How to help husband that has become combative in memory care?

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How to help husband that has become combative in memory care?

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My husband may be asked to leave his memory care facility because he has become combative lately. He is an advanced stages of Alzheimer’s they are finding it difficult as he has been resistant to care and being transferred from his wheelchair to bed. I was wondering if there are any tactics or medication that the caregivers could use to help him be more compliant and relaxed?

Alzheimer's & Dementia Memory Care Violent Behavior

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When my Husband was on Hospice I asked the CNA about things like this (just in case this happened) She told me that often with patients that experienced pain when being moved they would pre medicate them so that they would be in less pain, or no pain when the CNA would begin her duties.
I always made a practice of telling my Husband what I was doing or going to do BEFORE I did anything and I would talk to him throughout the task. For example when I was going to move him I would tell him I was going to move him over to the other side of the bed, then I was going to take his arm and bring it over his chest to the other side of the bed and I wanted him to hold onto the bed rail....and on it would go so he knew what I was doing. I never had a problem with him resisting me or the Hospice staff.

Are the caregivers talking to him or do they just come into the room, grab the gait belt and hoist him up? Maybe if he knew what they were going to do, where they were going to put him he would be more cooperative.
My guess is 2 of them come in and they are talking to each other about what they did last night, about a movie they saw and they are not talking to him or treating him as a PERSON but an object to move, like you would move a dresser or table.
If talking to him and explaining what they are doing does not work then pre medicating him might.

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Thank you for this information. Because of covid I have not been able to observe what they are doing but will check on this more consistently.

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I'm sorry you and your husband are going thru this. A major question the family fails to ask when placing a LO in a care facility is “What is your discharge policy?”. That is, under what circumstances would you discharge a resident? Your story strikes a nerve with me. It is a shame when MC facilities cannot properly address residents behavior. The problem? Training! These are dementia facilities for God's sake. Does the staff not expect combative, resistive and standoffish behavior? The problem is not with your husband but with the facility. The first line caregivers (usually nurses aides) are typically trained by watching a 4 hr video and told to “have at it”. They should at the very least spend a week viewing Teepa Snow videos and have hands on training. It is rare to find a staff person certified in dementia care. The resident care mgr in my wife's facility was fired for being “too close” to the residents. She was the only one in the facility certified in dementia care and training. My wife was combative to the extent of trashing family pictures, tearing the thermostat off the wall and damaging the Venetian blinds. With the families OK she spent 12 days in a psychiatric ward to address her behavior. Returned to MC a different person where she spent her remaining 14 months.

Does the staff know what triggers his behavior? Much of the LOs behavior is a reaction to the caregiver's actions. Many states are addressing caregiver training thru legislation. I hope yours is one.

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The Memory Care ALF I worked at required ALL of the staff to do extensive and ongoing training, including watching lots of Teepa Snow videos. Training, however, does not include dealing with violent behavior with a resident who is threatening everyone. That type of behavior needs to be calmed down with medication when caregiver intervention does not work. Yes, there are lots of tips and tricks the CGs can use to calm a person down, but oftentimes, they do not work. THAT is when medication needs to be used and many times, IT does not work. Everyone in the ALF cannot be subjected to tyranny from one combative resident. It's just the way life is in residential care. I would have a fit if my mother was hit by a combative resident in her MC facility and they did nothing about it, and that's the truth. Safety for ALL is the prime concern.

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My Dad has Alzheimer’s, is wheelchair bound and can still talk, though he doesn’t always make sense. He’s in an apt. with 24/7 care. Lately he’s been sundowning and becoming verbally and sometimes physically aggressive. He threatens to hit someone or swats at them. His hospice nurse has him take Ativan at bedtime and another dose 4 hours later. It’s helping. I’ve asked his cg to gently rub his shoulders and talk with him about whatever is going on. Remind him he’s safe, they’re there together and they’re ok.Touch works as well or better than Ativan. This is a new problem for us and we’re only a month into this, but it seems to be helping. Good luck and am praying for you. This is tough- esp. with Covid keeping lo out.

