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my mother is narcissistic and has always had a mean streak. she has had dementia for awhile and has had 24 hour caregivers for over a year. her preferred caregiver had to leave and new caregivers were introduced. she has been very abusive to them - ordering them around - yelling, just extremely unpleasant.

i am looking into skilled nursing memory facilities but i am worried because i have read some yelp reviews where people's parents have been evicted for bad behavior.

i am wondering if i should tell the facility of the bad behavior . . . and how do they handle it? i would assume with medications. that is actually the only thing i could imagine working.

you couldn't have yellers in a nursing home upsetting the other patients - so where are they and how are they being handled?

thanks for any ideas. i am at my wit's end.

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Hi seekseek....My name is Florence...I live in Sarasota FL...and I own and operate an "Alternative to a Nursing Home" that I named "On Angels Pond." It is actually a private adult care home. I only accept two clients at a time....and I provide them with a quality of life they would never receive in a NH. I accept Alzheimers...Bed Bound...Cancer....Hospice...and Assisted Living. I have CNA's working in my home....Doctors who make house visits....Therapists.come in...x-rays....lab work...even a Dentist....everything is done in my home. They client receives one on one care....home cooked meals....they become part of a family. Once a client moves into my home...they live there until they pass. I've had clients like your Mom....ones that yell all night....combative clients...and quiet sweet clients.... but what ever type they are...it just seems to work out well in the smaller environrment I provide rather then a large facility. They become use to the same people taking care of them everyday....and we spoil them....they receive so much attention. They can sleep late...or get up early....stay up late at night....or retire early...what ever they want to do. We cook anything they want for breakfast...but for supper we all eat the same thing. Thay can have snacks or fruit or drinks when ever they want to, I had one client that would ask for a bowl of ice cream at 4 a.m.....and I would give it to her. I would suggest that you find one in your area and visit it. We aren't licensed by the state...it's not required if you only take two clients....but we are not allowed to advertise. My clients come to me by referrals from previous clients' families...The Senior Friendship Center...Hospice....and the Doctors and Therapists who come to my home...and by Assisted Living Facilities that have gone as far as they are licensed to and need to have the client move into a full care NH, The advantage of not being licensed is that there are so many things I can do for the client that I couldn't do if I was licenswd...for example...cut or dye their hair...pedicures...finger nails....and I can use bed rails on their beds...facilities can't because it is considered "restraining" the patient....so the patient usually falls out of bed and gets hurt....but never in my home....I use bed rails if I feel the client needs them. Family members can visit any time they want...we spend birthdays...holidays together. I charge a lot less than a NH...and I supply everything the client needs....no extra add ons. They do pay for their own prescriptions....Doctor's and Therapists are covered 100% by Medicare, Just another option you might want to look into.....I hope this helps. .
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Also, when my father was in a NH for Alz., there was a woman there who would regular outbursts, crying, yelling, screaming. I don't know what meds she may have been taking, but they would call her husband in to calm her down. He was there daily as it was, but she was a handful and her poor husband would get called late at night if necessary because only he could calm her.
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Many people are against medication because they feel that it just makes things easy for the person/people caregiving. I would like to share that I believe that medications given to Alz/dementia patients is very right because the patient is in turmoil. If the medication gives them a better quality of life then I am all for it. Think of how a person must feel being tied up in fear, paranoia, etc. If medication can reduce these feelings for them, then your time spent with them is just so much more meaningful and memorable. They don't have to be zombies...just taking the edge off. Good luck to you in what you decide to do. Hugs!!
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YES! Medication can be SO helpful. If she were in physical pain, you would give her anything to stop the pain. Mental pain can be as severe. She has expressed suicidal thoughts. That means she is in pain. If her suffering can be reduced, then she will stop screaming. Then you will like her more because you will get more sleep. Then she will be happier because you are being nicer because you are well rested.

Just don't tell her what it is. Call it a pain pill or a brain pill or a vitamin for her blood. It may take more than one attempt to find something that helps without bad side effects. Will her doctor be willing to keep working with her to find a solution?

Personally, I bitch about antidepressants because they don't cure me. I'm a big baby and complain if I get a little headache from them. But I no longer think about suicide every day, and I am happy for most of every day. Give her drugs. You will both be glad you did.
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I wanted to suggest that you try a in home agency who deals with dementia and these type of behaviors with your mom. Area on Aging or the Alzheimers Association has a family counselor she should be able to point you in a good direction. My issue is occasionally my mother will stay up late and watch t.v. and I will be aggravated because it is up too loud. Typically, she forgets how to turn down the volume so I have to show her how. My concern is lately she has been awake at early hours of the morning and she will start crying about her situation with her husband right now and how upsetting she is to be away from him. Facility wants to get him body and soul and take all her money. It seems like this because of her limited visits. We do not know if Adult Protective services is will take him away from her. This causes her to scream and yell at the early time of the morning. I talked with her minister and a friend and they think she should be on a antidepressant. I am hesitant to put her on this medication because I know she is not big on medications. Should she be on medicine because she is so upset and she has expressed suicidal tendencies? She has not acted on these thoughts. She just feels like life is over without her spouse at home.
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I agree, medication is the answer. Getting into her may be the next problem. The the NH where Mom is they sprinkle it on her food and try to get her to take pills. She is a yeller but hasn't always been. She was a sweet woman, once, a long time ago.
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Seekseek
I can see you are at your wits end trying to place your mother. My only suggestion would be to try and mellow her out before the subject is even introduced because I will bet she is going to scream bloody murder at the idea of a N/H and probably fight tooth and nail when you try and take her out of the house. Talk frankly with her Dr and ask for his ideas on something that will calm her down and make her more manageable. In the elderly some drugs can have the opposite effect to the desired one so you may have to try several till you settle on the right one and correct dose. If she is stable and they are willing to continue the medication in the N/H she will cause minimal disruption. the alternative is a locked ward and I don't think you would want to see her placed there or having to endure that environment while she continues to be aware of her surroundings. The alternative is to continue with the 24 hour care at home and the constant turnover of caregivers. There is plenty of work for in home caregivers so if they are abused it's easy to find another job. good luck.
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i am sorry i am so frustrated. didn't mean to react in such frustration. thank you for all of the suggestions and the link. i think medication is "the answer," which is ironic because i am not normally "for" medication. i think it will mellow her out and if she is zoned out it is better than being out on the streets! thanks to all!
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Seekseek, If she's that bad, she needs medication. I understand that getting it into her may be a problem. I suspect that it wouldn't be the end of the world if she became mellow/zoned out! It's easy to cut back on the medication once her behavior improves.

