Shouldn’t memory care units separate extreme patients who scream and fight from others? Like a special unit? One person is agitating all.

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Shouldn’t memory care units separate extreme patients who scream and fight from others? Like a special unit? One person is agitating all.

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My Mom has dementia and in a Memory Care unit with about 18 others. The unit recently introduced a patient who has outbursts all the time and bangs the table/floors, screams at other patients and I witnessed her hit another patient. She is stealing the peace of the others. When does the welfare of the others outweigh the needs of this one? They all get agitated. Shouldn’t there be other units where people are cared for based on their level of behavior. It seems very wrong. While I am sympathetic for that woman and her family, I’m concerned about my Mom and the others who don’t have a voice to change this. This is hard on the aides/staff also. I’ve brought this to management’s attention. Has any one else dealt with this?

Alzheimer's & Dementia Memory Care Violent Behavior

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My mom was the agitator. She was sent for a psych assessment a few times. There they would try to adjust her meds to help keep her more calm. It would work for awhile, until another med adjustment. Over the two years she was in a facility she needed an outside caregiver to be with her on a one on one basis as a diversion, that helped. This was an additional charge as the facility had others they had to provide care for.

Moves are very hard on those with dementia.

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You are speaking about your mom in the past tense, so I'm assuming she's passed away? I am working as a private caregiver in the home of a 74 yr. old woman who has had Alz. for 10 years. She is very angry, especially when someone interacts with her directly. She used to be a head nurse in a cardiac unit, so I'm wondering if losing that voluminous mental capacity is just really pissing her off, or maybe I'm projecting? I also wonder if when it gets worse to the point of being non-ambulatory, non-verbal, etc. she might not be as angry? thoughts?

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If this person has violent tendencies, then she needs to be in a Psychic facility. Like said, for med adjustment. Yes, the safety of staff and residents should be the priority. Wait and see if anything is done. They maybe trying to adj her meds first. If nothing seems to be happening call the Ombudsman and see what can be done.

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My mother could be the agitator too. She slapped two other residents that I know of, and when she picked on the wrong person, she herself got shoved into a wall. Luckily, the families of the people she attacked never brought charges. There was a very large man on the regular floor who was very loud and could be combative. To the best of my knowledge, he never attacked another patient. He was medicated, monitored and supervised. The facility, both the regular floor and the Alzheimer’s lockdown, handled it the best they could. Incidents were documented and reported. If one resident took a dislike to another, they were supervised more closely. My mother was given a room across from the nurses station.

You can always speak with an attorney if you feel the facility is not handling this the right way, but chances are that they are doing all they can. And remember, if you do speak with the facility’s administrators, there is only so much about this woman that they can divulge.

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Ahmijoy, your comment brought up an issue that so far I haven't seen mentioned on this forum. Yesterday my mother asked what it cost to keep her in the nursing home, and when I told her, she wondered how we can afford it. I explained that she could afford it unless she lives to set a new longevity record--AND unless she bites, hits or kicks someone! Considering that she is bedridden and very easy-going and cooperative, this isn't likely to happen, but I wonder how often it does, how often a resident gets sued and how big the settlements are. I also wonder if there is any kind of "insurance" against such events, such as "dementia liability insurance". In any case, I'm thankful your mother didn't have any charges pressed against her. (However, I guess there could be both criminal and civil issues--I was thinking primarily of civil charges considering that some people will try to make a fortune off of anything even if minor.)

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They have tried to stick Christy in a memory care or lockdown unit. The industry does not understand or care to acknowledge the hellish disease that is beyond Alzheimer's.
They are no allowed to physically or chemically restrain, but they rely on a rule that states unless then behaviors interfere with the others.
We have kept Christy home and we are happy. There are HBC programs and it is Congress intent that we do all possible to keep her out of a facility
.
See Olmstead
https://www.hhs.gov/civil-rights/for-individuals/special-topics/community-living-and-olmstead/index.html

Dementia does not meet the requirements for psych facilities or any psyche services as there is no medication, no improvement, no recovery, no means of testing.

Alzheimer's medication do not work and they have severe adverse side affects.

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There is medication to help with the violent tendencies. Thats why a Psychic facility. They can closely monitor the person and find the right combination. My daughter says it takes 30 days to see if a med works. If not, another 30 days for a new one.

