My loved one has had violent outbursts and is hospitalized. Facilities have refused to accept her. What can we do?

Medication. There are depo- antipsychotics where one injection can last for a week or more. A psychiatrist needs to be involved and giving the orders. She will likely not be conversant and spontaneously interactive but the behaviors have to be controlled for placement. Also, this doesn't have to be forever. If you have a good psychiatrist engaged and who sees her regularly, the meds can be adjusted and sometimes tapered after a few months to see what emerges. Don't get your hopes up, but put the plan in the hand of a good clinician/psychiatrist and accept what is, not what you would like. If she is safe and her behavior controlled, that may be the best there is for now.

I know how you feel!!! My 92 year old Mom has dementia. She fell and broke her hip 2 years ago and has since lived with me and my family. She got covid (April 2020) and got really confused ~ more than the normal forgetfulness. She fell at our house and broke other hip 2 weeks after we brought her home!! By that time at the 2nd rehab she was paranoid of everything!! They gave her Depakote aka "Sprinkles" which is a mood stabilizer for bipolar and others. We brought her home and I didn't fill the prescription. Now I wish I had!!! We had more family arguments with her over the next few months!!! She fell again and went into rehab again and she was getting violent kicking and scratching and spitting at the nurses when they tried to give her pain medication!!! They were going to give her her 2nd covid shot and she refused that too!! Well then they gave her Depakote and I filled that prescription this time!!! She's been taking it (without knowing) now for a year and it makes her so much happier and cooperative!! Everyone in my house will go running for the refills ~ God forbid we run out!! It's a gift from God!! The doctor who prescribed it at the nursing home talked to her on my phone once and refills the prescription for us. The doctor said it's a baby dose we have her on. My mother is against all medications so thank God I can open the capsule and "sprinkle" it on her toast in the morning covered with jelly and then her dinner. So recommend!! Good Luck!!

MHHE1967: Hopefully her improvement has been noted in her medical record and she will get placement in a MC soon.

Another possibility: They may be looking for a specific length of time without incident - 3 months, 6 months? They may have guidelines that must be met before accepting her as a patient.

There is a dearth of behavioral facilities across the country particularly here in NJ. Most facilities (NH or MC) are not going to want to take anyone with a recent history of severe behavioral issues because of the liability they assume in protecting the other residents as well as their own staff. Even a two month "behavior good" history may not convince them to take the risk as behavior can escalate in hours and most facilities do not have the knowledge of staff on board who can make adjustments.
It is unfortunate that you and your family are going through this but it is not unusual (even prior to Covid.) I remember turning down two potential residents whose families desperately wanted them to come to our facility. I felt so powerless and sorry for them but I had 160 other residents I had to protect and our Medical Director, like most, was not a geriatric psych. Playing with behavior meds would have been long and risky for all involved.

Do NOT take her home. Engage the social worker at the current facility to find placement but be warned.... it may not be close to you or what you would choose but it might be the only thing available. Be at peace knowing that you are doing the best you can for her.
Wishing you peace and luck on this difficult journey.

This woman with her violent outbursts must be "locked up" - and I ASSURE YOU THAT YOU WILL BE PRESSURED TO TAKE HER HOME. No matter what happens, and what threats come, the facility cannot release her if you refuse. They are bound by law to find a place who will take her. No matter what happens, NEVER GIVE IN AND TAKE HER WITH YOU. Your life will be ruined and be sheer hell. Be tough. She needs to be locked up for her own safety and that of others. Behavior like this must be stopped and controlled.

Some times, people wrongly asume that all old people will get dementia sooner or later. Yes, a large percentage of them do. However, many never develop dementia, only a moderate degree of normal decline of cognitive functions. Another misconception is that all dementias will have the same symptoms. The truth is that the symptoms of dementia vary according to the previous personality of the individual (borderline, paranoid, histrionic, psychopathic, narcissistic, dependent, schizoid, etc.), as well as to the presence of a preexisting mental illness (bipolar disorder, chronic depression, schizophrenia, schizo-affective disorder, OCD, etc.) or history of drug addiction including alcoholism. Usually, violent, unmanageable dementia patients, have a co-existing mental illness. They require psychiatric care and many times, psychotropic medications.

My husband was in Memory Care for 2 months and was displaying violent behavior. The psychiatrist on the team recommended transfer to Geri Psych unit at nearby University Hospital. Covid restrictions were put in place, He developed urinary retention, fell out of bed and contracted Covid. While all this occurred they were adjusting his medications. There were no facilities that would accept him and with no visits allowed he continued to deteriorate rapidly. We took him out of Psych unit and he is now unresponsive and not eating but resting peacefully with family visiting and wonderful care from an inpatient Hospice unit.

