What happens when a parent keeps getting kicked out of facilities for violent behavior?

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What happens when a parent keeps getting kicked out of facilities for violent behavior?

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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.

Alzheimer's & Dementia Assisted Living Memory Care Violent Behavior

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I went through this with my mother, who was on Prozac and Clonazipan after my sister died and her MCI progressed rapidly. The Clonazipan was increased to a point where she did become violent -knocking down a Christmas tree, throwing coffee mugs at people and things. breaking things. We finally sent her to a psychiatric hospital (though is scared me to do so) and it turned out to be the best thing we could have done. They took her off the Prozac and Clonapin gradually, and put her on a new set of drugs for her anxiety that did not make her angry. She sometimes gets mad now, but does not get violent or try to hurt things/people. I say this to suggest, could he be placed in a Psychiatric hospital to adjust his medications so that he is calmer?

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Thanks for all of the new answers/suggestions/support.

I do not think that his outbursts were a result of any misbehavior on the part of the facilities he was in. I truly think it would have happened in any of them, no matter the circumstances.

At the current hospital he is in, he did end up having incidents where get got violent or needed restraining. His ability to understand or reason seems to have dissolved as well (it was somewhat present in the past few months, even if not fully logical). It (the cognitive loss) seems to have been happening incredibly rapidly. I am unsure if that is just the progession of the disease or if it's a result of the medications he has been on.

As previously stated I do think he had undiagnosed mental health issues and certainly anger management issues. ODD would not have surprised me in the least.

There were no UTIs or infections present at the time of the incidents. He is physically very healthy. Or was. Since being in the most recent hospital he has come down with Covid last week and now has double pneumonia. So currently he is too weak and/or sedated to have any meltdowns.

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If it has already been mentioned, please forgive me...didn't have time to reveiw all answers, Sometimes behavior changes can be physically related could he be in pain, but not know how to express it. Could he have an asymtomatic UTI, (ie, not the usual symptoms of burning/ pain with urination etc)
So many possible reasons....
Best of luck to you.

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DCorrelle: His physician should provide a medication reassessment.

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i went through this with my father. May I ask what state you live in?

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Consult with Hospice. My Step Father went through this at home. They can also work with and in the nursing homes facilities. They will keep him heavily sedated to calm him. We also had to call the police/rescue squad at times. It was very hard to go through. Hang in there. Sending prayers.

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Please video his behavior and bring it with you to the Geriatric Psychiatrist who can offer medication and refer your father to a mental health hospital. Google the doctor nearest to you.

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It may be possible that your FIL is doing well in the hospital because he likes the attention he receives while there. Nurses in and out of the room many times of the day, doctor visit each day, meals brought to him on a tray, someone coming to retrieve the tray after meals, housekeeping coming in to clean each day, etc. Then when he returns to a residential facility those frequent human interactions decrease dramatically.

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1. Address this behavior with his PCP ( Primary Care Physician) and, have him perhaps referred to a Geriatric specialist and/ or Psychiatrist/ Psychologist for assessment and, recommendation.

2. If you have already done the above, revisit this " unsafe" behavior with the specialists for further assessment.

3. I am not clear from your inquiry if your FIL is cognitively appropriate ( that is ,is he able to mentally communicate verbally and comprehend) ??
?? Attention seeking behaviors vs ??? other dementia or other mentally limiting condition (s).

4. Have medical staff assessment team assess his " care level needs" and include this " unsafe" behavior history for them .

5. Be clear with the medical team that you cannot care for him at home.

6. Does he have potential unresolved anger, rejection, attention , ODD ( oppositional defiant disorder) etc etc ???

Practice good self care. You will need strong, firm boundaries....

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It is VERY likely due to the medication they have him on! Try getting him off the drugs and have them all evaluated. There are natural alternatives to help calm people that do not have the severe side effects.

