How do we get the hospital to keep mom?

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How do we get the hospital to keep mom?

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89yo parents. Mom has been on hospice care for a year. Dad is at his wit's end. Mom had a major personality change starting three weeks ago. Aggressive, violent, threatening. My first thought was UTI but it was dismissed.

Hospice was in the process of the paperwork at their home on Wednesday to put her in emergency respite care because dad needs a break, when mom picked up a can of pesticide and sprayed him in the face (this is an example of the behavior he has been dealing with for three weeks). This dq'd her from respite care so the hospice nurse sent her to the ER. They discharged her the next morning, said nothing was wrong with her.

Yesterday (Friday) was horrible. She left feces all over her room, while dad was cleaning that up, she went to other rooms and spread it all over walls, chairs, counters, you name it. She tried to push him down the steps, she hit him in the back enough to take his breath away. When the hospice nurse arrived, mom was outside half naked yelling and screaming (dad was inside cleaning up feces). They sent her back to the hospital, hospital called dad at 9:30 last night to come pick her up. He refused (doesn't drive in the dark and has trouble staying awake). He picked her up this morning, she is combative, refusing to take the meds for the UTI they now have diagnosed.

Nursing homes are closed, hospital won't keep, and she may very well kill dad if left in their house. Any suggestions? There is an appt Monday for a nursing agency to come in, but at $23.00 an hour, my dad isn't willing to pay for what is needed -- round-the-clock care.

Home Care Hospice Hospital Violent Behavior

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She needs an emergency 72 hour psychiatric hold, often called a Baker act. Call hospice and ask how to get this done. You may need to dis enroll her from Hospice in order to get this.

Dad should NOT go and pick her up.

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This is a dangerous situation for your father and your mother as well. They should not be left alone together at any time. When people are mentally ill, which Mom is, and they display violent tendencies, they can be crafty enough to use most anything as a weapon and they seem to choose one person, as Mom has chosen Dad, as a target. Dad (and you) need to become “hard-hearted”. Mom is no longer herself. She is violent and unpredictable. She needs to be out of the home and under 24 hour supervision. Dad is overwhelmed and unable to care for her. She can be Baker Acted and placed in a mental health facility where she will be evaluated and placed.

Some difficult discussions need to be had with Dad. I wish you luck. Please keep us posted.

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Is there a different hospital to have her taken to when she next becomes combative? Agree with the previous advice, just wondering if another hospital would be a fresh start toward keeping her and getting a needed psych evaluation

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They are on the MD / DE line, the closest hospital is in MD but the hospital they need to use to stay on hospice is almost an hour away in Lewes, DE. The minutes they cross the line to go to a MD hospital, hospice is terminated.

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Dad needs to refuse to pick her up from hospital. He is obviously unable to take care of her anymore. It is not safe for him or Mom at home. He must tell the hospital that. Can Dad stay with you for a little while? If so, I would suggest he call 911 at the next outburst by Mom, have her transported by ambulance to the ER. Then he needs to stay somewhere else after telling the powers at the hospital she needs more care than he can provide. They need to help find placement and treatment. Perhaps psychiatric. He must tell them they cannot discharge her to an unsafe environment (home with him anymore).

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Yesterday, the hospice nurse and social worker visited in the afternoon. They told dad that at the first sign of aggressive craziness again, he was to call 911. And then when the hospital called for him to pick her up, he is to tell them he can not take care of her in the home properly because of her needs. Apparently my sister and I will also be called to come get her and we are to refuse as well (we are not local). He was even told that he may be threatened with abandonment and the police called or that his insurance and medicaid will not cover. . . . . As I was typing this, hospice called me. Mom is on her way to Beebe in Lewes, DE. She came at dad in the night with a knife. He will refuse to allow her to come home from the ER.

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I agree, Mom needs to be in a Psychic facility. She needs meds for this behaviour. When they are ready to discharge, then request she be put in LTC because Dad can no longer care for her. If no money, there is Medicaid. Consult lawyer well versed in Medicaid. Dad would become a Community Spouse and given enough money to live on. He will be able to stay in the home and have a car. This is basic info. Each state has their own criteria.

Once in LTC, if needed, Mom can go back on Hospice.

