Father in Law has been hospitalized three times now in the past couple months and each time he is stabilized and behaves very well and gets released. However every assisted living/memory care he has been placed in, despite medication for his agitation, he gets violent and trashes his room, threatens staff and other patients and gets kicked out on his first day there. Every time. I don't think we have any options left. We already had to move him to a different state as our home state had no more places that would accept him. We cannot have him in our home as it would not be safe for ourselves and especially our children.
Feeling lost and unsure what to do or what comes next.
Then much the same questions for the facilities he has been chucked out of. Were they giving him the same drugs as the hospital? How quickly did he deteriorate (three times in a couple of months means it wasn’t instant). Did there seem to be any reason for him to go downhill?
Next, more details about how he is “violent and trashes his room, threatens staff and other patients”. In particular, what was the violence? What were the threats? Did he actually make physical contact with staff or other patients? Was he making demands, and if so what? Did the facility consider calling the police, rather than evicting him? And where did he go, if he didn’t go to your home? If it was to another facility, who found it for him?
If you are really running out of options, I’d suggest that the police do get called, and he goes into the law enforcement mental health system. But as you will be asked a lot of questions, I’d try to get answers to the points I’ve set out above.
I think he associates hospital somehow as temporary and then he can go home, so I don't know how but manages to keep it cool there so he can leave. But he can't go home and he doesn't understand that. His confusion is too great at times to be alone and he was self harming. His violence too great to be with us. He is divorced from his wife for physical and verbal violence towards her and before he was hospitalized/302d for the first time in the past few months he had turned his paranoia on me, began stalking like behaviors, threatened to kill me and had a plan to do it (which he told me through phone messages and then called my husband and walked him through the plan and told him to keep it a secret...). He then vaguely threatened he could just kill himself, my husband and our kids so they could be together forever without me. He confuses me with his ex wives at times as well. We used to have a good (enough) relationship.
As for the violence in assisted living memory care, he has punched staff members in the face. He has broken glass and held pieces of it up to threaten with. He has set off fire alarms. He picked up a table and threw it through a window. He took off his belt and used it as a whip. In other facilities police and ems were called, and took him to hospital and then we are told the facility cannot handle him and he is not welcome back. He stays in the hospital until a new place is found by a team of social worker (new one each time), a placement specialist (same one each time) and my husband.
His most recent I do not know many details about yet but he was placed in a group home setting with what seemed like more experienced staff who understood his needs/triggers. The plan was to keep him more sedated for a few days while he got used to the place and slowly taper off to see if they could as the hospital only had him on low doses for anxiety. All I know is, again, first day there, and he woke up from a nap, got angry and began trashing his room. My husband had to go back and take him to a hospital again. I am awaiting more details, all I got yesterday was his room was destroyed and he had injured himself as well in the process of raging. I don't think he is able to understand the consequences of his raging out but he does seem to sort of understand that when he does, his son comes to get him (or meet him at the hospital) so it's all okay.
We're exhausted and confused. He seems to both understand/has "logical answers" for his behavior AND not understand what he is doing and just is going downhill so fast.
Behaviour is usually communication - but with dementia, even if you can identify the issue, it doesn't mean the situation gets resolved eg Being prevented from leaving the Memory Care building is probably quite a common problem.
It seems medication to manage FIL's behaviour has not worked in the longer term.
I think it will take a combined effort between FIL's representative (Guardian/POA) his Medical Team & a Social Worker to locate another suitable accommodation option.
I just need to know if this is going to be a neverending cycle of placements and getting kicked out or if there is even a place with the ability to handle this. They say they can, until they experience him...
He has threatened to kill you. (apparently in a great deal of detail)
He has threatened to kill your family.
He has assaulted staff members, with improvised weapons.
He has threatened to kill himself.
That's an awful lot of violence.
In a person that didn't have dementia and or mental capacity issues - this wouldn't even be a thought for law enforcement, family members, social workers and medical professionals. He would immediately be put on a psychiatric hold.