Is she seeing a specialist in mental illness and dementia in the elderly? These problems can be treated, but not just any doctor is equipped with the knowledge and experience necessary. Please don't be offended if I suggest something you have already tried.

It's tough when the person acting this badly has always been difficult. How much is the disease and how much is selfish stubborn behavior? I'm sorry you have to deal with this.
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Dear Seekseek: I can hear how frustrated you are. I hear you loud and clear. Many others on this site have been and are dealing with similar issues. Research is ongoing - I just found a question/answer forum below that, if you read the helpful answers to the poster, you may find some useful information as well. It's not your exact situation of course, but it deals with difficult behavior and aggression issues and there is mention in some of the anwers of places that take it in stride. If this of no help, keep looking through the various dissussion and question posts. Another suggestion is to contact a Geriatric care manager, a social worker, or your local Area on Aging council. Good luck.

This is the post I was referring to, that you can look for and read some of the suggestions by others:
Mom's violent "striking out" is endangering other residents and staff at her facility & may be asked to leave. What do I do?
Asked by SSwaim | Jun 17, 2013
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i don't think you are hearing me. my mother is difficult. she doesn't care about other people. she would not use ear buds. she feels entitled and that she has a right to do whatever she wants. she is difficult. i have been looking and looking. the doctor gave me the name of several facilities - all want "nice" residents. no one wants the problem people.
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Another suggestion - borrowed from another caregiver on this site - you could get your Mom her own "special" set of ear buds to hook up to the TV or radio so she can listen all she wants without disturbing other patients.
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Carol, thank you so much for your compliment!
Seekseek, keep on seeking!! You Mom is entitled to professional and empathetic care, and there are facilities that take difficult patients. I hope the patients you observed were mellow and functioning vs. mellow and zoned out! There is a guidebook that comes out every 6 months that lists Senior care service facilities in every county of your state, and what kind of services they specialize in (such as Alz/dementia) and what medical plans they participate in.. Your doctor can probably tell you the name of it (sorry- 'senior moment' I cannot remember the ttle). Don't give up!!
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well, i toured a few facilities and the first one told me they do not take difficult patients and advised that i not tell subsequent prospects because they would never take her. she said no facility wants to deal with difficult people. in one facility, a coordinator told me that they have a bunch of "really mellow" people right now and as i toured i saw all of these seemingly pleasant people. my mom would ruin that in a heartbeat. what do i do? where do difficult people go? she also has very rigid habits - and blares the tv and radio all night! no one would tolerate that. i don't know what to do.
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Orangeblossom provided a terrific answer. Yelling is not uncommon for people with dementia. Working with a doctor and the nursing home, I think you'll find a place for her. Level with them when you talk with the administrator. Nursing homes are in the business of helping people we can no longer help all by ourselves. Good luck,
Carol
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In the NH where my Mom is, there are a few yellers and the other patients, far from being upset, just don't pay attention. I asked one of the nurses and they are only allowed to give the meds that the doctor has prescribed and nothing more, so they just have to put up with it. They must let the doctor know about the behaviors, so it's up to the doctor and perhaps the family member in charge to OK administering sedatives. From what I've witnessed the yelling does not go on continuously (usually during the 'sundown' period and around bedtime), and the other patients simply ignore it because they are not fully cognizant themselves. There is a lady that sings, and most of the 'noisemakers' are simply repetitive with a certain phrase, word, or cry. Another lady repetitively cries at night "you broke my wrist" (she is mentally 'out of it', bed bound and needs to be cleaned, dressed and fed). I know the nurses are not rough with her - I've gotten acquainted with most of them, and they seem very tolerant and patient with the residents. You definitely want her in a facility that is equipped to deal with bad behavior. Some patients that are a 'flight risk' have a special bracelet that alerts the staff if they try to get out of the facility. In Mom's NH, they are very liberal and the residents can walk all around (inside) without issue, and don't even have a 'lights out' bedtime policy - they can stay up late if they wish. I have also heard of other facilities that have what they call a "lock-down' ward for patients that are combative or abusive to other patients. So yes, I would discuss the behaviors with the staff, and I would also consult with the attending physician she gets and make sure you are always informed of what meds your Mother is receiving and that you approve of them. You may want her to get sedatives (as needed) if necessary, but not anything that would be overpowering. Hope this helps. Its good that you are doing this advance research. I just got lucky with the NH the hospital case manager recommended to me.
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