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Medical Forum / Diseases and Disorders / Alzheimer's / July 2006

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Update on getting dad to the nursing home....

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Karla - 01 Jul 2006 17:16 GMT
Hello all,

Thanks to all who responded to my earlier post. Your responses were
helpful and it is also encouraging to know that others have struggled
(and continue to struggle) with these same issues. Early this week,
things with my dad took a decided turn for the worse. He seemed to
"have it in" for my adult brother who is disabled and living at home.
He kept asking me and my mother who that was. Was it his brother? Was
it a boarder? At other times he was convinced that my brother was an
intruder that had to be gotten rid of. The last straw was went he
started telling my mother that he was going to "club that guy to
death." My mom was scared and for two nights laid in bed with her steel
cane beside her and her cell phone under her pillow. She was afraid to
go to sleep because dad was waking up and wandering around the house
during the night. Every day brought multiple angry outbursts and
catastrophic reactions. She had had it!

I was hoping to convince my dad that he had an appointment with his
doctor at the VA in Omaha (almost two hours away) and drive him there
myself. However, conversation with him led me to believe that he wasn't
going to go willingly. He kept ranting and raving about how he'd never
go to that damn VA hospital again. In talking to the local hospital and
the social workers at the VA, we concocted the plan to try to get him
to the local emergency room and then have him taken by ambulance to the
VA hospital. My husband came with his pickup truck and we told my
father that we were going to pick up a part for his car (which
thankfully has not been drivable, since he would not willingly give up
driving, either) and did he want to come along. Dad wanted to come, and
on the way there, I told him I needed to stop somewhere else and drop
off some papers (the local emergency room). While i was inside trying
to figure out how we were going to get dad inside and my husband was
sitting in the truck with dad trying to figure out the same thing, dad
complained about being hot. My husband suggested that they go inside
where it was cool and find out what i was doing. Thus, they came in and
sat down and my dad picked up a paper to look at while I was still
talking to the admitting clerk and nurse. In a little while, a nurse
came out and asked him if she could check his blood pressure. He
willingly followed her and VOILA! he was behind the locked door of the
emergency ward.

The next two hours were really rough as I sat in the waiting area and
listened to him rant and rave about how he wanted to leave and they
couldn't keep him there. The nurses and doctor were really good about
trying to keep him distracted, but eventually he got so agitated and
was screaming at the top of his lungs, so they gave him a shot to calm
him down. Eventually he went to sleep while the ambulance was en route.

I tried to keep a low profile during all of this, because I knew if dad
saw me he would ask to go home. I did follow the ambulance to Omaha and
sign the admitting papers at the VA. I stayed overnight with a friend
and had not intended to see dad again before returning home, but the
next day the charge nurse encouraged me to visit him and assured me
that they would distract him if he got "wound up." I had a nice visit
with dad and he was glad to see me, but of course wanted to know if I
would take him home. I told him "not today." One of the nursing
assistants took him off to play checkers and I slipped out. However,
yesterday, he called on the telephone to ask me to come and get him.
Mom and I are going to visit tomorrow and we are going to have to tell
him "the doctor says you are too sick to come home." We are dreading
that.

The psychiatric unit at this VA hospital is just short-term care and
the local nursing home has a wait, so in the meantime, he is going to
be placed in another nursing home in the area. We are having difficulty
finding one with an Alzheimer's unit that actually has a male bed. The
VA HAS to keep him until they find a place for him, so we are hoping
and prayng that something in the local home opens up soon. Mom doesn't
drive and there is really no one to take her to visit daddy except me -
and I work over 100 miles from their hometown. Mom is finally getting a
little rest, but this thing is far from over.

I've written too much already, but this is therapeutic, although
emotionally draining to recount all that has happened the last few
days. Thanks for the opportunity to vent.

