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Experienced Member |
I was reading here that to make a transition to a facility easier is to start with a Day Care Center. My father is 90 and has Alzheimers and I think he's too far gone for the center.
He's becoming increasingly agressive to his wife over simple tasks such as getting him dressed or ready for bed or hygiene. This morning she said was the worst ever as he hit her in the chest twice & tried to choke her as she was trying to get him in the shower. He walked out of the bedroom naked and dirty with poo but she finally got him back into the shower, got him dressed and gave him breakfast. He's on haladahl (sp?) and has been checked for UTI and he's clear. We have someone come in 3 times a week to help with him but we really need someone there much more often. I'm thinking a facility is in his near future but his wife doesn't want him to go into one as she says his social security would be taken directly by the nursing home. Is this correct? Can this be done? If that happens, she says she can't afford to continue to live where she is. She says that she has to submit a change of address to social security and then it goes to the nursing home. It's a direct deposit into their bank account so I don't see how the nursing home can have that power to have it come directly to them. She also says her mother was in a nursing home and it was horrible and will not have her husband in one. We are waiting for aid from the VA but it won't start for several more months, I fear. I want to bring in more help for her but my gosh it's so expensive. My brother & I pay for it but it's rough. Obviously she needs the help and we will do it but I'm not sure which is the right thing to do anymore. Move him or leave him at home? There is very little he can do for himself any more. I believe we need some elder legal help. Their attorney moved out of state so I need to do some research on finding someone. Bleh.....I need some chocolate.................... |
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Senior Member |
Haldol should be given to the stupid dr who ordered it.Have mercy!!
Lynne |
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Experienced Member |
I wondered why there was an empty space in the middle of the chocolate box!! Oh well, happy to share!
 I think I might have to take a trip to Sees tomorrow.  Hugs to all and thank you again for your concern and support. It helps a lot! Robin |
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Senior Member |
Ummmm, I ...ummmm... accidentally stole that dark chocolate one from the middle... Dunno HOW that got into my mouth...  "She ain't heavy; she's my mother." Mom got her wings 11/18/2008 |
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Experienced Member |
Thanks everyone for all of your comments. You all have such a wealth of knowledge!
I talked to Dad's GP yesterday and he is sending us to a neurologist; the same one we went to several years ago. Dad's condition has changed so much since he first saw him so will be good to have him evaluated again and discuss medications. His GP is not anxious to place him in a facility, we are not anxious to place him in a facility...we want to make him comfortable and keep him safe in loving atmosphere for as long as possible as well as keep my step mom safe. But we know the time will come when she can't take care of him any more. The idea of a male CG is a good one. He's always responded well to women but I'm wondering if we shouldn't bring in a male. Yesterday I found a support group for step mom and some legal aid so we are heading in the right direction there. Thanks again everyone, Robin P.S. Thanks for the chocolate Dochka! I finished it up last night! |
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Senior Member |
Wow! MB, I can't imagine what to add to this post and the one after it. Well said! "Whatever tomorrow brings, I"ll be there-with open arms and open eyes" |
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Senior Member |
Here's some info from ECO's front page on managing aggressive behaviors. http://www.ec-online.net/Knowledge/Articles/agitation.htm |
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Senior Member |
Robindg, you have received such great responses to your concerns.
Many day cares will not take a person with severe behavior problems. The next time your father shows violence toward your mom, have her call 911, explain the problem.Make them concerned for your safety.They will take him to a hopital that has a behavorial unit.They have specialists who can diagnose his type of behavioral and have the chance to find the meds that work.This happened with my husband and mother. You will still have off times but the correct meds can change things drastically. A GP is not trained or qualified to deal with dementia. A good Neurologist and a gheratric doctor.The fact the doctor prescribed Haladol suggests this. This meds is used as the last resort.If you want a zombie or someone out of control , Haladol will do it. Most good doctors never prescribe such. Many care facilities will not take a person who is violent.If they say they will then watch out. They want to fill a bed and will give harsh drugs. Get a new diagnosis by someo one who is trained to deal with the elderly and dementia. I was fortunate when it came to a neurologist and gheriatric doctor.It was the GPs my husband insisted on having that did him harm. |
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Senior Member |
Hang in there, Robin!! Caring for elderly parents can become such a MESS, but KNOW that there are a lot of folks in the same position as you... at the very least, a geriatric care manager would be extremely helpful to all concerned. Good luck, try not to worry too much and please keep us posted.
"She ain't heavy; she's my mother." Mom got her wings 11/18/2008 |
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Experienced Member |
Thank you all very much for all your helpful comments. Yes, this is not my mom, this is my stepmother who is taking care of my dad.
