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

8 answers | Last updated: Oct 08, 2016
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 Answers

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 {}. 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.

SEE ALSO: Find Memory Care Near You

Community Answers

A fellow caregiver answered...

I was in a similar situation with my Dad two years ago and it was horrifying. Imagine having responsibility for someone with dementia who is combative and no facility will accept him. You can't really blame the facilities - they have to protect their staff. But the lack of helpfulness for this type of patient is shocking considering that it's not that unusual a behavior in dementia. My Dad went from a hospital where the social worker immediately pressured us to find him a suitable facility upon discharge, but provided no help except to hand us a list of facilities and say "good luck". When we contacted these "recommended" facilities, they wouldn't even consider accepting my Dad because of his reputation for being combative. We finally found a nursing home which reluctantly accepted him, only to be kicked out after 5 days to an ER, the very worst place to send someone who has dementia and is combative. Again the hospital social worker gave us a list of facilities and a "good luck". From there my Dad went to another emergency room where the social worker finally got my Dad on the waiting list for the only geriatic psych facility in the entire state: 15 beds. My Dad was in the psych holding unit of the ER for 24 hours in a bare room with a CNA watching him outside his door, it was horrific. When he was finally accepted at the Geri Psych Hospital, their social worker immediately began asking us where we would be placing my Dad on discharge, but giving us no options. This was a nightmare and the worst time of my life. My Dad was almost committed to the State Hospital -- the Geri Psych Hospital told us "it's not so bad" and yet the State closed this facility down just a few months later because it had multitudes of violations. I did contact a Geriatic Case Worker but she wasn't helpful, I had more information and knowledge about placement for people such as my Dad than she did, and she actually referred us so to some of the very agencies who rejected my Dad. Our salvation came when I contacted an elder care placement service. This fellow convinced me to place my Dad in an adult foster care home. He found a caregiver/owner who actually specializes in combative dementia ("she loves a challenge") and my Dad was saved. Adult Foster Care is the way to go if you have that option. She gave him the best quality of life he could have. My family will forever be grateful. There has simply got to be a better answer for our loved ones in this situation than to be in a scene out of One Flew Over the Cuckoo's Nest.

Swizzles answered...

I am having the same problem with my mother. The place where she has been for 20 years wants to throw her away. They have ostracized her and do nothing for her! They also have made a huge number of medical mistakes that almost killed her. I don't know what to do!

A fellow caregiver answered...

My dad has the same problem but I am lucky as he is in a good home I suggest looking for a medical care home that can deal with dementia and deal with accordingly .. My dad has just started lashing out at other people and staff they had originally gave him a calming tablet now they have changed it to diazapan twice a day to keep him more relaxed as the lashing out is a form of self defence which comes from the dementia and it's helping!!!

A fellow caregiver answered...

Thank you all posters for this info, this is exactly what I needed!

My mom is starting with aggressive dangerous behavior! It was difficult to convince her to go to a proper doctor, so I found a Mobile Doctor who started giving her the "incorrect" medications. Not only did her behavior continue, It caused her to start wandering, and her face started turning flush red. She got so out of hand I called an ambulance to take her to the hospital which they put her on a 51/50 hold which was good a good thing. They stated because she's wandering and being difficult, she could walk out and refuse treatment and there's nothing they could do. It's against the law to hold someone against their will. So since she is a danger to herself and others they felt it best to put her on the hold. While there they gave her the "Correct" medication which is Diazapan! Fingers crossed it continues to be effective. And if it continues I know I can now look for an Adult Foster Care who specialized in combative dementia!

Thanx again, I've been at my wits end!

A fellow caregiver answered...

We have a similar situation with my mother who has dementia, and demonstrated "aggressive" behavior in a nursing facility. She was transferred to a hospital, and after receiving pharmaceutical treatment was given clearance to go back to the SNF. However the administration at the SNF refused to take her back even though they were supposed to hold her bed for 7 days. I agree with Ms Bergman, that if they didn't want to accept my mother back, it means that they are not the right answer. I would love to find more information about adult foster care specializing in combative dementia. Is there a website or any other source of information about it? Would appreciate any response.

Lucy83 answered...

There are no resources to help with a family member with Alzheimer's OE dementia who is combative, delusional or hallucinating. I am appalled by article after article or blogs like this one that fails to address the issue. As a caregiver I feel left on my own

A fellow caregiver answered...

It was very heartbreaking to hear your situations. I wanted to share my story for you to see the other side of the situation. My elderly father had surgery and my biggest fear was he wouldn't survive the surgery or the recovery (he did - thank you God!!) but I never thought the most dangerous thing was the elderly man in the room across from him. This man went to the hospital and then his nursing home refused to take him back because of his violent tendencies. This man has punched and hit nurses and other patients. My father is trying to recover and scared to death of this man. The health care system has to come together to figure out solutions where your family members can be cared for and others can be safe. There have been some startling stories about elderly patients killing other elderly patients. I am so sorry that this is your situation. But my father has a right to be safe as well.