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Money is not an issue for them. She is back at the hospital after coming at dad with a knife during the night. Hospice nurse believes she will be admitted for a psych eval.

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Terribly difficult. I'm so sorry for what's happening.

Your mother doesn't belong in a hospital - it's not in her best interests for her to be there. So (no doubt to the hospital's great relief) they can refuse on good clinical principles.

She can't be alone at home.

She needs skilled behavioural management as part of her care, such as you'd get in a psychiatric unit, but I doubt if you can find a psychiatric unit which would admit her when it seems the primary trigger is her u.t.i. Might be worth a shot, though, if she's refusing treatment for the u.t.i.? Who is helping on the medical side, can you ask them about a referral?

Your dad isn't willing to pay for the care - why? It's expensive, sure, but cost can be a real reason or it can be obstinate resentment. Or, does he have other reasons too, such as the common caregiver's version of Stockholm Syndrome whereby you stop believing that anyone else can give your loved one what she needs?

What's your mother's underlying disease, if you don't mind my asking? Why was she admitted to hospice?

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Money is not an issue for them. Dad is the proverbial "he can squeeze a nickel so hard the buffalo farts." Mom was an alcoholic for many of their years, they did not have a good marriage. So your words "obstinate resentment" could be a good descriptor. She is back at the hospital after coming at dad with a knife during the night. Hospice nurse believes she will be admitted for a psych eval. Mom was admitted to hospice after a fall left her severely injured and unable to take care of herself. She'd had a stroke five years earlier and never fully recovered. She actually recovered from the fall and twice was about to be released from hospice when she had additional injurious falls, which then kept her on hospice care.

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I would get her back to the hospital and tell them that she refuses the medication for the UTI and you are not going to watch her die from sepsis because she is being released in an unsafe discharge. Don't make this about dad, make it about how unsafe it is for her. Seriously, as soon as you mention dad and his difficult situation they hear that you want to use the hospital as respite. She needs medical treatment for an infection that can take her life and she refuses the oral antibiotics. You will probably have to take her off hospice for this to happen.

Using the term unsafe discharge creates a liability for the hospital if they force it without ensuring that her medical needs have been met. Keep telling everyone at the hospital that it is unsafe for her.

I would be flipping out that they are not treating her UTI. She could literally die from sepsis if this is not treated. She needs IV antibiotics and probably sedatives because they missed it for so long and it is so bad.

You need to be the advocate because dad is overwhelmed and sounds like he doesn't have the fight in him right now. Go get 'em and don't listen to any nonsense about why they can't treat her.

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She is back in the hospital and dad will refuse to pick her up when they call. I want to be there but my husband might have the virus (he refuses to be tested, I am talking to his pcp on Tuesday) and he refuses to allow me to go without him. He also has frontotemporal disorder and mild neurocognitive disorder, so traveling anywhere with him causes all kinds of issues, which would then become the focus instead of being there for my parents. So I have to advocate from afar. (His brother died in early March in NJ from what they later diagnosed as COVID-19. This was two weeks before quarantines started so we were around hundreds of people for several days. My husband has been showing symptoms ever since except he hasn't spiked a real high fever or lost his senses of smell and taste.)

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Baker-Acting someone is not pleasant, but it is a way to get someone the help they need.

I Baker Acted my daughter when she was 19 (even though she was no longer a minor) b/c she was abusing drugs and completely out of control--suicide threats nonstop, etc.

Hardest thing I've ever done. And the best.

I needed her gone---and she needed to be somewhere she was watched and treated. When I made it about HER needs, not mine, the hospital reacted differently--I wasn't just a burned out mom, SHE was a sick adult child.

From 14 days in there to detox and have meds adjusted--(the calmest 2 weeks of my life!) she had to appear before a judge to determine her next step. She could have gone to a psych ward setting for 3+ months---and she knew it. She was allowed to come home with the caveat that she get therapy and stay on her meds.

With your mom, it is more likely they will treat her UTI and evaluate her condition. If she improves much, they may simply transfer her to another 'facility'--during the time she's in the psych ward, these decisions can be made.

She's passed over the line from 'kooky' to 'dangerous'. Your poor dad.

I don't know why they wouldn't continue Hospice, but that is not really the most pressing point.