I get a litte upset when I get phone calls from her or emails telling me what "your father" did. I feel increasingly guilty every day that I'm not there more often. They live in a small town about 40 min. from me and have to travel about 30 min. to get to their GP. Dad basically doesn't know where he lives or who we are. It makes sense that the person closest to him is the one he lashes out to though. I told her this weekend I would find a support group for her, legal aid and speak to her doctor about his meds on Monday. I would also like to visit the local day care and see what it's like and what they are capable of doing as far as his care. She now has a problem getting him anywhere because lately he refuses to allow his clothes to be changed or go anywhere. I'm sure there are lots of tips on how to handle aggressive people. I find things on the internet and send it to her or when I go over there, I say "hey let's try this method" but she's 84 and is pretty worn out mentally and physically. I'm not sure she can do much more. He is quite frail and walks very slowly with his walker and yet he manages to have the strength to lash out or in a couple of occasions, throw his walker at the CNA. I'm just worried for both their safety. Thanks again all. Robin |
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Senior Member |
Preach it MB Robin Im so sorry for what y'all are goin through here. Haladol?!  Oh God save us all from that drug! Eh I know it works for some folks but with your issues and my MIL's, Haladol aint doin the job I had her on that drug for 5 minutes needless to say that was the time that lil lady hauled off an popped me in the lip, picking at her body, wandering in a haze, hallucinating, and just all around combative in general....it had a very real opposite affect for us it could be the same for you. Your mother NEEDS help Robin please get her to understand this and DO take the advice of MB. PCP's LOVE an I mean LOVE prescribing all these meds without so much as a backward glance. They dont see what we go through they dont take the time to listen to anything outside "their agitated, hallucinating, combative, forgetful or just generally not making any sense and not sleeping. AND they dont educate themselves to this disease or others for that matter they are "General Practitioners" (unless you have found yourself a hungry doc who enjoys continuing education on these matters) So they prescribe their drugs of choice and when that doesnt work an we come pounding at their doors they start with "You need to seriously think about placement for your LO" Robin dont allow this PCP to place your LO into their idea of a neat package. One size DOES NOT fit all. Combative behavior with the help of geriatric neurologist can be handled effectively along with the help of home health to take some of the heat from your mom. You need to find a CG that can come in and get these chores done for your mom. Try a male CG if your dad seems to be showing more aggression to females sometimes thats the ticket. I spoke to a patients family not too long ago about just this matter I suggested a male not because I couldnt handle the case but because sometimes males have more respect for a male CG. Theres the issue of modesty for them or just a general mistrust of a female in general. There are all kinds of reasons, each LO is unique in their thinking. For your mom it could be something as simple as hating the very fact he cant do for himself anymore and thats the reasoning behind his combativeness with her. Even with Dementia its not always the disease that makes them combative but the situation they feel they are in. They are not children they are grown men and women with life experience and now that life is a jumble which they are very much aware of and can no longer respond in an appropriate manner. Unaffected they would walk away or respectfully voice their dislike but with this disease they can not.  ********************************************** Well, butter my butt and call me a biscuit. |
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Senior Member |
It would be nice if this were true, but the real world of caregiving in facilities is too often very, VERY different! Concerning violent outbursts - these are VERY common and MANY home caregivers learn how to manage patients who have these outbursts. It depends upon the individual patient and the individual caregiver. Mae is well-versed in this area and can offer a great deal of first-hand experience on managing unmanageable patients. People who have little experience with dementia and the different diseases that cause it may think that these kind of patients can only be managed in a facility, but this is simply not true. It takes understanding of the particular disease and someone who is willing to learn how to care for behaviorally challenged people to undertake this task. Some facilities do a great job of managing a patient's violent outbursts; others cause them; still others physically restrain or drug patients into oblivion, politely called, "chemical restraint." It doesn't come as news to many of us that facilities are often NOT the best places for our loved ones - it all depends on what is available to you in your area and how much the caregiver can do and how much support can be given to the caregiver to manage at home. This is NOT a black & white issue by any means. Whether in a facility or at home, caregivers SHOULD do their OWN research into the medications being given to their loved ones! It is unwise to depend upon this being done for you!! Haldol and many other antipsychotics and anti anxiety drugs were not developed for use with patients suffering from dementia caused by AD, Lewy Body, Parkinson's Disease, etc. Having a good diagnosis is extremely important as certain drugs (Risperdol - risperidone), if given to dementia patients with Lewy Body disease or Parkinsonian symptoms, can cause permanent neurological damage to their ambulation and ability to balance (tardive dyskinesia). Using risperadol as an example (from http://www.drugs.com/risperdal.html ):