It really isn't fair that one person disrupts a whole facility. Not fair to that person and doesn't help when trying to keep anxiety low with the other residents.

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https://www.olmsteadrights.org/about-olmstead/

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Thank you for all your responses. Heart to heart I appreciate your insights. These are all thoughts I will consider. I’m still going to push for a peaceful environment for all trying to be respectful to all parties. Thank you.

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i live in Australia my mother was in a Dementia only facility. Most patients were free to go around as they pleased but there was a locked door which separated some patients from others because they were difficult or tended towards violent outbursts.

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Yes, I think they need another separate area or facility for cases like this. Thanks

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If this unfortunate lady hit another patient then she is not just stealing the peace of others, she is a threat to them. Your mother has a right to personal safety. I would be worried, too.

What was the management's response to your concern?

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Thank you. Management asked for me to work with them. They are aware. Of course they won’t discuss particulars due to HIPPA. I don’t want to know someone else’s business in any case. I just want my Mom to be safe. My current plan is to request another meeting to review my observations since I’m there everyday. My sister is there often too. :-(

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I am going to "play the Devil's Advocate" here.
You see what happens but you do not know what is being done for this patient.
And HIPPA laws prevent them from telling you what is being done.

*They may be trying to have this person's medication adjusted. This can take a while.
*This person may have been just been uprooted from the home they have known for years and is ..angry...scared...lost...
*Taking things from another person's room is VERY common and if you read many of the posts others have asked about it. There is not much that can be done.
*The administration may be having discussions with the family that the behavior is unacceptable and they may have been given some time for adjustment and if the patient/resident does not adjust they will be asked to find another facility.

Continue to monitor what is going on.
I would also send a letter, not an email, that you are concerned about your Mom's safety. If you have or if your Mom has a lawyer that handles her affairs a copy to the lawyer might be a good idea. You might even ask, since you are concerned about your Mom's safety and theft, if you can put a camera in her room to monitor her safety and her possessions.
And yes there are facilities that will take agitated patients/residents but I am sure this persons family is trying what they can to avoid that. There are forms of dementia (LBD) that the person can have more violent tendencies and it is a matter of medication adjustment. But like with all medications for Mental Illness it can take time to find the right medication, the right dose.

Continue to have meetings with the administration but Please be patient..

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Excellent comment. This type of situation isn't uncommon in memory care. I also wonder if possibly Jackiehar might be more distressed by this woman than her mother is? Sometimes we are project our concerns onto the person with dementia who at this point might be less worried. My uncle, who had very tight boundaries all his life, paid no attention whatsoever when another resident would come into his room (during the day) and lie down on his bed, or just sit with him and stroke his arm. My sister had hissy fits over this, but uncle had no problems with this new intruder.

And yes, patience is the big challenge.

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In January, we moved my mother into a private home memory care facility (fully licensed and regulated). She was not on any meds and threw plenty of fits, throwing objects, banging, breaking things. I was very concerned for the four other residents and worried that my mother would get kicked out for her behavior. We were assured the staff was "used to this" (though I doubt the other residents were) and they said once meds were introduced (and if she would consent to take them - a whole 'nother battle), regulated, and she got used to being there, she would likely settle down. It has been 3+ months now and Mom is definitely less combative, less yelling and screaming, though she's still very angry.

Difficult as it is, try to give this new resident time to calm down. Meanwhile, if possible, keep your mother's door closed and introduce sound - even white noise - into her room if possible to mask the sounds of others. I wish you luck.

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I am sympathetic to others adjustment. I’ve talked to management and told them I’d give them a little time. I also know that doing that puts my mother at risk for a little longer. I placed her in this facility for her safety and peace. I wish we all had better answers.

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There have been a few news exposés in Canada recently but resident on resident violence (and resident on staff violence too) isn't new and is a dirty little secret in long term care homes wherever you live. Violent residents can be more than just annoying, they can cause real harm and even death to those unfortunate enough to be the recipient of their ire. I don't have all the answers, but wringing our hands and talking about the patient's right to care and privacy isn't it. I believe that a protocol for assessing residents for violence and making available appropriate interventions needs to be mandated, and the only way that can happen is if we bring this issue to light and apply pressure to our legislators.