So for those who are more in the know- is this a thing for those with dementia when their behavior is beyond what anyone can manage? Is there a more humane way to protect both the patient and those around them and keep them safe, while keeping them in a facility that is more locked down and with stronger medications that keeps them more leveled off like a psychiatric patient rather than just a memory care patient?
I am not trying to be insensitive at all. This sounds like a nightmare for DCorrelle and like their family is running out of options and I honestly don't know where families that get to this point turn to if their family member cannot be managed through the regular channels.
Do they offer the stronger medications in the memory care facilities? Are they allowed to keep them in the same "state" that a psychiatric facility would be allowed to keep their patients for their own safety if need be? Is this even something that is allowable within a patient's rights?
Again, I'm honestly not trying to be insensitive. I'm not a huge proponent of keeping patients constantly catatonic or numb all the time- but it sounds like DCorrelle's FIL needs something much stronger to calm him down and level him off enough to allow him to stay in a facility and I don't know what level of medications memory care facilities are actually allowed to administer to their patients before they need to be moved to psychiatric care.
Secondly, much is missing here.
The first thing we need to know is what is your father's diagnosis?
Is he mentally ill? They are releasing him as stable. That indicates mental illness, not dementia.
Is he diagnosed with FTD or other dementias notorious for violent acting out? If so the facilities are practicing unsafe discharges and should be reported to the state.
Thirdly, who is POA for this gentleman? Is there a conservator or guardian?
You say he is being thrown out of care. Where are they discharging him to? The streets?
I am going to assume this man is mentally ill. Because I cannot imagine three hospitalizations and discharges otherwise.
My suggestions, then, are the following.
Someone is being "called" to intervene or to be notified about these incidents of being kicked out of care. That person is either POA/guardian or not.
If there is NO POA/Guardian I would tell anyone NOT TO TAKE it on but to leave FIL in the hands of the state. A court will appoint a fiduciary and they with Social Services will manage this man. He will be placed and in a facility, if assessed as having dementia, that will medicate him to the level necessary. If he has mental illness he will be discharged when stable with medications he is unlikely to take, and will be followed by the police and social services of his statte.
There will not be a discharge if he is suffering from dementia. If he is mentally ill there may be a discharge.
I would disengage with this COMPLETELY. This man is either mentally ill or suffering dementia to the extent he represents to YOU and to our SOCIETY at large a clear and present danger.
I wish you the best. But you have no power in this. I would keep away from it. You didn't cause this and you cannot fix this and it has the power to destroy your family utterly.
His only diagnosis is "dementia" (no type specified)*EDIT, sorry it does say alzheimers dementia on one of his papers* and anxiety/depression. I strongly believe there is more going on, but keep getting the dementia as the only real answer.
He is not told he is being thrown out of care until he taken to the hospital each time. It is my understanding that assisted living facilities can do so and say they are not equipped to provide for his needs any longer. He does not qualify for a nursing home as he is very physically capable. He stays in the hospital until a new facility is found to take him. Lather, rinse, repeat.
When I say they say he is stable, they are meaning he is calm and able to handed off to a facility "safely." And he is. Until he gets there and flips out.
Apologies if I don't explain things entirely correctly...this is a whole new, incredibly stressful world and I am overwhelmed.
If they threaten you saying it's either you take him or he ends up on the streets... point him to the nearest bridge to sleep under. This is a dangerous and violent individual.
If your husband insists he lives at your home, move out that day with the kids and file for divorce.
He needs to be made a ward of the state asap.
It's not your problem to deal with. You have a home and kids. Don't get involved. Let the state handle him.
You are mistaken. They can simply resign POA by going through APS and filing paperwork in the probate court.
No one needs a lawyer.
I know a few people who actually got themselves removed from being a POA by doing exactly this.
