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Another update since the 4th of September. Dad was discharged from the hospital to a transitional care facility, on the 8th, to do rehab, but they more or less kicked him out, because the facility in question does not do Behavior care for patients with dementia. During his time there he was constantly threatening to harm others (the staff and other patients) and making up stories, from his own delusions, that only he believes. He threatened the staff and other patients, during early morning hours with harm. The social worker tried to get him moved to a facility with lock-down memory care, to no avail, due to distance, but were completely vague about what was going on with our father until they let us know they were discharging him and sending him home (throughout this time, he was being sent to do out-patient dialysis alone, despite being legally blind and partially deaf, on top of the dementia and we didn't find out until a few days before discharge, because the driver who bring him to the out-patient facility commented that they were bringing our father on his trips, alone and leaving him there).


On Tuesday, they sent him, despite knowing we had no way to monitor him 24/7, since someone had to go with him to dialysis in the morning, prepare his meals/meds and make sure he doesn't fall and hurt himself. After my brother went with him for dialysis, at 6AM, dad, apparently scared the staff at the dialysis clinic and dreamed that apparently I killed my sister (his daughter), when my brother reassured that didn't happen he calmed down, before coming home and eating lunch, then taking a nap. During this time my brother stepped out to go to an appointment for himself and I went with him, since he hadn't seen a doctor in nearly 3 years, due to spending every waking moment caring for dad. During the time we were out he went through the house destroying things and destroyed a TV monitor and tried to destroy the CPU; we came back him and found him laughing hysterically and repeatedly saying I killed his daughter, when my sister died 3 years ago due to cancer. After calling an ambulance and the cops, they brought him to the hospital, but I don't know what to do from him. I don't care any the damaged property. It's the fact that there's small children and elderly people living in this building with us; and he could have just as easily attacked them. At this point I don't know what to do and I refuse to allow him to come live with us anymore after today. What can I do to keep the hospital from sending him home, instead of a long-term facility for dementia patients? I tried contacting my local ombudsman elderly care, but no one contacted me back.


I honestly feel that the transitional facility should have sent him back to the hospital, instead of sending him home, because there's nothing me or my brother can any longer do for him, now that he's turned violent, won't listen and is telling complete stranger stories that isn't true. His primary doctor knows what's been going on, along with his kidney doctor; the transitional rehab facility already did a competency assessment and ruled that he has behavior issues, along with advanced dementia. What should we do to keep him cared for until he's moved to a long-term facility?

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Yes, you are correct. He should not have been sent home. He is in crisis and in need of heavy duty 24/7 care. For this reason and others they would like just to be shed of "this problem".
I hate the words "ER dump" but to be frank there is often no other way. Dad need to be taken to ER. Thereafter NO ONE is to say they will accept him home again. No argument. No platitudes by Social Workers of "We can make this work" and "We will get you help." They won't and they can't. So just say "No". He cannot return home. I can at this point become threatening with argument. Just continue to say that he cannot return home and that no one there is mentally or physically capable of caring for him. Be sure to use this phrase "If you attempt to discharge him home we will not accept him; it will constitute an unsafe dischage". This is the phrase to remember above anything else. UNSAFE DISCHARGE.
Your Dad needs more help than you can give. The Social Workers can get him care and position up on the list for admit to memory care much more quickly than you can. It is their job. It is what they are trained to do. It is what they have access to and you do not.
I am so sorry. This is an awful system to negotiate. A very imperfect system. I did nursing in it for many years. If they can force him out the door into your waiting arms that is just exactly what they will do.
For all the reasons you reiterate above, you can no longer do this. Please don't attempt to. So sorry for all you are going through. All the platitude and advice we give here sounds so 1-2-3 easy. And it is ANYTHING but. Awful choices. I am so sorry.
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Bronish Sep 2019
AlvaDeer....That is some excellent advice. I thank you for all the time and effort you put into this answer.

