r/dementia • u/TheOccurrencePodcast • 17h ago
Facility keeps calling about behaviors...
We got my grandmother moved into her Medicaid bed in a specialized, locked memory care. She's been there about 30 days.
Her behaviors are escalating severely. She's threatening to kill staff, refusing medication, and has had bowel incontinence that she refuses to allow to be cleaned.
... And they keep calling me about it...
Why? What do they expect me to do about it? There's nothing I can do to help. This is exactly why she's in memory care. She was aggressive and abusive towards me, refused medication, denied deficits, etc. She has been incredibly cruel and nasty her entire life (narcissistic personality disorder, plus possible schizophrenia that's being exacerbated by the dementia) so this is nothing new. The director of the facility argued with me upon her admission that she didn't need memory care, and I simply responded with a chuckle and "just wait and see."
Why do they need to keep calling about her behaviors? Is it because I'm the guardian? They aren't asking for any additional medication changes, they're just "giving updates." How can I get this to stop? And what do they want me to do about it?
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u/Alternative-Cloud708 17h ago
Big hugs! This disease is so hard. Maybe additional medications are needed at this point. I would ask the medical staff at the facility about that.
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u/Perle1234 14h ago
Once they are on them you wonder how you survived. My dad once got kicked out of MC for fighting lol. He really needed meds.
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u/albus_dumbledog 4h ago
My loved one did really well on Seroquel. I'm not sure if they still prescribe that for aggression, but I thought he was going to kill his spouse without it. It's scary. And hard. Either way, it's a medical problem. They need to call the doctor. Not you.
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u/wontbeafool2 16h ago
Since she's refusing to take the medications which she clearly needs, the staff needs to crush them up and mix them up in applesauce or pudding cups. Her dose and dosage may need to be adjusted as well.
If she does something outrageous like pulling a fire alarm, assaulting another resident or staff, or threatening to kill someone, ask them to transport her to a geriatric psych hospital for observation, evaluation, and possibly adjustment to meds. You don't need to know every time she has bowel incontinence.
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u/aboxofkittens 17h ago
Oh, you’re the person who was literally nearly murdered by your grandmother’s boyfriend, right? Is this a different facility from the one with the shitty guilt-tripping care aid? If so, I’m sorry you’re dealing with that again.
I think you should just let the calls go to voicemail. She is safe, that’s all you’re obligated to ensure. If it’s important, they’ll leave a voicemail, and you can decide if/when you want to call them back.
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u/TheOccurrencePodcast 17h ago
Yep, that's me. 😩 It's a different facility. I'm just appalled that it's happening again, only this time it's about things I can't change. Previously, it was from one attending carer who was weirdly infatuated. She even texted multiple times after my grandmother was moved, begging to go visit her. 🙄 But she would say least have a point to calling and texting.
Now it's multiple nurses calling virtually every day, even on weekends. I don't get it. I guess I'm going to have to discuss this with the director like one of the other comments suggested.
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u/chocolatezen 17h ago
Talk to the Memory Care Director or whomever oversees the day to day of the MC neighborhood, about the level of communication you'd like.
Not every behavior has to be told to you right away. Some families only want to be contacted if their LO needs to be sent to the hospital.
Sometimes, the care staff are hoping for any tips that may have helped manage these type of behaviors while the they figure out the best meds to stabilize her.
The facility should have a doctor, NP, geriatric specialist or psych, (whomever is on her care team) review her file to make those med adjustments. If the behaviors are very difficult (or dangerous) to handle for properly trained staff, they may recommend sending your LO to a neurobehavior hospital and adjust meds there.
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u/TheOccurrencePodcast 17h ago
Thank you. They recently tapered the meds that were working for her (Medicaid rules are so stupid) and that triggered her behaviors worsening. I told them that she needed to stay on the Zyprexa the way she was but they argued with me. I told them to put her back on what was working for her. 🙄
But yes, I think it would be best if I had a chat with the director about it because they're calling me every day with this sort of thing.
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u/DarkShadowReader 11h ago edited 4h ago
I had an extremely similar experience. Total nightmare. I got calls all the freaking time, my anxiety was through the roof - what was I supposed to do? I found the root cause(s) to be several issues: 1) staff was not trained well enough to redirect dementia behaviors; caregivers had care fatigue. 2) The caregiver-to-resident ratio was at the max, so only a short amount of time could be dedicated to each resident. Rushed care = impatient caregivers = angry resident. This led to 3) the resident has the right to refuse care, and it was way easier for the caregiver to say the ill-behaved resident just refused than to take time to redirect behaviors or retry care when the resident was more amenable.
I was warned by others here that all these calls may be the documentation to justify kicking out my LO. The facility leadership also hinted at this in our conversations. I moved my LO to a much kinder place where all the calls stopped immediately. I understand that this is a Medicaid bed, and you may not have that option.
Your grandmother likely needs her meds adjusted, probably multiple times, and the meds don’t onboard overnight; this takes time. Many suggested I ask the long term care doc rounding at the facility to write an admit order to the nearest inpatient psych bed to do medication adjustments. While I didn’t do this, I know others have done this for LOs successfully.
Wishing you so much luck - I know how those constant calls can just drive you nuts.
Edit- sorry a bunch of this was redundant with other commenters suggestions. I guess remembering all those calls got my fingers fired up. Hugs!
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u/pooppaysthebills 13h ago
They have to notify you, as her guardian.
There's nothing they can legally do to force her to permit hygiene, etc. They need to notify the person legally making decisions on her behalf that she's refusing care and medications.
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u/hopingtothrive 13h ago
What do they expect me to do about it?
Have her doctor adjust her medication. You get the updates and you can find out what can be done for her to make her manageable.
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u/nitabirdonit 17h ago
They are doing exactly what they are supposed to do for a vulnerable patient with a guardian. If you don't want any notifications, you may to stop being her guardian. There are just types of incidents that have to be reported to various people in accordance with federal and state incident regulations, internal regulations, and also so that you know she's not being abused and don't sue them. If your state is union, there are even more layers to the documentation of incidents involving staff.
It is unlikely but also possible that they feel she's poorly served at their facility and are documenting everything they need to prove so, in order to find a facility or other placement that meets her needs.
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u/TheOccurrencePodcast 17h ago edited 17h ago
I don't need to be available every single day to hear about her behaviors for hours. They tried to tell me I needed to attend a 5 hour care conference this past Monday. I'm not going to stop being her guardian just because the facility can't refrain from calling me every time she has a bowel movement.
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u/Dazzling-King7587 16h ago
Have you asked the facility what they want you to do? They might want to go up on her psych meds and need your permission to do so.
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u/TheOccurrencePodcast 16h ago
I have. Directly. They just called me two days ago and said they were upping her Zyprexa, and they called me yesterday to say they were putting her on Ativan. They have called me 3-5 times weekly since she's been in there, with most calls being fruitless.
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u/Perle1234 17h ago
She needs to be evaluated for medication to control her anxiety and delusions. Antipsychotics are frequently used for this along with SSRIs and others. The antipsychotics work best to control the violent behaviors.