My Alzheimer's mom is abusive - is it time for a nursing home?

Nickij asked...

I am the caregiver of my 94 yo mother who has Alzheimer's.She has been with me and my family for the past 5 years. I am also her power of attorney.In the last few weeks she has gotten progressively worse. She is verbally and physically abusive. She is starting to wonder. She does not always realize where she is. She is also sun downing now.I am torn between a nursing home and bringing someone into my home. I have five children and I am now leaning towards a nursing home as she is abusive to my younger kids(6 and 13yo).She is yelling and screaming most of the night so even with someone in the house we would still be awaken.

I don't know how to start this process. Can I take her to the hospital and ask for a 72 hour hold? Can ask her primary care doc to have her admitted for a mental status change? My mother has a $3100.00/month income with her retirement and social security. She has a house and property. Will we have to sell it if we put her in a home? We live in Washington, DC. We are now at our wits' end and I have no idea where to start. I do not want her to hurt us or herself. Please advise.

Expert Answer

Mikol Davis, PhD has worked in community hospitals with geriatric patients suffering from dementia, depression, and other psychiatric problems. He has a doctorate in Psychology from the University of San Francisco and has been in private practice in Marin County, California. Davis co-founded with his wife, Carolyn Rosenblatt.

You have several questions, so let's start with the one which asks if you should move mom, an Alzheimer's patient from your house to a nursing home. The most important consideration you raised is that she is abusive to you and to your kids. This is a very valid reason to place her in a nursing home. Though nursing homes have sometimes gotten a bad rap, it is important to recognize that they have licensed and presumably skilled staff in place 24/7 to deal with the issues you describe.
However, it is important to remember that they have to cope with her behavior problems also, and I urge you to get a medical evaluation from a gero-psychiatrist or a neurologist to determine whether any new strategies, including medications can help with her abusive conduct. There is also research which suggests that good and consistent behavioral approaches to managing this kind of conduct do work and can be put in place in a nursing home more readily than at home because they have staff around the clock.
The next step is to do your research. If you think your mom qualifies for Medicaid, you will need the advice of an elder law attorney who knows this area of the law in your state to advise you. If you think she can qualify in the future, perhaps after property is transferred or sold, you still need expert legal advice to make this happen. If she does not qualify, people generally sell property to move the family member toward qualifying for Medicaid. Otherwise, you pay out of pocket unless she has long term care insurance. (Most people don't).

The next move on your part is to research nursing homes in the area that specialize in handling residents with Alzheimer's Disease and other dementias. Look for "memory care" in the description of what the facility has to offer. Visit unannounced. Talk to other family members who have residents in a facility you are considering. Decide based on what seems to offer mom the most protection and care that she can afford.

Another important factor to look at is your sense of guilt. It happens to almost everyone who has to place a loved one in a care facility. It's not ideal, but neither is having Alzheimer's. No one can help what has happened, but you can help what you are doing about it and how you relieve yourself and your family of a burden that may be beyond your ability to safely manage at home. Not everyone can deal with the burden and the stress, and it's okay if you can't keep her at home. What you can do is to monitor her every day by visiting, watching over her to see that she remains safe, attend meetings about her care, demand accountability from all staff in a polite way and stay in communication with her doctor.

It is not likely that if you take her to a hospital and ask for a 72 hour hold that they will do this. She is not "mentally ill". Rather, she has a progressive illness that affects her behavior, and it has a physical cause. If you are leaning toward a nursing home, listen to your own wisdom in making that decision. It's perfectly okay and appropriate to make a decision based on what is good for you and for your whole family. Five years is a long time to be a primary caregiver. Follow your leanings and do all you can to keep watching over your mom. You are a loving daughter. Placing her does not take away from that at all.