It's not that hard to get yourself removed as a POA. In fact, the easiest route to getting removed as a POA is to do it through the hospital while someone is admitted. Their social workers get that done fast.
Its time to allow the State to take over his care. They will place him and hopefully get him the care he needs.
If the current POA goes down to the probate court and files the papers to get removed as POA, they will do it. The the FIL becomes a ward of the state if no other family will take over.
No need to repeat all the ‘violent criminal’ symptoms you have already set out, no need to say that insanity is not his ‘fault’. We all know that. No sense in trying over and over again to work out ‘why’, failing every time. The point is that our community deals with many such people in appropriate facilities, which are NOT mainstream aged care facilities. Many of them also have grieving families. Shift the focus.
Your husband needs to help his father.
I absolutely worry about him being around other people, but he is able to be charming in the hospital for the most part so the cycle keeps repeating.
I just wanted to know/prepare for what comes next because it seems it's going to keep happening until they run out of places to put him and that is going to happen fast. I appreciate all of your advice and those who let me know about ward of the state, etc. Lots of great advice and knowledge here and I am reading it all even if I don't respond individually. Thank you!
I have a friend whose MIL keeps getting sent home because she tears off her colostomy bag and sprays everyone and everything with the contents! I don't know if they still use strait jackets but this sounds like a situation where that might be necessary...
Have any of the hospitals he's been in been specialized psychiatric hospitals, or are they regular psych units in regular hospitals?
Was there mental illness prior to the dementia disgnosis?
Prior to dementia his only diagnosis was mild anxiety/depression. They were manageable without meds until recently.
Does the treating doctor have access to his recent history of paranoia and homicidal/suicidal ideation and detailed planning?
Have any antipsychotic meds been trialed?
While 'trying to find the right meds,' a person can act out in aggressive ways (screaming, hitting, fighting (physically and verbally). Although this has been an ongoing situation with your FIL. I really feel deep compassion for him as he is expressing himself the only way he knows how - and it is confusion and fear, and likely how some drugs / meds are affecting him.
Do review his drugs / meds with a qualified MD or get a second opinion.
It is a very sad situation and unfortunately, he'll be looked at (by some) as the 'bad guy,' when in fact, it is likely meds and his changing brain.
I would suggest if it is safe to try gentle touch / massage. The oxytocins / (the "feel good" hormone) may calm him down.
- A person could start with lightly touching his hand and see how that goes ... then holding his hand, and then offering / doing a hand massage.
- Do have the practitioner or volunteer talk to him in a very soft, soothing voice.
- If he is receptive, try a foot massage. Neck, shoulders, head, arms, legs. It really depends on how he responds. I use coconut oil. It soaks into the skin and is not greasy and it doesn't stain.
- Start with 5-10 minutes depending on how he responds.
This quality / type of contact / touch could greatly benefit him. Although he has to be receptive to it, certainly approach slowly and gently.
Google massage / elders / touch.
(This is why my massage practice name was Touch Matters. It really does matter.)
Gena / Touch Matters
No, he doesn’t need a massage, esp not from her.
The police can and do lock up people like this but unfortunately not until they maim someone.
Op should just walk. So should her husband.
In my State the closest Phychiatric hospital is 2 hrs north of here. Thats where those showing violent tendencies are taken. But its not permanent. Once they find the right combination of drugs, then the person is released to a Memory care facility. What is needed for those suffering from violent behaviour and those suffering from sexual behaviour is a place where there is appropriate staff, like men aides. That there is a neurologist/psychiatrist on the staff. A PCP/GP should not be prescribing meds for people with these tendencies.
Again, in this situation, I would let the State take over FILs care. No, its not his fault but its not his families fault either. He needs care that that average person can't give.
