How can we control my dad's violent behavior and find a care facility that will accept him?

Soprano2007 asked...

Help! My father has vascular dementia and was moved into a memory care unit in November 2010. Just after Christmas, he became violent with both staff and other residents. He's been in the geriatric psychiatric unit of a hospital for over 3 weeks where the doctor is trying to medicate him and control the violent behavior. The medicines are not working - he is still acting out. The facility where he was placed will not take him back, and my mother is struggling to find a facility to take him. She cannot care for him on her own which is why he was placed into a facility.

What are we supposed to do?! The very places that are supposed to help are turning him away.

Expert Answer

Helene Bergman, LMSW, is a certified geriatric care manager (C-ASWCM) and owner of Elder Care Alternatives, a professional geriatric care management business in New York City. She consults with nursing homes and daycare programs to develop specialized programs for Alzheimer's patients.

Persons with dementia, whether vascular or Alzheimer's in type, may experience fear and confusion especially when they are in congregate settings. They may 'act out', as you mentioned, to protect themselves against perceived danger. When someone approaches, they may delude that they will be hurt unless they 'lash out'. They may respond negatively to peers or staff but usually there will be one (or more) staff advocates who can help. Either they know appropriate communication strategies or how to respond to the individual's unique personality requirements. This takes time and effort and usually the family are the best staff trainers. Of course, you have to have willing staff members who are open to tolerating 'anger' and 'aggression' as a patient's defenses rather than 'violence'.

If psychosocial interventions are totally ineffective, and a move to a more 'soothing' environment impossible, then pharmacological treatment is needed. Although this has been tried, it sounds as though a different drug protocol is needed and it might need to be titrated daily until your dad's angst is resolved. This also takes time and effort so I suggest you seek the best psychiatric resources in your locale, consult with your local Alzheimer's Association, and seek a Geriatric Care Manager to advocate {www.napgcm.org}. If the facility he was at no longer accepts him back, he does not belong there. It does not sound as though it was a good fit.