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Thanks for pointing this out, cwillie!

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This reminds me of an extremely disruptive student in my child's classroom. All students suffered the entire year. In other words, it happens in many realms. I would communicate my concerns by framing it around the impact on your loved one's day-to-day quality of life. Work your way up starting with your loved one's social worker. My parent was paired with an abusive roommate (mostly verbal). I expressed my concerns and requested a room change. Nothing. Finally, I witnessed an explosive physical action by this roommate. I also saw how upset dad was not only because he felt threatened but because he was concerned for my safety. I was taking him out of facility that day and on the way out, we bumped into his lawyer who happened to be visiting someone there. He implored her to act on his behalf to mitigate this matter. I reinforced to the social worker that he had requested his lawyer to address the matter with the director. That's what it took. After I had asked multiple times for him to have a new roommate to no avail, another bed miraculously opened up and dad was moved. So, ask for your loved one to be moved as far away as possible from the offender because of the detrimental effect on your loved one (ie. lack of sleep, safety fears, missing items, etc.) I would also like to add that many facilities ask (don't require) that you sign a form that says that if anything happens to your loved ones, you won't sue, but instead let the complaint go to an arbitrator of their choosing. I never signed that form for either of my parents. The facility must ultimately know that they are accountable for the welfare of their residents.

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Thank you

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I have a friend who works in an Alzheimer’s unit. She said some places withdraw a patient’s antipsychotic medication to get a better ranking from the state. This makes the patients with violent behavior more prone to pick on the innocent others, no fault of their own. She said they even went so far as to tell a patient’s family who was beaten up by another patient that “she fell”. My friend reported what was going on and there was complete turn over of management and a lot of upper level employees. Make sure this isn’t going on with your loved ones.

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Good to know, wasn’t aware of this rating process.

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When my friend was in AL memory floor he sat with 2 other men at his dining table, One day the man sitting next to him punched the guy across from him. They immediately sent him to the psyche ward at the hospital and he was gone for about a month. When he returned he was calm, until down the road he punched the same guy again. Meanwhile Dick is watching all of this. The second time he was shipped out and was not allowed back. So they may try once to get them on meds to keep them calm, but if it doesn’t work they should be sent to a facility who can handle them. Sad to say they will probably be drugged to the point of incapacity since those facilities are usually not the best.

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Yes, the state of this industry is sad. I think they do rely on drugs a lot. But I don’t have the answer either.

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When my friend, Beth, for whom I was her POA, wouldn't let staff clean her up after she soiled herself, I was told to take her to a geri-psych ward in a hospital to find a medication that would calm her down without doping her up. It took phone calls to 3 different hospitals to find one with an opening. She was there 3 1/2 weeks before they found the right medication and dosage and after that she was easy to work with and not doped up. I never knew such facilities or drugs existed, so I was happy to get the direction I needed from the AL/Memory Care staff.

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Very good to know. I fear we may nearing that point with my mother. As it is, very difficult to get her to shower and change clothes. I've noticed when I visit that she has stains in places she shouldn't have. She won't change her clothes, though she used to be fastidious about cleanliness. "I'll change when I go home" she says. I have a feeling I better learn about geri-psych facilities in our area before I need them.

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The memory care my Mom was in had two connecting units - one for people who needed more supervision and one for the ones who didn't. Since they were connected, the patients could still go between buildings so there were some altercations. My Mom was pushed, hit and shoved several times by the same woman but was more shook up than hurt. By the time they called me and I was able to talk to her, she had forgotten all about the whole incident. Our attorney advised us to be very careful about how we addressed the problem because they could come back and say that they just couldn't guarantee Mom's safety adequately so she'd have to leave. Fortunately, that didn't happen and I was able to talk to the Administrator calmly about how they could assure Mom would be safe in her room (these incidents happened when the woman would come into Mom's room). The gave her a room key so she felt more in control of her private space. I'm not even sure the key was a "real" one but it sure helped her peace of mind! Not sure what happened to the other lady, but shortly after the 4th incident she was no longer there and we never complained! I hope that answers your question and I'm not just rambling! I think, bottom line, that all memory care facilities operate differently but this is not uncommon.

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Thank you!