Karla
ladylove77 - 01 Jul 2006 18:45 GMT
Karla, I'm sure you needed to vent after all you've been through the last
few days.  Am so glad though that you managed to get him to the VA hospital
and they have to keep him until he is placed.  Will be praying that the NH
nearer you has an opening for him very, very soon.
Gwen

> Hello all,
>
[quoted text clipped - 72 lines]
>
> Karla
Mary_Gordon@tvo.org - 01 Jul 2006 19:20 GMT
Karla, while he's in there, make sure the doctors consider some meds
for the longer term to help reduce his agitation. Antipschotics or
antidepressants can make a huge difference in terms of quality of life
by reducing anxiety, agitation, aggression, paranoid delusions etc. You
just have to find the right meds at the right dose.

I am not talking about "chemical restraints" as someone inferred I was
recommending in a prior thread. Sedatives are useful as they were used
for your father - not for routine use, but for those very occasional
instances where he is very upset and nothing else seems to work. As I
mentioned, in all the years my MIL was sick, I think she was mildly
sedated only a couple of times - with our permission - and no, she was
not zombified, and yes, she was carefully watched, put to bed, and not
in danger of falling. It was almost as though she got into a spiral and
a little sedation and a good nights sleep was enough to zap her out of
it, and then she was okay again.

It just can't be good for anyone to be so wound up and angry and scared
all the time - not just mood, but physically. Being very anxious all
the time not only makes you miserable, and everyone around you
miserable, its very hard on your health.

M.
Dennis P. Harris - 02 Jul 2006 10:50 GMT
> Karla, while he's in there, make sure the doctors consider some meds
> for the longer term to help reduce his agitation. Antipschotics or
> antidepressants can make a huge difference in terms of quality of life
> by reducing anxiety, agitation, aggression, paranoid delusions etc. You
> just have to find the right meds at the right dose.

i don't remember if he has had a full diagnostic workup?  for
both physical and mental (neuro-psychiatric)?  if he has a
frontal lobe dementia, some widely prescribed anti-psychotics
won't work, and may make things worse.

they really need to keep him in the VA hospital until they can
figure out the right meds to keep his agitation & paranoia under
control.  it could take several weeks, which should give you time
to find the best placement you can.
Karla - 03 Jul 2006 20:24 GMT
> > Karla, while he's in there, make sure the doctors consider some meds
> > for the longer term to help reduce his agitation. Antipschotics or
[quoted text clipped - 11 lines]
> control.  it could take several weeks, which should give you time
> to find the best placement you can.

Dennis and Mary,

Yes, dad has had the complete workup. They had him for three days about
six weeks ago and did everything possible including CT scans, etc. They
are working on trying to get his meds adjusted. The problem is that
they are a short-term care unit and usually don't keep patients much
longer than a week. However, with his behavioral issues, they are
having difficulty finding an interim nursing home to place him while we
are waiting for an opening at the local Alzheimer's unit. Luckily, they
HAVE to keep him until they find a place for him. There is NO way that
we will bring him home!

After reading responses from others, I was reluctant to go ahead with
the visit yesterday (Sunday), but my mom wanted to go. She wanted to
see for herself that he was being taken care of and her attitude was,
if he becomes agitiated, we leave. And that's what happened. We were
there less than 20 minutes. He kept asking if we were there to take him
home. And we kept saying the doctors said he was too sick to come home.
He finally told us that if we weren't going to take him home, we should
leave and so we did!  It was a long drive (2 hours there and 2 hours
home) for a short visit, but at least Mother felt she had "done her
duty" and Mom and I had some good visiting time during the drive. And
it reinforced our knowledge that we did the right thing. if
professionals can't get his behavior under control, there is no way we
could be handling him at home.

The social worker called this morning to arrange a "family meeting"
with the doctor, charge nurse, and herself on Thursday - so we will be
making another long trip! I'll keep you posted.

Thanks for all your encouragement and concern.

