MIL is currently in a small quiet AFH, she’s stable but very bored. We have applied to a MC that’s reputable, and there’ll be more activities and socialization.
After finally reviewed all the medical record, their nursing director says they are concerned MIL is not stable because she’s been on different meds. Apparently they saw a lot of scary symptoms ( hallucination, combative and hard to redirect ) from March/April 2021.
But it’s all in the past and she’s on her meds and stable.
She’s been on her current meds since June ( Aricept, trazadone, daily, seroquel as needed ), her last neurologist visit was at the end of September and neurologist says she’s stable and the next follow up appointment is in one year unless anything changes.
MC want her to do a 2 week geripsych inpatient stay before they can admit her. Their reasoning is MIL was never seen by a psychiatrist and they’re not comfortable without that.
What does a geripsych inpatient stay entail? Is it going to be covered by Medicare? MIL does have dementia but is currently not in any psychiatric distress.
Will they just lock her in her room? Tie her to a chair or bed?
Any experience?
her hands may be restrained and/or her legs.
If you are not comfortable with having her have this psych evaluation. Find another MC.
I don’t know who mentioned it on my post a while back, but you may want to be careful with having that on record. Now that we are interviewing nursing homes, one nursing home admin, just this week, said they had to do an actual visit with dad about the very issues you mentioned that are now under control. They are still willing to accept him but dad said no. I'm also concerned because this nursing home has a high percentage of using antipsychotic medications.
It's a shame that something that may be helpful or provide reassurance could possibly hurt our loved ones when it comes time for placement.
That said, my wife was admitted to a psych ward for her unruly, damaging behavior. Shortly after her admittance, she tore the thermostat off the wall, damaged the venetian blinds, and smashed the family pictures in her room. She was essentially incorrigible. The facility asked for our OK to place her temporarily in psych ward. Obviously, destroying the place wasn't an option, so we OK's the move. The facility made the arrangements. Before being admitted to the ward, she had to be admitted to the ER for some screening. This only took about an hour. In the ward, she was in a small area with maybe 6 others. The staff met with me and my daughter to map out her plan and discuss my wife's background. Each resident had their own room (no doors), a bed, a small cabinet for their belongings, a private shower and toilet. She was only there for 12 days, not the 2 weeks your facility is requesting. She didn't return to MC all doped up, but properly medicated to eliminate any further disruptions. Her remaining 14 months in MC were of a model resident.
So don't equate today's psych wards with the terrible insane asylums of the past. If you OK the move, and it's your decision, make sure the psych staff meets with you and doesn't keep you in the dark. Also, make sure you can visit her. My visits were filled with angst until I arrived and found the situation well under control. So if they can't guarantee a meeting and visits, seek another MC facility.
So far this one nursing home just came to our home and interacted with dad to evaluate his mental state due to the issue shown on the record and the behaviour unit stay. Still waiting to hear from one other before making a decision.
Would love to hear the outcome if you decide to continue with this memory care unit.
The geripsych facility did her a lot of good. The one we used specialized in dementia cases (my first question to the doc was if he had ever hear of Lewy Body-at least he got that one right.) They got her, for lack of a better term, "dried out" from all the meds the various psychos had been prescribing. Additionally, since they specialize in dementia, and they see the patient more, they are better able to assess the whole patient and create a comprehensive plan.
This is just one man's experience, but if you can get them into GS and medicare will pay for it, I would go in a moment.
Im not sure it’s a bad or suspicious thing that the MC wants this before she moves in, though it sounds odd given her mood has been stable requiring this now rather than having to send her after she is settled in because some combination doesn’t work in her body might be the responsible thing to do on their part. MC facilities have a lot of experience with all of this, we have experience with our LO and they can be more objective than we are they also are responsible for the other residents there so there might be some comfort in the idea that they will be as protective of Mom once she is there.
The insurance question is a good one and I would verify that Medicare will cover what they are asking for, it’s a good measure of wether or not it needs to be done. Someone is probably going to have to have it pre approved in some way and it may be that what they mean when they say 2 weeks is that it could be up to 2 weeks but I can see why they might want to be cautious about a patient on several mood altering medications who hasn’t been evaluated by a geriatric psychiatrist. Neurologists are the doctors who typically prescribe these at first and are the ones dementia patients are sent to but there can be a fine line between their specialty and a geriatric psychiatrists specialty, I can see a point where they should be working together with a patient. I mean if you want to the geriatric psychiatrist first and they were prescribing medications and treating for dementia it would be responsible to get a neurology consult as well as a neuro psych evaluation.
Don’t be afraid of the terms just make sure you ask all the questions and do everything you need to to feel comfortable and informed about what’s going on. Again I go back to, you know your mother best and her comfort and ability to get through the changes is what you need to offer to these decisions. Don’t be afraid to express those concerns and assert your value to everyone involved either.
Has the memory care outreach person met you and your mother at her current care home, and talked with those CGs about her past and current behaviors?
A geripsych admission is usually 'treatment of last resort" when less restrictive measures have failed - such as adjusting meds in community without any improvement and behavior continuing to deteriorate.
Might want to look at other memory care facilities....this is a very unusual request as a prerequisite to admission. Good luck.
I sort of can understand the MC reasoning to see a GeriPsych.. they are the experts in this area - elderly grey matter - & can re assess a person's whole medication plan.
Some folk probably have a gigantic collection of drugs: from primary Doctor + Neurolgist + other Specialists = a giant cocktail. A reassess & cull may be needed.
Withdrawal/change of meds may be unpleasant, cause behavour issues, hallucinations etc so I am guessing the MC feel it would better done as inpatient.
My mom began hallucinating with a uti. ER. Rehab. Then rehab psych put her on Aricept and Nimenda. Her primary was not sold on these and took her off the NimendaI took over her med care in ALF and stopped the Aricept after 3 days bc of bad dreams. I think less is more of these concoctions. It was for my mom. She has dementia and memory issues but without a uti to send her to crazy land, she is grounded in this world. Moves confuse her. And since we’ve been at my house (last 5 days) I have yo keep explaining where we are. But no behaviors, hallucinations or delusions.
And no. I have no experience with geriatric psych stay.
Good luck! And good for you for trying to make mil’s life as good as it can be in a more active facility.
The second nursing home, which I kind of like more, wants more records to find out if there were more behavior issues besides lack of sleep. They're questioning the home health agency and primary doctor. I hear they are also questioning him being on the Seroquel (their numbers are low for use of antipsychotic drugs according to health.usnews).
So that may be another reason.
we are now trying to get a referral from the GP to get her an office appointment for a geripsych evaluation.