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On a personal basis, I think anyone with this behavior is horrible and it is up to the professionals to put an immediate stop to it - no matter how severely they must act to stop this. People like this harm and destroy other people - and with what right? If she can't be controlled then she should be kept in total isolation and all attempts should be to medicate her so she is calmer. Under no circumstances ever should someone like this be allowed among the general population - never, ever! And if need be, kick this person out and put them in a hard core facility where people like this can be controlled. There really is no other solution - but you can threaten to expose the facility on t.v. and the media and you will start law suits. Sometimes that will help them stop this.

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im working all angles. Thanks

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They are reliable for the welfare of their residents. You need to be your mothers advocate. Show up every day without letting them know what time you will be there. Document everything you hear and see. Use your phone camera, pretend your taking pics of your mom etc. Talk to the aids and other patients family members and document them by using a calendar or when you go to your car record it on your phone. Depending on the state in which she lives, each facility has to abide by rules and regulations.
Sometimes there is a adjustment period for new residents and moving for a Dementia patient can be extremely frightening for them. Outburst are to be expected. That being said, safety for others should be put into place.
Go back to the administrators and ask for them to send the violent one to a hospital to find the right meds so she can get stable before she is returned.
If that doesn't work, contact the state board that regulates those type of facilities and send in your complaint along with a copy of all your documentation.

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Thank you. I am going every day and keeping a log. I’ve talked to the facility management and director of nursing. I expect adjustment periods and occasional outburst from all. It’s this ongoing situation that is tough. Helpful to hear my instincts are correct and I’m going in the right direction.

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This person should not be around other patients as she scares the beejeezers out of them. What are they waiting for - one of them could have a medical emergency due to her mean temperament?!

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Sometimes the person who is violent and agitated has to be sedated. It could be only a temporary stage. You may want to talk to your mother's case manager about their policies.

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Thank you

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Where my mother is there is a zero tolerance policy. My mom had to be sent to the senior psychiatric center twice to correct her medication so that she could be a peaceful resident. (She is not sedated, btw, there were other issues.)
What is the policy where your mother lives?

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Do all you can to figure physical discomforts. They can't tell you, They do';t know what it is. They can't fix it themselves.
It has taken years to interpret involuntary signs.
I feel bad for the times that I though my wife was just being difficult. Chrsity has FTD and cannot comprehend or communicate.

My nephew was born with CDL and also cannot comprehend or communicate.
He is now age 50
The FTD and CDL are not related.. It puzzles me that they both exhibit the same aggression, violence, difficulty when they are hurting. They both have almost insatiable appetites

Also of interest is their grumpiness is the same when there is a weather front.

They could be constipated, have a UTI, have to pee, even if they just did, feel a little nausea or heartburn, drymouth, joint ache, or an irritating itch that they don't know how to scratch. POLYESTER!

Christy has been a sweetheart since 2014, because we are constantly and immediately attentive to any possible discomforts.
Constipation and burning diarrhea are the most common.

Please be certain that the dementia is not FTD.
FTD reponds adversely to drugs, especially sleep medications.

Your doctors may not have the clinical expertise to recognize and diagnosis FTD.
It took them 9 years to recognize Christy.

https://memory.ucsf.edu/medications-dementia

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I don't care if it is God or the devil who is involved. If someone acts out in a horrible, abusive, nasty, loud way, this person must, must, must be immediately controlled and removed into an isolated area away from other residents. No resident, and for that matter no staff, should have to put up with tantrums and other violent outbursts. I don't care why or what they do, it cannot be tolerated. The other people must be protected and have the right to be protected. These people cannot be kept in the main population unless they "behave". And something I never, ever understood is this. In so many facilities it seems perfectly acceptable for the 'patient' to behave horribly in words and deeds, and the staff has to 'take it' and never speak back or do anything. I think that is pure insanity and very cruel. What do they think what this does to the staff who doesn't dare say something appropriate to stop them in their tracks, vs. being "nice, nice" which doesn't work. The staff has to keep all this inside them and who cares about their feelings - and then they explode. It has to be o.k. to make patients stop and sometimes that means the staff has to get really 'rough and tough' to make the patient understand. The staff is human too.

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Shouldn’t memory care units separate extreme patients who scream and fight from others? Like a special unit? One person is agitating all.

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