Should the following resident be in Assited living?

donmomofnine · Oct 30, 2004

uh, no, he certainly doesn't qualify in my mind! Are you part of a CCRC? Where do your residents go when the no longer qualify? We are fortunate to be part of a CCRC and we just move them to a nursing bed in a case like this.

....and Haldol?? Do LTC residents still get Haldol in some places? I would never have a resident on haldol. It's contraindicated in the elderly, for one thing!

Antikigirl, ASN, RN · Oct 30, 2004

uh, no, he certainly doesn't qualify in my mind! Are you part of a CCRC? Where do your residents go when the no longer qualify? We are fortunate to be part of a CCRC and we just move them to a nursing bed in a case like this.
....and Haldol?? Do LTC residents still get Haldol in some places? I would never have a resident on haldol. It's contraindicated in the elderly, for one thing!

Yeah I know about the old haldol...but the hospice nurse said give one per MD order..then it came over on fax...grrrrrr! Okay got the order, but I gave the lowest dose possible, and then notified them in one hour about the pill rolling! It was quickly D/C'd...now we have NOTHING! Uhgggggg! (plus he started the pill rolling deal very quickly..tells me he is kinda long term psych med history, and haldol at his age was proably what was used before..since that was the drug of choice for most mental states..uhggg! They just got a Rx for Serequil (oh man I spelled that wrong...) which he has been on before, so I hope that will help, but I doubt it will help enough for his condition to keep him in assisted living! Plus, zoning him out on meds because he is too much for assisted living is simply NOT FAIR! He needs to move, pace if he wishes..have choises in care..and assisted living..well if you don't blend in with the masses, you are at a serious disadvantage....

No, when a patient must be removed their family is responsible. We try as hard as we can to get them help though various organizations, but in essence it is the families resonsiblity. Luckily my DON is a very well educated woman in our community and has so many resourses to help..she is just Awesome!!! I can't tell you how much she makes things easier for residents and family...with little time to do this...and rarely gets a thank you! She actually wants to train me for her position and was the inital thought till she got to know me and knew...I am best in acute nursing and emergencies..it is what I do well...and she realized her job would NOT be my thing! So we are both trying to find another to fill her shoes..she retires in 2 years and would like to continue on as a parish nurse (which I fully agree with! She would be so wonderful at this!!!!!). I love my DON...she is my friend, mentor, and someone I hope to know forever!

The trick will be, with this patient, is to get a Physicians order for placement...now if we can get that it will be so much easier. His family is on the East USA, (we are in Oregon)...but we will try very hard to have his move be as easy as possible, including staff volunteering their own time to help if necessary (I know about 6 or so staff that would be happy to help, including me!).

I will have to ask about the possiblity of working closely with a CCRC! I am sure my DON has that resource...now just to find out what is hindering this from being common practice when people are transfered.

Nurse Ratched, RN · Oct 30, 2004

The other thing I will note is, assuming you have admission criteria of some sort (who can you take and not take), you are opening yourself up to a world of liability to keep someone who no longer meets those criteria. I worked adult day care for six years, and as much as we loved our clients, when they fell outside of our enrollment criteria, other placement had to be arranged. To continue to care for someone if your own policies say you do not have the resources to do so is problematic at best and grounds for a lawsuit at worst.

I am sorry - it's clear from your post this is a much-loved resident, but he has to go somewhere that is built to manage his needs.

obeyacts2 · Oct 30, 2004

uh, no, he certainly doesn't qualify in my mind! Are you part of a CCRC? Where do your residents go when the no longer qualify? We are fortunate to be part of a CCRC and we just move them to a nursing bed in a case like this.
....and Haldol?? Do LTC residents still get Haldol in some places? I would never have a resident on haldol. It's contraindicated in the elderly, for one thing!

Around here, Halldol is a drug of choice in situations like this, and hospice pushes it too, when Ativan doesnt do the job. We dont use it in pills, but in the liquid form. My question is, if his behavior is so out of hand, how long before he acts out on another resident rather than staff????????? I hear LAWSUIT if he attacks some big busted old lady resident.

I also agree with the poster that says he sounds like he has a long psych hx prior to admission. Could you have a serious talk with his family regarding his hx? All I can say he does not belong in AL.