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Why can't the administrator or charge nurse call his doctor and ask for anti anxiety meds?? Why do the always act like they have no idea how to treat this? Luke they have never seen this before and don't know what to do. Ive heard about this over and over. Then threaten the family the person must leave. As if they can control the resident.
All they have to do is say he is getting combative so we have to adjust his meds to keep him calm and everyone safe.
Instead they turn it into a very distressing situation for the family.
Someone needs to pick up the phone and call the doc. I believe they have a doc at the home on call. I dont know why they have to turn this into a catastrophic event. So the family will have to call the doc and say his meds need to be adjusted. That is done to keep him free from distress and anguish. He's not happy either. Its not that hard of a fix.

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There are several techniques, but the right one to use depends so much on what *exactly* happens when they try to transfer him that it's impossible to guess what might work best for him.

But I can't help thinking - for heaven's sake! This is a specialist memory care facility, yes? If they aren't already using a range of different approaches to reassure and help him, what are they for???

Are you able to visit your husband, or are you only hearing about this over the phone? It must be terribly worrying for you, either way; I just wondered if you would be able to say when he began to do this, whether it's with any particular individuals or with everyone, whether they've checked for possible problems such as pressure sores or overgrown toenails which might be hurting him and making him afraid to be mobilised...

It's so hard to know when you're not right there, is the thing.

Medicating him to make him more compliant would be an ethical no-no, at least until everything else has been given a fair trial. It would also probably make him even less able to mobilise.

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That's a tough situation. I'd explore a few things, including those that others have posted here. I'd also explore why he's getting that way when being transferred to bed. Can they do some detective work? Does he have pain that he's expressing? Are they touching him somewhere that is painful? Is the bed uncomfortable and he doesn't want to get into it? I'd also find a geriatric psychiatrist to see if medication could help. Is he a hospice candidate? Hospice nurses are trained in detecting pain in nonverbal patients. Also, in my state there are a few long term facilities designated for people with dementia who are have behavior issues. I'd explore that, in addition to asking the MC he's in now to find him a place. I think they have some duty to assist in finding new place for him. You can also contact the Ombudsman for that facility. Most states require long term care facilities to have one. It is usually posted on the wall at the facility. Not sure if you have access to get in, due to covid, but, the facility may be able to provide the name and phone number OR the state regulating agency for long term care facilities. You might also have an attorney review your contract and options. I hope you can find some help.

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Sunnygirl

The thing is, The Administrator will not care where she sends the resident to. (Ombudsman may not either) Just as long as she gets him out of her facility.

With this being said, the resident may end up in a worse Memory Care Facility. The cycle will continue.

They do not have a clue.

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Yes, there are meds for him. Speak with his doctor. My dad was very difficult and down right mean until I talked with his doctor and got him on his "bedtime pill". He asks what it is and that is what I say. The meds help him sleep through the night too. Talk to his doctor soon.

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Ask social services in his facility to recommend a psychiatrist that will be qualified to manage aggressive behavior.

There are several medications that can reduce negative behaviors without being too sedating.

If his facility has no psychiatrist on staff, ask for their recommendation for an independent practitioner. His insurance should cover the work up and prescription.

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I recently read an article about the importance of physical contact for dementia patients, especially if they can’t talk. Spouse laying in bed with him, holding him, rubbing his back, brushing hair, lotion on hands, etc. Basically, showing them love. The article said it can change their behavior for the better and made a good case for it. Look at how babies will fail to thrive if they aren’t held and talked to. Same with us at any age!

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I know this would be so good to do but I can not see him for any more that once or twice a week for 30 mins at a time due to Covid. It is heartbreaking. I am hoping with hospice I can see him more.

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Thank you for all your responses and I am reading thru them all. One thing I should clarify is that he is not violent, he is resistant when the MC staff is trying to do care and "bucks" his body when they are lifting him to the bed or to the wheelchair. He can not verbally express his pain or discomfort and I have talked to his doctor about this and she will be trying some pain medicine to see if that makes a difference since he does experience back pain at times. Also due to Covid I can not be in his room or see him in person for more than 3o mins once or twice a week which is heartbreaking. My husband is now under hospice care so maybe the addition of the hospice nurse can help with this. Thank you.

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It's so good to hear your update and that he's under hospice care now. I hope some of the comments have helped. Considering his behavior has been less than violent or combative and that he's under hospice care, your concerns about his being asked to leave should be alleviated. Because he's unable to communicate his feelings or his aches and pains, it's very common that he is resistive. Hospice now takes over his care. They will provide him with the best quality of life in his remaining days. I wish you luck, JMarie.

How to help husband that has become combative in memory care?

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