To answer questions and thoughts about his medications...his violence/threats began before diagnosis/medication was given, so while I know meds can exacerbate things, I also know it may not be the meds either. It may just be him, less inhibited by the dementia. He was angry and violent with an ex-wife in the past..has smashed furniture and things in the past with her. He had never threatened me/my family until this year, though I know he had some resentment towards me (combination of me being a woman and me "taking his son away"). It may be a combination of the meds and his personality and the dementia (I don't personally think it's just the dementia, knowing his personality and background...but, I am not a doctor). I do think he is likely afraid, and upset at the upheavals and loss of his previous life. I can understand that. I think it's just...complicated.
I do not have a complete list of medications tried on him. I do know the hospitals/BHUs have ultimately been able to keep him calm with minimal meds, and low doses of what he has been on. He spent over a month in one when he was first diagnosed with dementia. It doesn't seem to make a difference what meds he is on when transferred to a new place (that isn't a hospital), he flips out regardless of adding additional meds to keep him calm/sedated or just keeping his meds the same as what kept him stable in the hospital. I will ask for a list of what he has tried, I assume there would be an antipsychotic in there..but my husband will have to get that list for me. I distanced myself from his care and haven't talked to his doctors or visited him in hospital or elsewhere, because I don't feel safe near him.
That's the truth.
I would like to suggest you get and read Liz Scheier's memoir of her decades long attempt to help her aging mentally ill mother. It is called Never Simple.
Or would he like to "let go" and resign the POA and allow the State to take over as guardian?
I would suppport him in that.
I would support letting go, for sure. But I am not sure that husband wants to do so until it's last resort. He wants to protect our family and supports me not being around his dad at all, but he is also clinging to the thought that it's all just the dementia (as the hospital that diagnosed him said it was). I know it's so hard for him regardless but especially so to think his dad would harm his family or him. His dad has been completely obsessed with him his whole life (honestly to the point where if it could be just him and his dad, other family out of the picture, his dad would be thrilled...hence the death threats) and he is very much the only child on a pedestal. He hadn't ever seen a negative side to his dad personally, only heard about it (from dad's ex wife...and me as his dad would get mad if I set boundaries around family time...if son set them it was fine) and found it hard to fully believe.
Thats the first priority here.
He needs to not interact with his father in the hospital. The false calm he provides gets blown up over and over when he breaks glass for weapons and hurls furniture.
This is. Homicidal individual, especially toward you. Yes, go for the restraining order for yourself and the children.
If his behavior escalates in the hospital due to his not being coddled, that’s really for the best. They can handle him. Your dh cannot.
You hit the right answers yourself, first in your post of April 1st, and second in your answer of April 2nd. FIL “has been completely obsessed with (your husband) his whole life (honestly to the point where if it could be just him and his dad, other family out of the picture, his dad would be thrilled...hence the death threats) and he is very much the only child on a pedestal”. FIL was violent to his ex-wife, and has no respect for women, including you and the largely female staff at any age care facility.
Peggy Sue said that her in-laws “loved, absolutely loved, being admitted to the hospital. The family visits, the flowers, the concern from staff”. For your FIL, add in more and longer visits from his son, and the female nurses appearing subservient to male doctors. That’s why he calmed down in hospital, not medication.
If this is still the problem, there could be a couple of useful ways to make it clear:
1) Next time FIL goes to hospital, your DH doesn’t visit. See if FIL calms down. If he doesn’t, they won’t send him back to a facility.
2) If FIL is in a facility, get your DH to take time off work to spend around the clock with him, meet female staff at the door to his room. See if FIL calms down. If he does, this also shows that it’s an obsession about his son and women, and it’s a mental illness issue which is not treatable in a normal facility.
I would still suggest that the best way to get FIL to somewhere capable of his care, is to call the police and charge him when he is violent and threatening. That will get him out of the age-care roundabout, and into somewhere set up for this behavior.
Sympathy and best wishes, Margaret
My daughter talked with a psychiatrist who specializes in dementia after his second violent episode. She was told that there are some medicines (including ones he was on) that actually do not work for dementia patients and actually make the behaviors worse.
I pray that you are able to find a placement for your FIL.