Currently, my mother is in SNF. Prior to moving her into LTC, she was in assisted living for close to six years. She has a host of chronic health conditions. My family and I decided to move her into LTC after several repeated falls with the last fall producing seizures. Since being on the seizure medications, certain personality features have been magnified, such as her rage and anger. I received a call this afternoon from the charge nurse stating that they placed my mother on suicide watch because she has been repeatedly stating that she wants to die. In truth, she has been saying this since last May when things don't happen fast enough or doesn't get what she wants. For example, because the housekeeper changed the position of her bed, she now wants to die. Because of her rage, she's also attempting to run people over in her wheelchair and has hit several of the staff. She also takes her rage and anger out on me and my partner when we visit. The repeated exposure to her anger and rage has made it challenging for me to visit her. Most of her anger and rage at me is related to her being placed in a SNF - wants to go back to her assisted-living facility. Because of her conditions, she cannot take SSRIs or SSNRIs because of low sodium. She also can't take antipsychotics because of afib. Our last resort has been xanax, which she has been on for several years, but neurology prefers for her not take scheduled doses of the medication. Her doctors have also recommended memory care, which I have called a few facilities - ones that take Medicaid. Unfortunately, there are waitlists. Other memory care facilities are cost prohibitive even if she still was private paying. So, until a space opens up, we can't move her into memory care. I'm afraid that the facility will kick her out because she is the "problem" resident. What other things can we do to help manage/navigate her rage and anger? She wants a phone, but she often calls emergency services when she doesn't get what she wants or things don't happen fast enough. So, no phone at the moment. She likes to watch certain television channels but she hasn't been interested in watching TV since moving into SNF. They do have activities at the facility, which she often participates in, but it doesn't seem to be enough or not enough for her. She doesn't like puzzles. We try to show her pictures because she likes pictures, but this only entertains her for about five minutes. She likes music, but she hasn't been that interested in listening to music. Instead, she wants to rage. Finally, prior to her last fall, we did utilize hospice services because her psychiatrist recommended this. The assisted-living facility was short of staff. The facility was having a hard time supporting her. Unfortunately, hospice didn't work out.
I would opt for the best psych medication available for her symptoms and to heck with the side effects. Your mother deserves some peace.
I would not do PRN antianxiety meds. Have them given on a regular schedule --it takes a far lower dose to PREVENT anxiety from ramping up than from treating it once it has gotten up a full head of steam.
Does the xanax help her? Is it prescribed as an "as needed" med that has to be asked for? If so, that's CRAZY!! She obviously needs a med that will calm her waaay down from her level of rage. Push for that. Real hard. I would talk to the doc at the SNF to see what they suggest. Your mom certainly isn't the first difficult patient they've had.
Why didn't hospice work out? She didn't qualify? Was this before or after the falls and seizures?
Best of luck.
I don't know what you mean by "Hospice didn't work out". Hospice doesn't take on care. They send someone to bathe twice a week, an RN once a week briefly and usually a phone call from social services person and clergy if wanted. They give medications to be supervised by caregivers. They do little else anymore now they are a part of the military industrial complex and owned often by Hedge Funds. They are profiting off of huge amounts of Medicare money, but you are on your own with care.
I think your loved one will need transferring to neuro psyc. I agree with the need for Hospice. She needs comfort care now. She wishes to die and has nothing to live for. You should support and honor her wishes. So get hospice back so she can receive medications, if for no other reason.l
I am so sorry. This is a dreadful way to end. I hope you can find a way she is brought peace. Whatever you do, do not allow any family to try in home care. Whatever facilities they must use they must now use. With the help of hospice hopefully she can be helped.
My MIL has been on a varying cocktail of antianxiety drugs/sleeping pills & tramadol for pain for almost a year now. It is the one and only way she can have her wish to stay at home as she transitions to the next life.
DH is so uncomfortable giving her these meds. He'd rather sit for 3 hrs and be screamed at than give her one Xanax. He still believes he can 'talk sense' to her. Well, that ship sailed a looooong time ago.
I know so many people who are just terrified of any calming meds. But they definitely have their place in our lives.
Sounds like your mom really doesn't HAVE a choice. She has to be semi-sedated all the time to maintain residency in her 'home'. She's not that special. She doesn't get to make life miserable for the other patients. Doubtful she 'gets' that.
I have no clue why my MIL has begun raging at people. Probably another step down in the dementia process---DH refuses to accept that she HAS dementia and simply says she's 'crazy'. Yes--she is, most assuredly, but it's not fixable.
If your mom kicks up enough fuss in the NH, she can be evicted. It'd be better to work with her drs behind the scene to get her on a cocktail of meds that keep her calm.
With my MIL, something as simple as the CNA moving the bandaids from one shelf in the kitchen to the shelf ABOVE caused a 4 hr complete and utter breakdown. DH said she wasn't making sense and was being nasty and completely out of it. Did he give her a Xanax? Nope, b/c he thinks it's wrong to drug her. Well, sucks to be him--he had a lousy night with her and after he left, I guess SIL showed up and drugged mom to the gills.
Nobody is going to care if you have to use meds to keep your mom calm and as functional/compliant as she can be. Anyone who would be judgmental of that needs to spend a couple of days with an elder who is raging out of control.
I wish you luck. This is not fun for anyone and not pleasant in any way, shape or form.
I am not a doctor, but I agree that xanax is not a good solution. I have been caring for my husband at home for 8 years. He is aggressively resistant to all cares, and has been kicked out of 2 nursing homes for behavior. We have tried many different medications with the hope of calming him. I found that regular use of xanax was causing more anxiety because it is an addictive drug, and he was extremely agitated when he was craving his next dose. So, I weaned him off of that, successfully.
I will tell you the medication which has been like a miracle drug; Trazodone. Ask her doctor about it. Not only did it help to calm my LO, but his leg tremors stopped completely.
I would also suggest you spend some time at the facility, I mean hours at a time, so you can get a sense of how well she is being cared for. She may be neglected if she's difficult. She may be afraid of someone there. Or, she may simply be acting out, hoping you will give in to her requests. You may not be able to satisfy her. If you are confident she is in the right place, and there are no better options available right now, she will need to accept it, even though she may be very unhappy about it.
If you know she is in good hands, and you are doing everything you can for her, relax a little. Don't let anyone manipulate your emotions to get you to acquiesce to a situation you will regret.
What kind of dementia does your mother have? Is there an actual diagnosis? Or is it just that's she's old and difficult to handle so memory care it is?
I'm asking this question not as a judgment on you or your mother but because memory care is a terrible place to put a person who still has any of their own faculties left.
Her doctor can prescribe a liquid version of Ativan (lorazepam) that can be given to your mother as needed. When she's starting up, she can be given a dose. She could also benefit from being on a low-dose daily of it too. Or some good, old-fashioned Valium. There are options that can help her.
You also have to look at the picture from another angle. Your mother is sick, she lives in a nursing home, and she's miserable. What quality of life is that for anyone? When she says she wants to die, she has good reason to want to and it may not be the mental illness talking. It may be the reality of what her life is.