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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Your Dad is in a unsafe place. Get her on a waiting list for memory care facilities so she can be placed when covid lifted. The Hospice Dr. can give her some mild anxiety med. Request a social worker from hospice came to help your dad deal with what is going on. He has in his mind he can deal with his wife rather than pay extra help. Anxiety Med. is a first.

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Please read my update below.

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UPDATE: Mom was taken to ER on this past Sunday (Father's Day) after dad opened his eyes in the early morning hours to her standing next to his bed with a butcher knife. (I found out yesterday that the knife actually broke, handle came off, when he was trying to get it out of her hands.) Dad refused to pick her up and hospital kept her for 24-48 hour observation.

Hospital decided to transfer her to a "behavioral health facility" (new word for psych hospital, I guess) on Tuesday. Both Wednesday and Thursday mornings she had choking episodes (that's new, didn't have that before) that resulted in trip to the hospital. She came back to the facility after the Wednesday episode but was kept overnight after the Thursday episode and that is where she is now.

She has spent more time at the hospital since being sent to behavioral health center than at the center. No psych eval has been accomplished yet. I spoke to staff and was told she is calm and peaceful. I forgot to ask if she is being treated for UTI. I was also told she is funny. When asked where she was, she responded, "I am here." When asked where "here" is, she responded, "The nut house." I also asked if they were having trouble communicating with her since she has expressive aphasia. They said she is speaking quite well and have no problem understanding her. Hmmm . . .

When offered dinner Wednessday night, she was only given a plate of pureed food, which she refused. She asked for a cookie and they told her no, so she went to bed without dinner. I wonder if that contributed to the choking on Thursday morning? (She tried to eat too much at once, had a mouthful of small bits of sausage when she was only supposed to take one small piece at a time.) Also, Dr. Google tells me that choking can be a result of UTI. Untreated UTI leads to dehydration, dehydration leads to dry mouth, dry mouth can result in choking.

Hopefully mom will be back at the center today and they can actually accomplish the psych eval and get the process moving. And I am praying that the bed stays open at the rest home.

(Thank you, BarbBrooklyn, for your suggestion to post my update as a reply.)

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So glad to read your update and see that the ball is finally rolling for your mom. My dad is currently in rehab and has had what he describes as choking episodes. He is also rushed back to hospital and it proves to be reflux. Not saying that’s what’s going on with your mom, just another possibility among many. And my dad doesn’t necessarily have any psych issues (maybe we all do?!) but he definitely puts on a better show for doctors than his normal self. Hope answers are found for your mom soon

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Grammie, I'm so glad that mom is starting to get the care she needs!.

Even though you can't edit your original post, it is probably easiest for you to simply post an update at the top here rather than replying to each in individual. ((((Hugs)))).

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Thank you! Did just that. I'm used to forums where you can post an update in your original post so people don't miss it. I'm also used to forums where you can lock a post so no one else can reply and apparently I can't do that here either. I don't like to ignore folks replies but it does get a little overwhelming.

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Imho, a hospital is a business, moving patients in and out. However, your mother needs to be held in a behavioral/mental health facility. Your mother is mentally ill. I would not wait on that decision. Your father's life is in grave peril!

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Unfortunately, I don't know how to update my original post. Mom was transferred to a behavioral health facility on Tuesday. However, they have twice taken her to the hospital for choking, so she has actually spent more time in the hospital than at the behavioral health facility. A nurse at the facility told me today that she has been peaceful and calm and funny. Apparently she is speaking -- which is surprising since she's hasd expressive aphasia since a major stroke several years ago.

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Would concur with having her committed to a psych hosptial. They will have her turned her around within a couple of weeks.

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Was done on Tuesday. I don't know how to edit my original post with an update.

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Medicate and re-examine all other meds, actions, and inactions-- get a second opinion ! Be that POA. Don't ask Dad. do what needs to be done for two parents obviously suffering from dementia in various stages. Remember how dementia behaves-- declines, then plateaus, then declines more and plateaus for who knows how long. New meds are obviously in order and a new place for combative Mom... so Dad can rest up for a while... AND he may not see her for 2 months after she is moved. Better still, tell him it is the COVID rule.

