My DH was placed in an ALF in Nov 2011. In May 2012 he had anger issues and was admitted to a geri-psych hospital for 16 days and returned to ALF a calm man. He did well during June and July. In August he was doing a bit of shouting (as do several other residents). The ALF also had two long term employees quit and 1 go on medical leave. All three were ones who were very nice to my DH. My DH had another incident again 10 days ago. The ALF wanted him back at the geri-psych so I made arrangements. One more incident a week ago before I could get him transported (300 miles) and he got a 30 day notice to move. My DH entered the geri-psych on Wed Aug 29. My DH is 6 feet tall and the female aids cannot deal with his anger like they do with smaller residents. Of course my DH does not listen to reason either. --smile--
Does anyone have any advice what to say to a new ALF in this situation? I am guessing I need to place DH in any facility that will take him?
To make matters much more difficult, we live in a very remote area. I currently live 100 miles from the ALF my DH got kicked out of. There are only 2 other facilities in that town. There are a few facilities in a town 2.5 hours away. I think I will need to move.
I guess you check the two other facilities first. Then, what parameters exist that make moving closer to the other town practical or impractical? Sorry about the situation. It's exactly the kind of additional stress and heartache we don't need.
"what to say to new ALF" -- are you asking whether to reveal all that happened and that you were asked to remove him from the former ALF? I'm thinking that it will all be in his medical records anyway, so full disclosure is the best way to go.
Re the geripsych unit--my husband also had to return after a 2-week stay. The improvement only lasted about 2 mos; then we were back to baseline. The second stay was 5 weeks, and I didn't want him released until they were sure this admission would result in more permanent improvement. The second medication adjustment was much more intensive, more trial and error, etc., and the results have lasted over a year. Make sure you impress upon the docs treating your husband that the first med adjustment wasn't satisfactory and consequently, that the ALF isn't willing to take him back. You need them to do a better job this time so that there won't be further problems with placement.
I agee with Marilyn-full disclosure is probably the best since it will be included in his medical records. Since Marilyn has been through this before, she's got experience and good advice. It is imperative that the drs at the geripsych keep your dh long enough not only to regulate the meds, but make sure they are effective in controlling his behaviors. I was warned that once my DH had a history of violence and being kicked out of more than 1 ALF, it would be next to impossible to place him because the ALFs (even NH's) would decide he posed too much of a risk to the staff and other residents safety. In our case, it was going to be difficult to place him after he ran away from the one and only ALF he was in.
Yep, I do full disclosure... I spent most of the day on the phone. Our local facility (which all my friends thought would be perfect since it has recently started taking ALZ patients) refused after a 2 minute conversation (it is not locked, just wanderguards). One of the other facilities is full, another one talks about the residents "back there". I seem to have all my eggs in one geri-psych basket with the doctor on vacation for a week. ahh, well, the nurses are the ones logging and dealing with behavior issues.
MarilynMD -- I will be firm with the doctor at geri-psych, but since my DH has no place to go, the pressure is on for the doctor to make sure the meds are OK. Unfortunately, my DH is such a model resident except for very occasional anger, it seems like it is an impossible task to say they have it under control.
Re your last sentence: since the problem behaviors are intermittent, all the more reason for an extended stay in the geripsych unit. Your post doesn't say anything about what triggered the anger incidents at the ALF. I think this is a critical piece of information to ascertain and to make the doctors at the geripsych unit aware of. It might not be easy for you to uncover a pattern, but usually, there is one. For my husband it was pretty straightforward, he wouldn't comply with personal care. If I was in your situation, I'd talk to everyone I could at the former ALF to try to pin down what the triggers were, and also ask to review their written records.
Thanks for that the information. The geri-psych required the old ALF to sign something that they would take my husband back, so they signed it, even tho it would only be for 1-2 weeks. Yeah, 1-2 weeks would not be an option. Yuck. The geri-psych knows that my husband has been kicked out. The only problem is that if the geri-psych finds a placement for him, it would probably be 200-300 miles from me. What a problem it is to have a tall, strong, healthy, young husband (ha ha, the only time anyone is called young at age 73 is when they have ALZ). Sorry for the black humor, but that is survival for me. I am making lots of phone calls and trying to figure out how I could move within the next 1-2 weeks. hikergirl
Note to MarilynMD: the trigger point could be behavior of other residents or it could be hallucinations since DH has talked to me about being locked up for hours or days and forgotten, after an incident. I just got a verbal report saying he has been improving all week. Yikes that doesn't help at all since they have done no med changes. A recipe for another disaster once he is placed.
Hopefully, they know what they are doing and will have the necessary meds. ready if and when they are needed. Hope this all gets resolved for you very soon. Keep us posted and vent as needed...it really helps.
hikergirl--yes, you have identified a problem--the "young" males who have dementia plus physical strength. I was seriously worried about that (Steve was 60 when dx), used to work out every day, no other physical problems, etc. But I have to tell you, the geripsych team really got the meds down pat and he's another man now. He still doesn't like being showered, but two aides work in tandem to do it (not uncommon--most dementia patients hate bathing). I hope your husband has the same type of experience and is successfully medicated.
hikergirl, I don't know what your insurance siituation is but I will share my experience which might be helpful to you. DH was 58 when he went to a geripsych hospital for violent behaviors and was not coverd by Medicare, but private health insurance from his former employer. In 2008 before the mental health parity act was passed (2009) his health insurance considered his dx as a "chronic" illness and would only approve a 2 week stay which they would pay for,even though the drs said he needed more time at the hospital to control his behaviors. Once the insurance co refused to pay the geripsych hospital, they did nothing for him regaring a med regimen,told me there was nothing more they could do for him and released him without behavior modification meds-only Ativan when needed. They did tell me he was too dangerous to come home, so he went to the only ALF willing to take the risk. I was there everyday for hours to make sure he wasn't violent, had to come back every night because he wouldn't take his meds from them and he escaped 2 weeks later and no one knew he was gone.
Please make sure they have a successful medication program for your husband. Mine was 15 years younger than yurs and very physicaly fit and healthy (still is) and they couldn't handle it. Still can't. that's one of the reasons he's stil at home.