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YES. Ask for written report of drugs he is on and when they change the drugs. It is often a hit or miss trying to find out what works. Unfortunately, the recipient of the drugs suffer during this process. It is heartbreaking.
* Ensure you get reports of the drugs he's on and do your independent research of possible reactions to these drugs, and esp or in addition to when some drugs are combined.

My heart goes out to you.

Gena / Touch Matters

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Speak with an elder care case manager, social worker, Natl Council on Aging, or Alz.org or Alz 800 number and they may be able to put you in contact with someone who can assist. Google it.

Sounds like FIL needs a geriatric psychiatrist who can place him on meds to calm him down. This process will take awhile before right balance of meds/right med are found. The sooner you start, the sooner a resolution will be found.

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You will need a different ( perhapsgeriatric) dr to prescribe the correct medication. I went through this for 10 years with my mother. They need a balance of anti anxiety medications and more. So they are calmer without being drugged into unconsciousness…music and photos may help too…. Don’t give up … he can be calm … with a dementia brain injury medication is key. This stage also will pass. There may be a problem also with not consistently administering the meds. I am not a Dr … but this should NOT be happening!!

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I have been there and done that with my sister. She had frontotemporal dementia, which began in her early 40’s. She was never violent and actually was not diagnosed until about age 48/49. She first went to assisted living. Whereas she was young and physically strong, everyone else was in their 70’s and beyond. She was pretty stable there for about a year, although during that time she went from having an entire apartment to one room with a bath. She was thrown out of there after about a year for pushing down another resident and breaking her arm. Next she went to another assisted living/memory care home and became increasingly violent to the point that we had to have a private caregiver in her room 24/7, so we were paying double for her to stay there. During this time, she trashed her room daily to the point that they removed everything in it that she could destroy. She was physically violent with everyone who entered her room, and she had to stay in her room while other residents were out and about. This stay lasted about a month or two, as when she was admitted, they told us it was only temporary until we could place her somewhere else. Her violence was not aimed at anyone in particular, but at anyone who stood in her way. With the help of social services, we finally were able to place her at a facility that specialized in violent behavior and with the help of a neuropsychiatrist, they were able to get her under control with drugs. She basically stayed in a zombie-like state and walked and walked and walked the halls, sometimes not sleeping for 3 days at a time. They still had trouble keeping her in her room or even getting her to sit still long enough to eat, but she was no longer violent. It was both with relief and sadness that we finally decided, after a bad fall and her refusal to eat or drink, it was time for hospice. She lives another 12 days and died at age 51. She had decided early on to donate her brain to science and her cause of death was Pick’s disease. I hope in telling her story that it will give you some insight as to what you are facing. It’s a matter of finding the right help for your FIL and the right place to put him. If this means a geriatric psychiatric facility, so be it, but you need to keep your family safe. We did not have to give up our POA to get the resources we needed, but she lived in Washington, DC, so we had excellent resources available. I wish you the best of luck in finding the care that your FIL needs. Keep your family safe.

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My husband has FTD. We first placed him in a MC, he became violent after a few days and was sent to a locked behavioral hospital for med adjustment. He was released back to the MC. He was fine for a few weeks and then pushed another resident. ( He had gone in their room, the resident stood up and told him to get out). They kicked him out. We found another MC that was for Alzheimer's & Dementia ( I thought all MCs were!) He was there for a week or so and became violent. He was sent to a psych hospital over an hour away. Was there less than 24 hrs and was unresponsive. Was sent to a hospital with UTI and sepsis. They got that taken care of and he ended up in that hospital for almost a month because they couldn't find anywhere that would take him due to his past violent behavior. Finally he was sent to a SNF near our home. He was there a week and they sent him back to the first locked behavioral hospital ( without my knowledge - saw something happening on the camera and had to call to find out what was going on - that's a whole other story!) He's been at that SNF almost 11 months and he's been fine. He's been on Haldol and they've actually changed it to as needed. I think it's because his FTD has progressed. He's basically does not communicate, for the most part can do nothing in his own, but he can still walk.
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.

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See my story about my sister. Sounds much like your husband.