Around here the AL facilities wouldnt take anybody that impaired. Occasionally, if a pt has problems that may resolve (say temp problems walking after a fall or surgery) they will allow the resident to have a private agency CNA from outside to do one on one care for awhile,, but that is it.

Lauura

Monica RN,BSN · Oct 31, 2004

In the LTC I recently used to work, such a resident would have been promptly out the door with a police officer under a baker act... and no way would we have accepted him back. period.

Once he goes out, you do not have to take him back, assuming he is either taken to a mental health facility under the baker act, or even admitted in the hospital as you stated for a week. That should have been the point where your administrator or supervisor should have notified the hospital's discharge planners that he was not being accepted back. They would have had to place him elsewhere from that point.

lovingtheunloved, ASN, RN · Oct 31, 2004

I work in an Alzheimer's and Behavioral Health facility. Welcome to my world. He is ABSOLUTELY NOT appropriate for assisted living. He belongs in psychogeriatric lockdown.

Fiona59 · Oct 31, 2004

Above goes with my line of thinking.

The question we ask is "Is he a danger to himself or others?"

Mental health crisis teams would assess and remove if the above question was "Yup".

It sounds cruel but as you said you or your co-workers are at risk as are other residents.

Does your state have a mental health act?

renerian, BSN, RN · Oct 31, 2004

Uh a strong no from me.

renerian

Antikigirl, ASN, RN · Nov 1, 2004

It seems that my administration is bending rules to fit higher need clientel for the money they can get! Even my DON is getting quite angry! They tend to cover areas of concern in the application process, family goes with it, and boom there they are and us nurses have to take up the slack and in cases like these, try as we might to get them moved out when we know they simply don't belong here!

This gent passed with flying colors, and was very independant before the Dx of cancer. Then when that stressor hit him, and hospice came in and took away most of his meds..that is when things went to heck! His depression and powerlessness over the dx I feel triggered extra stress and thus these probelms came into play (he only had a dx of mild dementia...who doesn't at my facility..LOL!), then the removal of the meds sent it skyrocketing! What were they thinking when they did that??? Not like I was there to stop it (I can't be there 24/7 to stop this from occuring), and my DON and I had to fight to have some of his meds put back!

Yes, I believe that he is a danger to himself and others, but wow...my voice counts for nada! I went to his chart and NO ONE but me charted ANYTHING about his behaviors..I freaked and was severly ticked off! I put him on high alert so ALL shifts have to chart daily on his behaviors, and a general notation about his day! I hope then I can use these to proove my point...but it is like they say...if it isn't charted, it didn't happen...and my collegues sure dropped the ball, making my job of getting him removed very difficult! I need proof...and they didn't provide that to me. NOW they are, they have no choice...

His family is typical..denial and not wanting to be bothered. They moved him into our facility and assumed their end of the deal was done. Unless they have something to complain about..LOL! They even told our hospice nurse not to bother them unless he had passed away...very sad indeed .

It will take quite a bit of the old charting and prooving but I will get him to a facility that can meet his needs..that is my job! BUT if he touches a caregiver or nurse..he is out of here fast if I am there!!!!! Sad that it may just take that

Fiona59 · Nov 1, 2004

How I can relate. I used to wonder if it was only me that had problems with the "problem patients". I charted my behind off one shift. On my days off, same shift the entire charting was: "One episode of agitation". No what set it off, how it was handled, was anyone hurt? This from a nurse who prided herself on telling me she had forgotten more than I'd ever learn!. Well, I guess she forgot to chart.

The patient finally wound up after 7, long, scary, (for the staff on nights and evenings) days in the local mental health facility. The charting got him there. The family said they'd been begging for help for ages, but had no documentation, and Dad always presented well at the appointments.

I hate it when Care Managers ask "what did you do to set it off". Duh, I was in the med room, came out and saw my NA having a cane swung at her by a 90lb senior. She apparently went in to do a bed check, and the sweetie leapt out from behind the door.

I guess we both should have seen that comng!!

Marie_LPN, RN, LPN, RN · Nov 1, 2004

Assisted living is for those who need assisted.

This man sounds like he needs full-out care.