In fact, this COMMONLY prescribed drug for dementia patients is now labeled as NOT recommended for patients with dementia... http://www.nami.org/Template.cfm?Section=About_Medicati...y.cfm&ContentID=8189 Yet, MANY dementia patients are currently being prescribed this drug!! It is imperative that doctors KEEP UP with clinical findings and adverse effects of these kinds of drugs as the adverse effects on elderly adults is NOT well-studied and new information is becoming aviailable daily about how carefully (or not at all!) they should be used in elderly patients with dementia and complex medical histories & treatments. Patients with dementia should NOT simply be managed by a general practitioner. They need to be under the care of a neurologist, preferably a geriatric neurologist whose knowledge and continuing education of the differences between the different diseases and causes of dementia is more focused and accurate than would be the knowledge of a GP. This is why having a GOOD diagnosis from a team of specialists, headed by a geriatric neurologist or neuropsychiatrist, is so very important! How diseases which cause dementia are treated is CHANGING every day and physicians who are not specialized in that field of expertise or who do not keep up with continuing education may be doing their patients great disservice by continuing to prescribe treatments that do not work and which can, too often, cause great harm to the health, outcome and comfort of their patients. "She ain't heavy; she's my mother." Mom got her wings 11/18/2008 |
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Senior Member |
Robin, your mom (is this your mom or his wife?) isn't far off, but to be sure, the finances would need to be discussed with a financial social worker at a facility. If he is not able to private pay, then, yes, medicaid would take his social security check and leave him $50/month for incidentals in most states... I do not know how this works for COUPLES, though, so the BEST thing to do is consult and check the requirements for your state's medicaid requirements (they differ from state to state). Since you are in CA, I think it's MediCal there and offers some benefits not available in other states.
His doctor can order home health visits, which can include aide visits a couple of times a week for bathing, changing. His doctor should be alerted that your Dad's level of aggression is increasing and his medication may need to be changed. I am HOPING he has a geriatric neurologist. Haldol (Haloperidol) is an antipsychotic which was not developed for use with dementia or AD, so there may be another drug which he will respond to better. If his behavior becomes more violent, he can be checked into the hospital for an in-patient geriatric psych evaluation, which is done in-patient in a locked-down unit, usually requires a 10-14 day stay. A team of specialists will observe and test him for many different things to evaluate "where he's at", then join together to discuss their findings, give an opinion of his current status and recommend a treatment plan. If he is started on new meds, it's best that it happen there so that if he has an adverse reaction, the staff can handle it rather than your mom. Your mom needs some counseling to understand that if he does become violent, she cannot manage by herself! Sometimes, family members inadvertently provoke such outbursts because of the manner in which they are attempting to relate to their afflicted loved one. This is especially true with couples who have lived together for so long - they tend to relate the same way as always except that the afflicted person has changed and is now giving them a real hard time. Getting your mom to an AD caregivers support group might help a LOT. She is going to need help and will not be able to do all of this on her own. As far as adult day care, these differ in their guidelines. If your father's outbursts can be more controlled with meds, he should qualify. Adult Daycare facilities which take people with AD are familiar with the behaviors that happen and are usually able to handle whatever comes up. Best thing to do is call and ask questions to see... Consulting with an eldercare attorney or geriatric case manager would be a VERY smart way to proceed, especially if your father's wife is not your mother and she has DPOA, etc. "She ain't heavy; she's my mother." Mom got her wings 11/18/2008 |
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Experienced Member |
I think I would feel a sense of relief if we moved him. Guilt, yes, but relieved to know that he's cared for by prople who know how to deal with his agressiveness and that she wouldn't be in the firing line any more.
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Senior Member |
Gosh, I wish I had more practical answers, especially about the finances, though I'm sure there are folks here who do.
I just wanted to say that, in my personal opinion, a violent person should be in a nursing home where the facilities are built to handle it, and the caretakers are young and spry. Your dad can't help what's happening to him but, at a certain point, patients with dementia can become a danger to themselves and others, as you know. My mom recently moved to assisted living. I thought it might be horrible and the guilt was awful but it turns out she's doing very well there. So living in a proper facility doesn't have to be a nightmare, though family will still need to visit, call, and supervise to be sure all is well and his care is good. |
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Experienced Member |
Wow, I had no idea about that drug. I will call his doctor Monday.
Thanks for the head's up, Mae. Robin |
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Senior Member |
Robindg, first Haladol is a tough medicine to be taking.
If I were you and you will be getting help from the VA., I would consult with the gheriatric doctor who will be assigned him. There maybe a better medicine to control his aggressive behavior. I would not leave her with him alone for any lenght of time until this got resolved. My husband became aggressive but Seroquel helped so much Haladol is a meds they use in NH to make the patients zombies to make their job easier. Hubbies doctor told me he would not have any quality of life with Haladol. |
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