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DCorelle, I was thinking again about your FIL and the problems. Here is a guess, that might be worth considering.

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

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PS It's the only thing I can think of that is actually under the control of you and DH.

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Dcorelle, your journey atarts with your husband.

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.

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Blue eyed girl 94 - I wasn’t suggesting that the posters FIL not be placed somewhere safe - I was just objecting to the ‘insane’ ‘violent criminal’ reference. I guess I feel more sensitive being as I’m going through it myself. My loved one was never violent until he became unwell. My situation is not dissimilar to the poster. Believe me I tried everywhere to get him admitted to a psych unit even offering to pay privately but no one could help. I eventually found a place myself. He was stable for a while then reverted back. I’m cutting a long story short here however I did find a facility that would take him. They were willing to mange him - it wasn’t easy! He was stable for a while but then became violent/agitated again. Luckily he got the help he needed and we changed his meds which seem to be working. He gets a little agitated here and there but nothing like he was. I can tell you I was absolutely determined he would not be left in some psych unit - I’ve fought a very long and hard battle to get him where he is today. I know everyone is different - people have various commitments and may not have the time, energy or resources to deal with this. I know first hand it’s not easy! I just dislike the reference to someone being called an ‘insane violent criminal’. Dementia is a cruel disease and people can’t help how it affects them. I wish the poster all the best in getting the help she needs for her FIL.

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He fashions knives with broken glass, Debb. He wants to use them specifically toward op. And unfortunately, until he does that he’s not getting the care he needs to keep society including op safe.

Thats the first priority here.

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DC, where is your husband in all this? Is he actively participating in planning for his father?

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.

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He is participating in his care...to the best of his overwhelmed abilities. He does mostly let the social workers, etc figure out where to place his dad next, he tours the places and signs the papers but trusts their opinions. He transports his dad to facilities. He meets him at the hospital (or transports him there himself, in the most recent case. They thought it would help keep his dad calmer to be with his son. It generally does, but he can't be with him 24/7).

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.

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Still reading and taking all of your advice in as it's added. Thank you!

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.

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As an old nurse--and I am sad to say this--there are few medications and medication cocktails that ever work. First of all someone in care isn't adequately assessed, and meds aren't titrated as there is no MD on premises. Secondly, even when the meds work temporarily, they seldom KEEP working.

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.

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What the problem here is, that there "are not facilities" that take people suffering from this kind of problem unless you maybe live near a city. Assisted livings and Memory cares are privately owned and do not provide this type of care. So for a SW to say they do is in LaLa land. All Memory care is just a step up from an AL. More of a locked down unit with hopefully staff trained in Dementia. Most aides are women they would not be able to handle a angry male.

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.

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I don’t have advise for you other do whatever you can to keep yourself safe…hugs to you …

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In response to Margaretmckens comment in response to mine. It was YOU who said the posters FIL was a ‘violent criminal’ and ‘insane’ so maybe YOU should check your OWN common sense before posting such cruel comments. The poster stayed her FIL has dementia. Yes he’s violent however this is NOT the same as the people you are referring to.

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He has homicidal tendencies toward op. He fashions weapons. He throws heavy furniture.

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.

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There are private facilities that take in people like your FIL. Check around your area. Call the local elder care group in your area for advice. You don't necessarily need to give up your POA unless you want to. Having h him in the right place is the key. When you find that, you don't have to visit him, but you will know he is cared for by people experienced in this kind of patient. Good luck!

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He needs right medication to get stabilized. He might have to have short stay in psychiatric hospital to get meds right. From there, he can be placed in skilled nursing facility for long term care. Hugs 🤗

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Exactly.

