Dementia: Episodes of Unbecoming Behavior

snakebiteWithin days of the Assisted Living facility calling me in to work through how we might better help my Mom, she was involved in an incident where another resident ended up on the floor. We received few details, but I have witnessed, and the staff has reported that my Mom is getting more combative. She has periods where she is verbally abusive and physically threatening. She’s now about 5’7″ and 110 pounds, but is able to command a larger presence and scares other residents.

My general rule has been to tell my Mom once what is happening and what has been reported to me. The discussion is always difficult and she is always frustrated to hear that I have been told something about her when she was not present.  I totally understand that emotion.

However, even when she was present, she doesn’t remember. My Mom will argue each item and demands written documentation. When it is provided, she rips it up. From that point forward, I work to implement the changes and redirect conversations or frame them with information that my Mom will accept.

Within the past year, I have met several residents who will share how my Mom was one of the first residents that welcomed them into the community. However the dementia has changed her and now, she’s the woman everyone avoids.

The head nurse calls to let me know the doctor is going to meet with her and look into some new medications. The Ativan (by itself) can’t help anymore.

Just when I think I have absorbed the changes in my Mom, something new emerges. Rattled.  

Your Mom is not doing well in the Assisted Living Community

sunriseThe death of my father impacted my Mom cognitively. For years they were a team that managed their dementia by being together. Now my Mom’s alone with no wing man.

Her decline is escalating and unfortunately, she’s getting more combative. I’ve noticed this on my visits as we interact with others in the community — at least she is usually kind to me. However, she now believes someone stole a card set she used to run bridge games and this is causing grief for everyone. She has always tended to perseverate on specific topics and this month, it’s the bridge card set. My mom turned over the set to a woman to run the games but doesn’t remember and/or doesn’t like it on any given day.

I was called by the head of the community and they asked to have a meeting with me. They took me through a litany of events and issues and are worried that they are going to be unable to care for my Mom. She is refusing to take the prescribed medication, which includes a change to give her Lorazepam daily. Before, it was used as needed to reset her anxiety, but her behavior now has moved the recommendation to a daily dose.  

I ask for suggestions, my Mom can’t be the first resident they have faced they have trouble helping. The head of Assisted Living has decades of experience as well as do the collective experience of the other staffers at the meeting. They share the varied things they have done to try and help my Mom that have failed — many that worked for others. They have even tried a variety of new things given my Mom’s interests and mobility. The psychologist and the head of the dementia care unit have spent time with my Mom over the past few weeks and felt that unless she started taking the mood medication (Lorazepam), the community would be unable to help my Mom. The biggest difference with my Mom is her mobility.

If we can’t reset my Mom’s anxiety, and her behavior, they will put her on a 30-day discharge plan.

So here we are and the first step is getting my Mom to take her medication. I ask if they can just give her the 1 pill. It’s very small, she could easily take it and then they could reintroduce the vitamins and other medication that they believe are “essential.”  My Mom has never liked taking pills and resents that the staff watch over her while she is presented with 7 pills in the morning. Most of them are vitamins. I requested that they minimize the number of pills my Mom was taking several months ago, but the doctor felt strongly we should not make a change. She recently just refused to take any pills.

As my Mom continues to decline, it’s still surprising how many things she can do. However, her disease is moving her into a very negative place and we are struggling with how to best help her manage within her community. Just when you think you have a handle on the situation, it shifts and challenges you in new ways. Confronted. 

Please share your experience – positive or negative with different medications or a similar behavior.

Your parents agreement with the retirement community is being terminated

telephoneAbout three weeks ago, I got a call that changed everything. The Executive Director from my parents retirement community called to tell me “Your parents agreement with the retirement community is being terminated.”

“What did they pay for when they moved in?” was all that came out.  The Executive Director clarified that they were going to require that my parents moved from Independent Living to Assisted Living — this was really a transfer, not a termination.

Someone mentioned this to me a few months ago. It didn’t register, but now I understand that if a resident is a danger to themselves or others in the community, the community will invoke it’s right to force a resident to make a change. My parents would not (and possibly could not) make the decision to accept live-in support in the Independent Living apartment, nor would they opt for this move on their own.

Enough events have occurred that the retirement community is going to force this transition. So much has happened and we are still moving through this process.

I have many things to share … and hope to be get back to writing.  Engulfed.