I'm so sorry, too, that being in this Fallen world can really be tough ....I was wondering if the father in question may have a UTI going on.....and/or could also be dehydrated.... could be anything! I have no idea.
Byt, I just wanted to thank you for your well thought out answer to these poor, suffering souls.
I pray also that God be with them thru this dark season of their lives.
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Gee, I know there are complications due to his kidney failure however is he able to be properly medicated? Sometimes kidney failure precludes that but if possible he should be on haldol if permitted by his nephrologist.
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Your Dad has Dementia. He needs to be at a psychiatric facility to be monitor his meds. To find the right combination. Its not safe to bring him home. Once this is done, find a nice LTC. Use up his money and then get him on Medicaid.
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Im so sorry you experiencing this horrible period!!! My dad had a breakdown and we took him to the e.r. They kept him for a week and called me to come get him. But while in there the first day he saw a psychiatrist, who was really good. She diagnosed him as depressed, had feelings of guilt b/c my Mom had passed and he carried a lot of guilt. But while he was in the psych ward they gave him medication to stop his outbursts, hallucinations, etc, everything to do with dementia. Telling part of my story because the doctors have to work together. It seems like your dad needs medication to calm him down, get rid of the hallucinations and whatever is causing his outbursts.
Also, I've learned when dementia patients behave in an unusual manner there could be an infection. But the doctor monitored my dad, gave him meds that worked for him before they sent him home.
Also, when they say your dad s getting discharged you can also request him to be discharged to a hospice or palliative facility.

I do have to add, however, you or your brother "will" have to be with your dad 24/7 in the beginning to get him settled down before you get back to normal.
You may have to ask for medicines. I'm not familiar with all but some that may help are RISPERDAL, SEROQUEL, ATIVAN (cream or pills). Or something stronger. There is another that starts with the letter T. (Idk). But look up 'medicine for advanced dementia with hallucinations'.
Hope this gives you insight and helps. Remember your dad is mentally sick. His brain cells are dying. He cant help his behavior, especially at the advanced stage. And his dr should have suggested a hospice or palliative place for you to look into.

May GOD BE WITH YOU!🙏🏼
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I meant to include. Make sure his dialysis is being done correctly. He's not developing clots. I have a friend who thought her husband was developing dementia, but he wasn't. He had something wrong with his kidneys. He had all the signs of dementia but he didnt have it. Thank God for her, right!
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Agreeing with all of the above, and please do have them check your dad for urinary tract infection. It's hard to believe, but even a mild UTI can cause utter madness like this in the elderly, especially with dementia involved. A hospital should keep your dad for full psych evaluation until they can fine-tune his meds and get him down to a manageable level.

Your goal is to medicate the violence out of him so he can get into a memory care facility -- NOT a psychiatric facility. Avoid that at all costs if you possibly can.
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CaregiverL Sep 2019
Sleepless...what has to be avoided at all costs are discharges to “home” If he needs psychiatric hospital to get meds & see what works, so be it, He is violent so he is a danger to himself & others!
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I would absolutely not agree to discharge to home. No one can handle him there. He needs to go to a psych facility where they can find the right combo and dosage of drugs. We were prepared to send mthr to a psych facility with her dementia because she had been violent previously. Only a psych facility has the ability to restrain a person physically or medically; nursing homes, assisted living, and memory care cannot and will continue to kick him out because of his uncontrolled behavior. The ER dump may be required if he's not currently in the hospital. I'd also file a police report so the damage can be paid for by his homeowner's or renter's insurance (if he has any).
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elaine1962 Sep 2019
I agree 100 percent with surprise. She is absolutely 100 percent right!! Please listen to her.
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Consider a 6 bed facility, which often is more prevalent in smaller communities.
Staff ratio of 2 staff to 6 patients is superb vs. 1 to 10-11 in AL. My sister had mild dementia when I moved her to AL 3 years ago. But as her needs increased over the years ($$$) I realized a smaller facility should be considered. Best decision I made(DPOA). The staff remains stable and very caring. The home is sunny and spotless, with a large yard, fruit trees and a Dove (bird) aviary. Yes, it took a white-lie..."This residence has been sold, so everyone is moving. We need to leave today." My sons packed her furniture and I drove her to the "6 pack." They were sitting for lunch; she joined them...and I arrange/decorated her new room. Now she tells me "I work here." The other 5 ladies are in wheelchairs and it's her new job to tell staff if someone falls. She is really the only fall-risk, but OK; everyone needs a job. And, to visit @ different times allows an honest
opinion of actual care and safety being provided. Six bed homes can be amazing. FYI- treat the staff as Oscar winners...because they are!!!
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Lala17 Sep 2019
DearCompassionate5...Thank you.
What city is that home in? Sounds wonderful. Thank you for sharing
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