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firstly i am a little surprised and saddened by some of the answers here. my loved one also has alzheimers and was never violent until after he was diagonosed. i had a similar problem in and out of homes/hospital etc. i finally found an independent facility who were willing to work with him and manage him. he's been there for over 2 and a half years. don't get me wrong it took a while however he is now stable. his meds have been adapted over the years - he was taking seroqul and currently takes risperdol. it's been a very long and hard journey to get him where he is today. i'm not sure what state you're in however if it's CA then let me know and i'd be happy to recommend this facility. If not there are places that find facilities for people - sure it's not easy - a lot of places won't take him- however there will be those that will. if they are able to manage your FIL and he has the correct medication - it's absolutely possible he will stabilize. I totally understand how difficult it is - my loved one was the same - breaking things, hitting out and so on. for the person who commented that your FIL is a 'violent criminal' and 'not sane' - shame on you!! our loved ones are still human beings regardless of this cruel disease. my loved one is NOT a violent criminal nor 'insane' - it's unfortunately part of the disease - some people are affected differently than others. i wish you lots of luck anyway in finding the right place for your loved one. i also just want to add - it is very difficult to know how to calm someone when they are behaving this way. however sometimes sitting my loved one on the sofa and letting him be worked fine, other times taking him outside or for a walk round the garden - it's not foolproof but it may help. it's possible your FIL is scared - it's not his fault. he doesn't understand what's happening - YOU do but to him he feels he's now living in a house full of strange people, not knowing where he is or what's going to happen to him. maybe just take a little time to read up on the disease and try and understand it some more. i understand you need to keep yourself and others safe - i get it - however understanding your FIL's perspective may benefit you also

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OK your own “loved one is NOT a violent criminal nor insane”. Feel grateful for that. However jails are full of people who ARE ‘still human beings, regardless’ of what they have done - even criminal violence while insane. The challenge for society is to treat them decently while stopping them from harming others. I feel NO shame in saying that, and I suggest you question the common sense of your own comments.

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A locked facility and have an MD review medications.
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

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This patient has homicidal ideation against op and her whole family, Gina. He breaks glass and brandishes it. He throws heavy furniture.

No, he doesn’t need a massage, esp not from her.

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A specialized geri psych unit sounds like a good idea.

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?

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DC, it sounds as though FIL needs to be in a locked psychiatric unit until the correct cocktail of medications is found.

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?

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No, just regular hospital behavioral health units and ERs. He is currently in a hospital that has dedicated geriatric psychiatry unit though. So hopefully that can help/get us some answers.

Prior to dementia his only diagnosis was mild anxiety/depression. They were manageable without meds until recently.

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I just want to clarify that I don't personally care where he is placed as long as it's not my home. At this point I don't feel concerned for his comfort (though I do feel guilty about my "lack" of feeling there). I was worried it would come to a point where that was his only option left if no other AL/memory care would accept him. The places he has been put in, have been at the recommendation of hospital social workers and an elder care placement specialist who all keep saying memory care is what he needs and they'll be equipped to handle him. He keeps proving that they can't.

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!

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Your situation is a nightmare...my husband is not (yet) violent except for a couple of times before doc got his Seroquil dose and times worked out by experimenting. In those several times he did things like throw a chair at me -- became incredibly strong even though he looked frail. I worked out a "protection scheme" for myself -- his bedroom has an inside lock, so I will lock myself in there if it happens again and perhaps call the police. I had a lock put on the door to the garage, which was his workshop. I don't want him coming after me with a hammer. I have been puzzling over what to do if his behavior eventually becomes uncontrollable and facilities send him home. Given some of the suggestions here it sounds as though surrendering POA to the state and letting them deal with it (I assume in somewhat the same way they would deal with the violently mentally ill) might be a good one. Otherwise...you truly do have the priority of protecting yourself and family, no matter who might think you are being unkind to FIL.
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...

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Whatever medication your father in law is on currently is not the correct medication for his violent behavior! You need to get him to a neurologist immediately to get him on the right medication to stop all this. A family member needs to communicate to the neurologist what he is doing in order for this behavior to stop. Once the neurologist has an understanding of what is going on the correct medication will be prescribed immediately.
Your husband needs to help his father.

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What happens when a parent keeps getting kicked out of facilities for violent behavior?

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