grandfather with dementia

[sunnystdnt]

I'm a pre-nursing student but this topic doesn't have anything to do with my studies, but rather LTC protocol. First, let me give you some background: my grandfather was diagnosed with dementia about 3 years ago and has been to many different LTC facilities including rehab (since the initial fall which lead to diagnosis of dementia), assisted living, a more controlled assisted living place specifically for Alzheimer's/Dementia patients, and now a secured Alzheimer's/Dementia nursing home. The place he is at now is trying to convince our family that he needs to yet again move to another LTC facility because of bad behavior. After meeting with other places the nurse suggested he move to, they ultimately said he would receive no better care or no different care than what he is getting now. So my question is why would they suggest him to move? We understand he can be very combative at times; (which I'm guessing is somewhat normal for dementia patients) he refuses medicine, doctors appointments, bathing, etc. They've upped his Seroquel numerous times but the PA at the nursing home has told us he won't up it anymore because he's not sure the reaction it will have with his heart medicine. They are constantly calling my mother with lists of bad behavior, asking her for advice. My mom doesn't know what to do, or what advice to give them. She is inexperienced with dementia and since I'm not yet in the nursing program, I'm also unfamiliar with the lingo and also not quite sure how she should handle talking to them. The nurse manager has told us redirection usually works with him, but I think they are frightened of him. By the way, he can't walk, he is in a wheelchair and has lost the majority of his weight since his fall, he is very frail and is 85 years old. Is it normal procedure for LTC facilities to move patients to other places that they see are "too hard to handle"? What other things can they do besides redirection? I know LTC is very very fast paced and busy so maybe they don't have time or people to give him the care he needs, I'm not sure. That's why I'm asking. I'm actually really interested in getting into geriatric nursing when my schooling is done mainly because of my grandfather's diagnosis. It's a very strange disease.

[chrisrn24]

We can't give medical advice but I will suggest looking into getting him placed on a Geri-psych unit if he's having some behaviors. It works wonders!

[CapeCodMermaid, RN]

There are some facilities with dedicated dementia units. People with behaviors and dementia do far better on a specialized unit than on a regular long term or short term floor. Perhaps those other facilities are telling you your grandfather won't get different/better care at their facilities because they don't want him. It's a horrible disease and usually antipsychotics are NOT the right answer. They have a multitude of side effects. The facility is probably asking your mom because she knows him. She must know what he liked to do before he moved into the nursing home. She doesn't need to be an expert on dementia to be an expert on her father.

[sunnystdnt]

That makes sense. I get that they would ask her for advice on activities to keep him busy (ie, hobbies and the like pre-diagnosis) and they have and she gave them a list of interests he has. A lot of the things he liked to do before he can't do now because his cognitive skills are just not the same and he gets frustrated because he knows it. And in this instance, they specifically want advice for his bad behavior. Like what to do when he yells at nurses. Or what to do when he refuses doctors appointments. They also let her know how uncomfortable he makes some of the aides because he thinks they are his wife sometimes. Are there other things besides redirection that they can do? I just want to get a feel for techniques they can use so she can give them some ideas besides redirection. Every time he gets moved to another place it really messes with him and I think that should be last resort, in my opinion. But I'm not an ltc nurse so my opinion doesn't really mean anything in terms of rules or protocols or anything. I'll look into specific Geri-psych units around here, though, that's a good idea.

[sunnystdnt]

Geri-psych facilities focus more on their behaviors then? I think the nurse manager did suggest one but patients transferring out of the hospital have priority so he probably wouldn't get in. The other places though are the same as the one he's at now. Thanks for both of your responses.

[ttt4271]

Alzheimers patients with extremely aggressive behaviors pose difficulties even for facilities with dedicated Alzheimers units. 1. They pose a risk to other Alzheimers patients some of whom may be much more frail than your grandfather. Keeping him from injuring others is the nursing home's responsibility and can be very challenging. 2. Aggressive patients pose a risk to the staff who are responsible for insuring all of his needs are taken care of even though he may be physically and verbally abusing them as they try to help him. 3. Surveyors hold us responsible for declines and poor hygiene, weight loss, etc. even though these patients may be constantly refusing care and abusing staff.

As a DON in LTC I have had staff members quit because of patients who have been especially abusive to them. The DON calling your mom is likely grasping at straws for ways to deal with the behaviors so she doesn't lose her staff or get a bunch of state survey tags related to the behaviors that are going on.

Alzheimers units are great for the typical wanderer, but don't really do alot to help the physically aggressive behaviors. There is a push to get rid of the psychotropics for dementia but in these types of behaviors they are likely needed.

A transfer to geripsych unit to manage medications should be done if he doesn't have a psychiatrist managing his meds. Sometimes the only way to help facilities manage these types of behaviors is to sedate the patient; but it needs to be done by a professional in this area not just the primary Dr.

Transfer to another Alzheimers unit might be helpful if the staff are more experienced or lower staff: patient ratio.

Not taking meds can be a big problem, have they tried liquid meds or compounds? When I was DON at facility with Alz unit we did alot of med compounding into lotions that the nurses could just massage onto the skin. Not all meds can be compounded but I know we used several antipsychotics, antianxiety, and pain meds. You just have to find a pharmacy with the technology to do it and if we have it in Iowa I bet it can be done in NY....