round the clock aides, not a priest telling her that she had nothing to be afraid of. The only thing that helped was a combination of anti depressants and anti anxiety meds.
A few weeks before mom died, she suddenly started wringing her hands, weeping and looking terrified. She had aphasia so she couldn't even tell us what was wrong. My SIL, who was much closer geographically than I noticed this on a Tuesday evening.
Working backwards with the staff, we eventually discovered that a new psych APRN had cut mom's meds in half without alerting family. This order took effect on a Monday, and by Tuesday PM, the effect was noticeable to SIL.
It took us about a week to trace the source of the issue and get mom back on track. The NH, to their credit, fired the "service" (they had outsourced their psych stuff) and got in a better team.
Still it took a toll on mom and on all of us. And SO unnecessary.
These poor folks have broken brains. I understand that we don't want to drug folks into submission (my mother was never groggy or drugged up, just calm and happy) but common sense seems to have flown out the window in some places.
Why was the assessment carried out so early? Do they want her room for somebody else?
I'm sure you're right that the change and commotion has been bad news for your poor mother's mental state; but more than that: what prompted the move from the ALF to Florida? Has whatever that was been brought under control?
We have watched her over the past 10 days and listened to every phone call (sometimes 15 plus a day) from the Geri psych unit here in FL.
Although her calls were repetitive and she was angry - demanding to go home, wanting to sue us; disowning us etc. - definitely a pattern in the morning until about 2pm - all of our visits went really well; each one better then the last.
We all were anxious as what the visit would hold bc of the angry calls prior to the evening visiting hours. She was never angry or upset with us; we really noticed a big change in the visits this past weekend; she was laughing and telling jokes. She was engaged with other patients and introduced us and loved showing pictures we brought her.
We asked for updates each visit from the nurses - they described her having a few bouts of agitation but a good day. There were no episodes of combativeness - she didn’t strike anyone the whole stay.
We looked at the printed pictures of the facility every visit. Even though she still says “I want to go home” - she sort of corrects herself to say “I want to go to my apartment at the Villas.
This morning they held a hearing with a magistrate- there was an attorney there who was appointed to represent Mom. I’ve never met such a rude and pompous jerk! He towered over my mother and I - leaned in close to Mom and yelled “you can’t live with your daughter, she said No” - Mom grabbed my hand and I reassured her “Mom your going to your apartment at the Villas and your family will be there everyday to help”; mom settled and smiled and said “Sir - I’m going back to the Villas - my daughter knows”. I couldn’t believe this guys delivery!! About 15 mins later while visiting with Mom; the DON from the facility came in - was pleasantly surprised at how calm Mom was and agreed Mom could return to the MC facility tomorrow.
At tonight’s visit; Mom was over the moon excited! We are looking forward to going to the pumpkin patch this weekend.
So far she has leveled out on Serequel 25mg am, 25mg afternoon and 50mg a bedtime: depokate BID and prn Ativan (no Ativan over the past 4 days tho).
Tomorrow is a BIG day for us all. Prayers for round two are appreciated. Thank you all for your support - it meant the world to me.
(Side note: past 2 days - no phone calls - not even in the morning. One observation I had is - when we visited in the evening - she always had her dentures out - she seems sweeter without them - not that the dentures were scary or intimidating- but she was adorable and a sweet sweet lady. Maybe it didn’t really change her without them in but rather, it changed me. It took some of my exhaustion away and she was easy to comfort as this sweet 76 year old spitfire - seeing her so sweet - gave me a boost of patience and love - I needed that each night. One moment at a time 💜). - Ann Marie
Can I recommend that you get some clarification on the whole medication fiasco. I would find out who the doctor is and get her chart noted that no one has the authority to alter her medication without a care meeting.
I pray that she continues to do well and lives her new home.
Well done! Hugs!
Is it possible the dentures are causing pain? Dementia patients are known to have difficulty localizing pain and instead become agitated.