She could kill your father--or seriously wound him. Best to head her off at the pass, so to speak and get her in a psych ward setting soon.

Is she this hostile towards anyone besides your dad? A CG coming in may just make her worse. I worked EC and I would have walked out the door if my clients were at the 'fecal art' stage.

Good Luck. Be there for dad. Even tho mom is off the rails, he still loves her, I'm sure and this is breaking his heart.

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Because Medicare won't pay for hospice and hospital stays, so hospice has to be fired to get medical coverage. Hospice is used when it is decided that you will no longer be pursuing treatment. If hospice was doing their job they would have caught this infection, treated it and then there would be no need of medical treatment.

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I would call the police. They should be able to take her to the hospital for the 72 hour psychiatric hold. Tell the police what is happening. Just call 911 on her. That’s what I would do.

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Where are you? Where is dad? He obviously needs some emotional support to do what is best for mom.

Yes, I would call the police, they will get her into a psych facility.

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I am five hours away with a husband with frontotemporal disorder and mild neurocognitive disorder AND possible COVID-19 (he refuses to go to the doctor and get checked). Mom is back in the hospital after coming to dad's bedside with a knife in her hand this morning.

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He should have refused to take her home. Have her go back to hospital & talk to Social Worker there. Have her placed in a facility. Hugs 🤗

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He now knows that he can refuse. She is back at the hospital. Hospice nurse thinks she will be admitted for a psych eval since she was at dad's bed early this morning with a knife. He says she will not be returning to the house.

(8)

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Graygrammie, long distance advocates are effective.

I am praying that your mom gets the help she needs to keep your dad safe.

Great big warm hug filled with strength for the days to come.

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Graygrammie, I am so sorry for your troubles. Please let us know how this goes. You are in my thoughts.

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Mom will be going to facility for a psych evaluation and medication adjustment tomorrow, then after they feel she is stable (they say three or four days, I was expecting much longer), she will be released to a "rest home" that has agreed to take her as long as they have a bed available.

(8)

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GG, thank goodness everyone is safe and now mom will get the help she needs. You are going to have to help dad stay strong, this is going to be hard for him.

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I'm five hours away with a husband with dementia and possible covid (refuses to talk to doctor). Sadly, I am not able to be much support to my dad.

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Does your dad have any local support? Neighbors, clergy?

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All their friends have passed, there is one neighbor lady that Mom gets on with, and cleaning lady that comes that they are fond of (and, that is a whole other issue for me, I'm not sure I trust her motives -- she's too good to be true). Dad has never told anyone at church about mom and she rarely attended with him. So, nope, no local support.

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Dad can afford to pay, but won't?? Maybe tell him that if she gets violent, he has to restrain her and the police get called - she may well tell them that he beat her up. He could end up in some kind of legal trouble. If he has the $, it's time to use it if he plans to keep her at home.

Call her dr who handled her in the hospital and find out why they would release a violent person to return to the care of an elderly person. It may be she has those periods of appearing totally normal when in front of others - aka showboating. Ask the doctor to help you find a facility that can handle her. It's always easier to move from hospital to some kind of nursing facility. So, if nothing else, when she gets violent again, send her back to hospital and then call the social worker at the hospital and tell them what is going on - she is a danger to your father and cannot return home. There are facilities that are taking people during the covid thing. You just need some help to find one and that's how social worker can help you.

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After going back to ER Sunday morning, Mom is being moved to a psych facility for evaluation, and then to a "rest home" that dad will be paying for. Dad is hiring professional cleaners to come in and clean all the mess Mom left throughout the house, it was that bad. The hospice social worker did ask me how they stayed married for 66 years because of how they fight with each other but mom is more compliant with other people some of the time.

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Ggraygrammie, how is it going with your mom?

Are they actually treating her?

My prayers are with all of you in this sad, scary situation.

