Should we leave him in the nursing home, or bring him home?
When someone has been getting increasingly more aggressive, threatening and has been violent on one occasion with the nurses who were trying to help him (punched them both and grabbed one by the arm and threw her down), is it possible for them to get well enough to come home and be safe around family and his caretaker?
We have been married for 41 years and he has just become increasingly threatening in the last four years. It seems he has finally crossed over the line. However he has shown huge improvement after they started Namenda 5mg, then increased to 10mg daily, increased Seroquel from 25mg, slowly to 100mg.
After being on good behavior for a week, he called me and was threatening again. Very agitated. He has threatened to kill me and the nurses, threatened to burn our house down. Said he WILL get out and do these things. How long does it usually take to find the right doses of meds? Should I bring him home when he is calm and see if it helps? I thought he might have had a reaction to Haldol. He was pretty scary when he was young and drinking.
My question is how do I know what to do when he is so good and all the nurses at nursing home like him, but doctors tell me he will only get worse and he is getting better care for all his medical problems there. Did he just finally step over the line after years of "stepping in and stepping out"? Home or stay in nursing home? He has enjoyed his care but has these outbursts and is very angry when we talk about it being permanent.
Expert Answer
It certainly sounds like your spouse has an "˜agitated dementia' but is beginning to respond to pharmacological treatment. However, as you speculated, it may take some time to identify the correct drug protocol to maintain him at a high functioning level while simultaneously controlling dangerous behavioral outbursts. Drugs like seroquel need to be titrated slowly to avoid adverse side effects and this may need to be done in a structured environment like the nursing home or a hospital. Once the correct formula is found, he may be able to return home"¦.even for a day or more.
In the interim, I offer a few suggestions. I recommend you avoid discussing the Nursing Home as a permanent residence and instead reinforce that it is temporary until your husband's physicians say he is better. Perhaps this will make him less angry. I also recommend that you attend a care plan meeting for your spouse to focus on his behavioral responses to care. Often residents with dementia will strike out when they are either confused or not ready for direct care. Caregivers need to be trained to retreat at these times and come back later to avoid resident opposition. Your participation in these meetings might help the staff to better understand how your husband might respond at specific times. Family feedback to staff can be very informative if they are open to listening.