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Tell the doctor your concerns and ask for a case worker there at the hospital. Tell them you are concerned about her safety but also for the safety of your Dad because of her violent behavior. They tested my aunt for COVID-19 before they allowed her to enter the assisted living facility (nursing home, etc). She was in the hospital at the time. Here in S.C., you are also required to stay in hospital 3 nights before you are eligible by Medicare unless you are going to rehab first. Hope this helps.

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It does sound like she needs placement that addresses her mental and behavioral problems. The hospital can only keep her if there is a medical necessity to do so. They do not take patients just b/c they are too hard to take care of at home. Suggestions about involuntary placement in a mental health facility.

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If there are senior services or adult protective agengies get them to help file for
Probate guardianship as she is a danger to herself and others. There can be an
immediate short term comittment for evaluation. The hospital is not likely equiped to handle her long term anyway -They should have had this done after
second incident. The UTI was a consideration -but if it did not work something else has to follow. Nursing homes generally can't handle her behavior even if they
were open to new patients. Probate ordered institution and care is the only solution I see here for the time being. I am an attorney now; previously a registered pharmacist; but mainly speaking from some personal experience in both professions.

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It would take more than $23 an hour to get me to take care of her! She's Nuts. She will abuse Anyone who tries to care for her. Get her into a mental institution FAST and Don't feel bad about it, Her brain isn't working right. And why is she on Hospice Care? She is not dying if she is able to smear Feces all over, and torment Dad. As for killing Dad, that is a real possibility. Get her out of his home. Take her to the nearest mental institution.

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She was moved to a behavioral health facility from the hospital she was taken to Sunday.

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Fact of Life: Hospitals and their "hospitalists" often discharge patients early. Often they are they don't like or don't want to handle. There is an appeal process that may extend the time a little bit. First tell them you aren't ready, can't come, it's inconvenient, whatever you can say. You must give the hospital staff four hours notice that you are appealing the discharge. I can't find the phone number but there should be one among the admission papers you were given at the admission. (My paper has been green each time.) The phone call to Medicare itself (wait till late in the day) gets you two days for appealing before they deny it. Then you appeal the appeal, giving the hospital time to find a place for combatant mom. They will find one and it may not be one you would choose in these times. Good luck.
Here is a helpful Medicare website:
https://www.medicareinteractive.org/get-answers/medicare-denials-and-appeals/original-medicare-appeals/original-medicare-appeals-if-your-care-is-ending
https://www.medicareinteractive.org/get-answers/medicare-denials-and-appeals/original-medicare-appeals/original-medicare-appeals-if-your-care-is-ending

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This has gone beyond using the word inconvenience. She should tell the hospital mom cannot come home because she is a danger to her caretakers and tell about the insecticide she sprayed in dad's face. She simply cannot be cared for in the home any longer and hospital/dr should assist in the paperwork to find a place suitable for her current needs/out of control behavior. Mom can't help it and they do have facilities better equipped to handle her than for dad to take the risk again.

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It sounds like she is a danger to herself and others. I would persue an involuntary mental health commitment to stabilze her mentally. Geriatric psychiatric unit. If you can hide the medications for the UTI in food that she will eat, I would try that. I would also contact the area agency ombudsmen for assistance as well. It takes about 2 days for the medication to kick in. Another thought if it could be crushed. If she is really violent, I would remove your Dad from the home for his safety and ask the hospice for an agency that will assist with home care in an emergency. You could also have her taken back to the hospital and tell them you can't take her home under these circumstances. Maybe the antibiotic can be given as an injection or an I.V. You could also contact her PCP and request that they admit her to the hospital.

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Please see my above answers. I wish I could just update the original post.

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This may sound overly simple, but sometimes simple is the answer. The UTI is causing the behaviors. Once that is treated she will be herself once again. Focus on how to get her to take the meds. I see now she is back in hospital and they will do that..... this is so traumatic for all involved, but believe this will pass. It happened to my grandmother in law.... screaming, hitting, taking all of her clothes off...since then I always ask to check for UTI when I see strange behavior in any elderly person. Keep breathing.