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The hospital kept Mom this time for 24 - 48 hours "observation" (basically, time to figure out what to do with her). She is being sent to a psych facility tomorrow morning (only because dad refused to drive over there tonight with clothes and her walker). After her meds are adjusted (they say she is over-medicated, but I think that is the difference between medical care to get better and hospice care to be comfortable until death). They say she will be there for three or four days and then moved to a "rest home." They are NOT treating her UTI. She was given IV Rocephin during ER visit number 2 (Friday night) because her culture came back positive Friday afternoon from ER visit number 1 on Wednesday night. Their neighbor got one pill into her Saturday, then Sunday morning she was taken back to the ER and based on the urinalysis, they determined she did not have a UTI, so have not given Mom any more antibiotics. My sister (a nurse) is furious. As she told the person at the hospital, you don't start an antibiotic and then stop it before the course of antibiotic is completed. We'll see whether Mom gets any more antibiotic. Thank you for your prayers.

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89 and still feisty.

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Not “feisty” and not helpful

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I was going to recommend a psych evaluation but I see that's already happening, thank God. No matter what anyone tells you, it's NEVER okay for an elder to be causing THIS much grief and terror for another human being. Your mother is not 'feisty' or cute, and your father is in a terrible position having such a thing to deal with!

If she's not having a reaction to a medication, which is doubtful, she can be having a psychotic break or something like that. A pscyh hospital is the best place for her right now, so a qualified doctor can try to figure out what's going on and get her back to thinking/behaving on an even keel.

A 'rest home' is the very best place for mom now, and it will give dad a well deserved and needed break from all the hysteria.

Wishing you the very best of luck moving forward, for you and your whole family. Sending you a hug & a prayer for peace.

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Wow I am so sorry this is happening to your family. What a horrible disease. When mom was admitted to the hospital for what they thought was pneumonia on a Friday thankfully, palliative care called me to see how things were at home. I told her everything that had been happening which was nothing like your situation, but I did find that she had been drinking rubbing alcohol. They then determined that she was no longer safe at home. Have you tried calling adult protective services? Some of the dementia units are starting to reopen here in Wisconsin. Have you tried again with the nursing homes, memory care facilities, or hospice u it’s? I’m assuming you have. I think the psych evaluation is going to be your best bet. Palliative care at the hospital needs to be involved. Do you have an activated POA? We needed that to make sure it was our decision on where she went.

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Shad, do you REALLY THINK that a woman with long standing mental illness and who tries to attack her husband with a knife is "feisty" and not possibly psychotic?

Do you not see the need for psych meds for folks with demented and broken brains so that they can live in some kind of peace with their loved ones?

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Not sure who Shad is that you are addressing, but mom is now in a behavioral health facility for evaluation, will be going from there to a hospital to address medical issues, and then to a nursing home that is holding a bed for her for one week. Hopefully that is enough time.

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It is Harder now because of Covid and Many--Working from Home. Until you can get a Social worker or someone like this to help, Either do the 23 dollar an hour(Dad)or talk to her Doctor for guidance.

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Mom is currently in a behavioral health facility for psych eval, then going to a hospital for medical issues (which are many), and then a bed has been found for her in a nursing home that is being held for one week.

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Can her primary give you any suggestions? Try a prescription for a psch drug. It did wonders for my dad and even helped him get some sleep. Can you speak to the social worker at the hospital?

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PCP is out of the picture because she is (make that "was") on hospice. However, at this time she is off of hospice, considered a ward of the state, and is in a behavioral health facility.

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She may need an emergency psych admission. Please find a hospital that has an inpatient psych unit to take her to. Yes, the UTI may play a role in her behavior. However, her obvious combative behavior and attempts to hurt her husband must be addressed too.

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She was transferred to a behavioral health facility on Tuesday.

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If she is a danger to herself or others, in Florida you can get her admitted to the psychiatric unit; most states have involuntary admission laws. I'm surprised your hospital did not do this. Of course healthcare in America is pretty bad--a lot of doctors and nurse practitioners just don't care other than getting their paycheck.

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I'm surprised too that the hospital released her twice without a psychiatric evaluation.

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I would I would call your local police and get Adult Protective Services involved! They may have to admit her to a psych ward while her condition is being worked out! You might want to put her medication hidden in her food to get you through the next few days. If your dad has been physically abused, Adult Protective Services will step in. So sorry you are dealing with this. I understand the aggressiveness of the elderly with UTIs. Hang in there!

