What can we do if my aunt is about to be kicked out of her nursing home due to anger issues?

A fellow caregiver asked...

I am the caregiver for my aunt who is 71 years old. When she was well she had a very hyper, high-strung personality. She had a stroke in January and was left with brain damage and paralyzed on the left side. She is currently in a nursing home. I've been told that she will not regain any use of her arm, but she has made some progress with her leg. She has taken some steps with the use of a leg brace, but still cannot walk.

In the last two months her cognitive skills have steadily gone downhill. She can't remember what you told her 5 minutes ago, but can remember something that happened years ago. I did some research and spoke with the doctor. It appears she is suffering from vascular dementia. She has had many anxiety attacks since her stroke. Unfortunately, they've gotten worse in the last month or so. She speaks with a psychologist two days a week and a psychiatrist who has seen her several times prescribed medication to try to calm her down, but to no avail. She has become very abusive and spends her day in the community room yelling for the nurse every minute. She is upsetting the other patients and getting into confrontations with them. The nursing home suggested that I hire an aide to sit with her during the day until she goes to bed so that she has one-on-one attention. This has not done any good. She was fine for a few days, but as soon as the aide did not do what she wanted, she became abusive. Since then I've been contacted by the agency and told that they would not be sending anyone else to to care for her. They are concerned about the safety of their employees. They've told me that my aunt has thrown cups of water at them, spit at them and been very abusive.

Yesterday the nursing home contacted me and told me that she is out of control and they are concerned that she may hurt someone or herself.She has thrown herself out of the wheelchair and sleeps in a low bed, and at one point, on a mattress on the floor because she kept throwing herself out of the bed. They want to transfer her to a geriatric-psychiatric unit at a local hospital for two weeks to try to adjust her medication and get her under control.

I feel so helpless and making all of these decisions is creating such stress on me. I retired from my job in April, 2007 and was looking forward to enjoying my free time and my two year old grandson. Instead, I'm dealing with my aunt's health issues and her constant phone calls. She has called up to 20 times a day to the point where I've not answered the phone. Is this a normal procedure for a patient with her problems or is there another alternative? Anything you can tell me would really be appreciated.

Expert Answer

Kenneth Robbins, M.D., is a senior medical editor of Caring.com. He is board certified in psychiatry and internal medicine, has a master's in public health from the University of Michigan, and is a clinical professor of psychiatry at the University of Wisconsin-Madison. His current clinical practice focuses primarily on geriatrics. He has written and contributed to many articles and is frequently invited to speak on psychiatric topics, such as psychiatry and the law, depression, anxiety, dementia, and suicide risk and prevention.

I am very sorry you are having to deal with this very difficult problem. Unfortunately, it is very common that as dementia progresses, people become frightened and confused and this leads to aggressive behaviors. In your aunt's case, her long history of anxiety may be further exacerbating the problem.

Your aunt has displayed anger problems in the nursing home and that led to their recommendation she be evaluated in the hospital on a geriatric psychiatry unit. Given the problems she has had, I would encourage you to follow that recommendation. In the hospital, her doctors could look to see if she has a medical problem that is playing a role in her difficult behaviors, or whether she might be on a medication that is making things worse. It is very common for such medical issues to exacerbate behavior problems associated with dementia. If that is not the case, there are a variety of psychiatric medications that could be helpful to her. These include antidepressants, mood-stabilizers and antipsychotic medications. I would generally suggest avoiding benzodiapepines, medications prescribed for anxiety, because of the memory problems associated with them. Each of the medication types have their potential risks and benefits and the doctors can help you make decisions in your aunt's best interest. In the hospital medication could be started and adjusted more aggresively than at the nursing home because she will be seen regularly by both doctors and nurses who will be able to carefully monitor her response. It is likely by the end of such a hospitalization her behavior will be significantly improved and she will be able to return to the nursing home in a much safer and more comfortable condition.

In terms of the phone calls your aunt has been making to you, I would strongly encourage you to set limits. If she is in the later stages of dementia, she is not likely able to remember what you said or even that you spoke to each other. This leads to her calling over and over, never seeming to be satisfied. I would suggest that you establish a definite time you will speak to her, and the staff at the nursing home or the hospital remind her of that when she asks to call you. It would likely be best if it is the same time each day, so she can hopefully adjust to it. If she has a phone of her own, this may be a time to take that from her.

I hope the staff at the nursing home and perhaps at the hospital can improve your aunt's quality of life and you can rest more easily.