Need to get the doctor or hospital to write a letter covering her treatment and state that "she has been stable for ________ days with the following treatment plan." It will help overcome the issues of her unstable past.

i would look for a behavioral unit due to medication is working but they are trained to deal with behaviors there are specific place for dementia with behaviors as the social worker or discharged planner it is better to make sure she is placed in the right place it is hard to move a person with dementia to many times on the person

I have not had this experience, at least not yet, thank goodness but this has made me think about what I might do should I find myself in it. First you say her “previous” memory care, when they suggested she be admitted to the hospital what did they say about her coming back? If you were happy with that facility I would ask them what needs to happen for her to move back in. She is medicated now and has been controlled for some time by the sounds of it and while I support a facility’s need to protect their patients it seems to me that behavioral problems has to be something they deal with regularly so there must be rules/procedures for when to send them to the hospital for psyc treatment and when to accept them back.

If there isn’t a way she would be accepted back or you simply don’t want her back there I would work closely with the social worker/discharge coordinator at the hospital on finding an appropriate and acceptable to you place. I would not just let them find a place as they may have more interest in getting her out of their facility than finding the best place for her, a take the first bed you can get kind of approach but if you are willing to take on some of the leg work by visiting options or giving them your first 3 choices from the last time you looked for memory care for her they might be able to help get her in through their channels and they can verify up front that her behavioral issues have been managed for an acceptable period of time. Maybe there could or should be a plan for when her meds need to be reevaluated set up by the doctors so if X starts to happen she goes for medication evaluation before it gets to the point where they are concerned for their residents and employees. This might require bringing in a geriatric specialist who can be part of her care team and follow her from now on if she doesn’t already have one. I can only imagine how hard this is for you and I’m sending all the strength and support I can.

My deceased sister had LBD. A few months after we moved her from Az to the midwest-she became a challenge to caregivers in Assisted living but not full memory care-trying to hit or argue refuse care. I knew she was frustrated with the facility not having enough things to do-she could not learn her way around. Care was unreliable only one Nurse on her floor would help us when i asked for info. status etc. My sister eventually tried to get out of the place-due to unsupervised door way-got angry when they tried to stop her-she slapped someone. Did this a couple times each time sending her to ER for eval.

This is pre covid days. ER gives a blast of haldol and send her home. This was not a good long term solution. They recommended psych eval at a place that terrified me. I refused to allow sis to go to their option vs. what i eventually chose. I knew sister would not thrive there under their care or come home with any hope of lasting improvement. I resisted eval for a while until i figured out that resisting would not give any answers or help my sister get stable. I was not thrilled with psych environment but she did get out in about 8 days-after she met requirement of no anger for 3 days. While she was in the hospital for eval I decided we were going to leave the current community for other locations.

Yes with combative history does limit the options of where place will accept. One place did accept she seemed okay at first med changes seemed to help but then "accidents" kept happening at the new facility and i decided she was not safe there either. Mind you they also had combative men in the same unit. I watched one time as a man dished out some serious attitude towards the aide and she had a bigger bad attitude to tell the man who is the boss here. I found my sister in the bedroom-fully clothed-nothing seemed to really be happening in a scary or sexual way she was just standing there looking kind of lost. I decided then and there we needed to get out of that place. Of course this angry guy was no where to be seen on tour day and we were not told how many other residents had anger issue. My sister had remained calm for the 6 months it took to get her accepted just before covid hit-was a miracle to get her out at the last second. pre covid was the last time i could spend time with her just before the move. I was thankful to get her out of that scary depressing place-no other option at that time to do the exit sooner. I sensed the "care" would drop dramatically due to increasing cases among staff and residents. fewer workers and no way to check on her at all there were no phones in the rooms and she could not dial by herself anymore anyway. The state covid cases show that community had a lot of resident cases-which ended in death will never know. One new place with just a few residents-a sister community by the same organization where sis had lived for a few months in AZ before she moved to my area- said they would take sis if they thought they could handle her only after the psych eval. Probably a letter from psych dr. and or second eval from other specialist maybe would help you get into new place-see if last place under consideration by you-ask what it would take for them to accept and see if you can provide that.

She probably should stay where she is now.

P.S. My loved one first exhibited signs of Alzheimer’s when she was in her 50s. She had been in memory care for only eight months. Prior to Covid, she could drive and worked out at the gym three times a week.

My grandmother was in a nursing home for 5 years. The kind of one where all assets are signed over to them, they get control of social security, pensions, anything. Anyway towards the end around age 90 she bit the nurse caregiver in the breast. When I went to visit her at night after work, you could hear her screaming from her bed in the entrance was to the wing. I would try to calm her down. My dad had just dies a few months earlier. We were lucky they did not kick her out. But I assume they just let her die at that point. She was seeing angels and loved ones coming out of the ceiling.

Leave it to the social workers and just be certain not to take her home. She may need to be medicated when she is placed; that is always a sad outcome as finding the right meds that don't over-medicate into non-reaction but do control outbursts is very very difficult to find, especially outside a medical unit. Just be certain you don't take her home, and that you insist that is not an option. I sure wish you luck. They may need to await special psychiatric placement. I am so sorry; this is a hard case for certain.

If her behavior has improved and is staying consistently calm is this being recorded in her medical file? A facility will certainly read her medical files and this will be the proof you need to get her back in somewhere.