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I noted in other responses below that dad called 911 Sunday morning when mom was beside his bed with a butcher knife. Mom was kept for "observation" while they decided the next steps. She is currently at a behavioral health center for evaluation (where she had a choking episode and had to be rescued according to a nurse that called from there) and then she will go to a hospital for her medical needs and then to a nursing home that has agreed to accept her. The nursing home is holding a bed for one week. I hope that is enough time.

My father is traumatized. He has hired professional cleaners to come in and clean up all that mom left behind. He's done seven loads of laundry in two days as he keeps finding soiled clothing throughout the house. A cleaner comes today and carpets are scheduled for July 2. I hope that as things settle down, dad will be willing to bring mom back home eventually and hire the in-home care that has been needed instead of trying to do it himself. But that will be his decision.

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1. Mom with an UTI can have even more confusion than usual. She needs safe place to be cared for.
2. Dad. Can't handle situation. It's too much.

Nursing homes are open. And non covid patients are preferred.

The situation needs intervention now. Both parents need help. Call home health. They can send a nurse to evaluate her and totality of situation. Tell them urgent. It's the job of home health. They can facilitate transfers, services. Doctors and their offices are more responsive to them than to patients and families. They are available 24/7 for calls.

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I noted in other responses below that dad called 911 Sunday morning when mom was beside his bed with a butcher knife. Mom was kept for "observation" while they decided the next steps. She is currently at a behavioral health center for evaluation (where she had a choking episode and had to be rescued according to a nurse that called from there) and then she will go to a hospital for her medical needs and then to a nursing home that has agreed to accept her. The nursing home is holding a bed for one week. I hope that is enough time.

My father is traumatized. He has hired professional cleaners to come in and clean up all that mom left behind. He's done seven loads of laundry in two days as he keeps finding soiled clothing throughout the house. A cleaner comes today and carpets are scheduled for July 2. I hope that as things settle down, dad will be willing to bring mom back home eventually and hire the in-home care that has been needed instead of trying to do it himself. But that will be his decision.

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Im sorry for your dad - that is awful. Was your mom always combatative and now its just worse or is this something new? It does sound like she is having some psychotic issues and needs meds. Your father cant stay with her - too unsafe if she came at him with a knife. Please keep us posted. Sorry!

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Mom and dad have always had a volatile relationship. :( Lots of fighting over the years. But in the last twenty years or so, they settled into a nice groove and were actually becoming companions to one another. I think when there are unresolved issues buried and then something happens (like this UTI) that strips away self-control, a lot of ugly comes out.

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Grammie, if she is now a ward of the state, it is no longer going to be dad's decision what to do.

I think I'd be grateful for that, actually. The poor man need a rest.

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Yes, as of right now that is true. I was told that when she goes to a nursing home and he begins to pay the bills, then the state steps back out. His voice on the phone for the last few days has been so much more upbeat. He's even back to emailing all those forwards that seniors seem to like to send among themselves. Yesterday was a baby elephant vs goose. At least it gives us something lighthearted to talk about in the evening!

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Gray, I am sorry, but do you really think Mom should come home? When people start exhibiting the signs your Mom has, they need 24/7 care of professionals. She can continue hospice in LTC. I can't imagine the stress your Dad has been under not knowing what will happen next. Then to find her with a knife in her hand. He needs to realize she is better off where she is. He is 89. Even with help in the home this situation is too much for an 89 yr old.

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You are right. I need to let go of my hopes of mom ever returning home. My sister and I have already decided that we want to resume hospice care when she gets to the nursing home simply to have another set of eyes on her regularly.

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graygrammie that is such good news that your mom is getting the care she needs and your dad is finally safe from the situation.

I want to encourage you to keep her in the facility. Dad can go visit and then get a break from the situation. Bringing her home is just not fair to dad and she obviously needs more care than he can provide, making it unfair to her as well. You said he is traumatized, that doesn't just go away and he will not be able to relax with her in the house, putting him at greater risk of having a serious medical event. Please encourage him to keep her in the facility. She can go back on hospice and stay in the facility getting her needs met, he can sleep knowing she won't be after him with a knife, win-win.

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Thank you for this perspective. I guess my hope had always been to not see either of my parents die in a nursing home. I really don't think dad will ever be willing to bring her home though. Even if he is able to forgive, you are right, the trauma doesn't go away.

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How do we get the hospital to keep mom?

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