I just saw they stopped treating her for UTI?? Your sister the nurse should somehow get on this to insist they complete the treatment or have your father as her POA insist - your mother has rights- and your father - on her behalf - can say yes or no to anything. It never ceases to amaze me what they don't know at the hospital. It took an experienced nurse to realize what was happening to my grandmother in law.

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In all the confusion of what has occurred over the last few days (ER w/ two-day hospital stay, then transferred to behavioral health facility, then emergency trip to a different hospital, back to facility, another emergency trip to the hospital where she is at this time), I'm not sure anyone is dealing with the UTI. However, I was told by the nurse at the facility that in the amount of time he had with her, she was calm and pleasant.

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I see they live in southern Delaware — “slower lower” also means less medical care access and also not the best providers-/ my primary care still only takes cash and gives a hand written receipt - can only Snail mail records - it is like I’m back in the60s!
I saw your issue is now being handled and I would stay on top of it since you can not trust providers to do right by your mother. Definitely hospice was finally helpful with your advice but they should have sooner told you to exit hospice and have her taken to an ER even if in Maryland
Good Luck

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Tare her to the Hospital and get her admitted for whatever.

When they want to discharge her tell them you can't snd aren't able to take care of her and do not design her out.

They will find a place for her somewhere.

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Grammie, there are fates worse than dying in a nursing home. What if your mom kills your father? She is then jailed for homicide (happened a few years back; elderly mom shot her 70 year old son/caregiver).

Because he was going to arrange for her to go to assisted living.

She died in jail.

Old age and death isnt what Hollywood depicts...saintly, calm elderly folks gazing upward at the light and being held by their adoring children.

The best depiction of an actual death that I've ever seen dramatized is that of the Mother Superiour in Poulenc's opera the Dialogues of the Carmelites. It depicts a woman of great faith, dying, in pain, agitated and violent, a doctor who will not increase her medication because it might tip over the line and kill her. She dies, gasping, losing her faith and thrashing. Hard to watch and terribly accurate.

I think that dying in a nursing home, with professional care and hospice at your side with morphine to ease pain is EXACTLY what I want.

I would not want to burden my husband or my children with caring for me if I became violent.

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After having witnessed terminal agitation, I wonder how often people are lying when they say that someone passed peacefully at home, peacefully in their sleep, etc.

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I'm glad she is in a place where she is safe, dad is safe and she can get the care she needs/deserves. Deciding to place a loved one in a care facility is never an easy choice, but especially in this case, it appears to be the only safe choice for everyone involved.

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Saw your recent post of where she is currently. A note on UTI: I'm not sure why, but often they are reluctant to culture urine. My mother had UTI that initially was 'clear', but after 7 days cultured Ecoli and required antibiotics. Maybe that was a mild infection compared to what they are looking for, but still, little things make a difference. Hope you and dad are able to get some answers, and that dad is able to get some rest. So sorry it's been such a battle for you!

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Thank you. Dad has sounded so much better on the phone for the last two evenings. Dad was a chemist / microbiologist in his younger years and knew that the "straight cath" test for UTI would not provide the final answer.

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Under no circumstances, no matter what is threatened, should anyone go near her and certainly not pick her up. She is totally gone and dangerous. Do NOT give in no matter what. Take the keys away so he is not forced to get her and YOU do not have the legal authorization. I would file a report with the police as she is a danger, call the Office on Aging and if need be your senators and assemblymen and doctors. She cannot come home - period. They must find someplace to put her. Call Adult Protective Services. She will/can kill your father who does NOT deserve this. She is gone - keep her gone. And perhaps talk with an eldercare attorney. You must take charge to forbid her returning.

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Mom is lined up for a nursing home after she completes her psych evaluation at a behavioral health facility and stay in the hospital to address medical needs. From there she is going to a nursing home.

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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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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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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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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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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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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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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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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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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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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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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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How do we get the hospital to keep mom?

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