Karla
Tumbleweed - 03 Jul 2006 21:12 GMT
<snip>

> Thanks for all your encouragement and concern.
>
> Karla

Glad the visit wasn't too traumatic, hopefully your mother will be more
settled now.
Signature

Tumbleweed

email replies not necessary but to contact use;
tumbleweednews at hotmail dot com

Evelyn Ruut - 04 Jul 2006 00:13 GMT
>> > Karla, while he's in there, make sure the doctors consider some meds
>> > for the longer term to help reduce his agitation. Antipschotics or
[quoted text clipped - 45 lines]
>
> Karla

Dear Karla,

Thanks to you for keeping us all posted.   Everytime someone shares their
story here, someone in the future will be able to access it and hopefully be
helped.   I hope your mom is finally getting some rest.   Even though I am
sure she is concerned, it has to be good for her to get a break.   I know
how we felt.    We were too exhausted to realize that we finally had our
lives back, and it took us a few months to get it together and start to
really enjoy our lives again.

Signature

Best Regards,

Evelyn
(to reply to me personally, remove 'sox')

Liz (Aust) - 04 Jul 2006 10:32 GMT
> And
> it reinforced our knowledge that we did the right thing. if
> professionals can't get his behavior under control, there is no way we
> could be handling him at home.

Hi Karla

My husband was diagnosed with FLD and until last week had been in one
hospital or another, including a psych hospital, from Dec last year.

I know how you and your mother feel as I had a similar situation as he
was agressive and irrational and even when I was on the point of
bringing him home I changed my mind due to his 'challenging behaviour'.

I am glad that I did and that I listened to the wise words that I found
in this group and the comfort of knowing that I did do the right thing,
not only for me but for him as well.

They have the agression under control with meds, at the moment, and he
has been moved to a rehab place for those with mental illnes, until
something else comes up. He is different to your dad in that he is only
56 and that makes it more difficult to get a placement, well at least
here in Aust.

He is actually enjoying where he is and is coming home on the weekend,
for the most part we now have a pleasant time, after I explained to him
why I could not cope with him, he really seems to make an effort to be
pleasant.

The hard part is that he thinks only of himself and what he wants and
although I understand that it is the disease. He has totally changed in
terms of what he eats, wears and likes and that is also difficult to
understand.

I am not saying that your dad will ever come home but hopefully it will
be easier as time and meds work.

Liz
lesanne - 01 Jul 2006 21:25 GMT
I am very pleased for you Karla. And for your Mom. And for your disabled and now safe brother.

Signature

Les

 Hello all,
Tumbleweed - 01 Jul 2006 22:18 GMT
> Hello all,
>
[quoted text clipped - 72 lines]
>
> Karla

Karla,
my advice FWIW, DO NOT go and visit him for a few days, and CERTAINLY NOT
tomorrow. All you are going to do is aggravate him. He obviously, from what
you say, isnt going to understand he needs to be there, indeed he is
incapable of that,and even if he was, he'd soon forget so you'd be back to
him not accepting the situation.

So, the very best you will accomplish is to upset you, him and your mother.
The worst, he gets violent and needs sedation, plus the previous upset to
all. And your mother certainly will not be getting the rest she needs and
deserves. Give her a few days to 'wind down' and discover real life. She'll
probably end up having her first good sleep for the past several years! This
isnt going to be like a standard hospital visit where you sit down and have
a rational chat with the patient!

I speak from experience (partial) in that we also tricked my dad into going
into a home in a similar way to you, and were told he was extremely agitated
and violent for the first week, he also needed to be sedated like your
father, apparently he tried to break out and organise other patients also!
We were advised NOT to visit him because it would not only be upsetting for
him (let alone my mother) but him as well , and we took their advice. A week
later, he was much better, we could visit without upset, and he would accept
answers such as 'you are staying in tonight for more tests we'll pick you up
tomorrow'. There is no way at all he would have accepted this on day 1.

Of course, you may disregard this advice, but before you do I suggest you
think about what you expect the visit to be like and why you are doing it.
If its just to help your guilt (needless), I feel you both will feel a damn
sight worse afterwards if it all goes wrong, and you wont be helping him
adjust. At the moment he will associate you and your mother with 'home'
where he feels safe and wants to be.

Good luck whatever you choose to do.

Signature

Tumbleweed

email replies not necessary but to contact use;
tumbleweednews at hotmail dot com

 
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