Should we leave him in the nursing home, or bring him home?

11 answers | Last updated: Sep 14, 2017
A fellow caregiver asked...

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 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.

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.

Community Answers

Daug-in-law answered...

As his spouse, you can provide caring even from a distance. It is important that you do not over-extend yourself. I agree that you should not speak of the current arrangement as permanent, but use a 'wait and see' approach, instead of telling him that he's there forever. He is receiving professional care which he would not get at home. You are doing what is best for him and for you.

When you come and visit him, you can come more refreshed and have quality time versus him being home and tiring you out. Also, you may find that family and friends are more apt to visit in this setting.

Good luck with this decision and others that will follow.

Nccaregiver answered...

I know of similar situations about a male with agressive behavior and one with severe depression who were both moved out of a nursing home setting and into an adult day care and were able to have a better quality of life. Here is a link to their case studies. You may want to consider adult day care where the nurses are better trained to deal with behavior issues.

Annevincent answered...

This information comes at a great time for me! I came home about a year ago to take care of my mom (77) who has Alzheimer's and my dad, who is 92 and has no clue as to the depth of mama's disease! He is hard of hearing, so does not realize all the "crazy" things that are going on at home. He can see the things that she does and just cannot understand, but still thinks that she should be cleaning and cooking, etc, etc.
At any rate, my mom has become violent lately and just this week has choked me, slapped me and thrown me against the wall. My mom is a very tall, large (not fat) woman with a very strong personality, but in her real life, very loving and caring. When she was young, apparently, all the girls "fought", so I think that she is going back to those times. She tells me most every day that she is gonna knock my head off and she is getting more difficult to change her soiled clothes every day (even with pullups - I don't like to call them is humiliating for her, I thing!). We can still take her places and mostly, she is happy and loves to go, go, go, but it is getting really hard on me. She has fell twice - one just this past weekend and another time about 4 months ago where she broke her shoulder! She looks good and people that just see her briefly think that she is doing well, but she turns very aggressive at night (they have tried to give her meds to help her sleep - no good) and also in the morning. I know to walk off and leave her and come back, but I cannot leave her laying in a urine soaked bed or in urine soaked clothes because she is inclined to have serious urinary tract infections! She is on Namenda and has been for a very long time. I am just not sure what to do. Many homes will not take people with violent tendencies - especially here in the small town where they live. And...I feel that I can care for her, but not sure how much longer before she hurts me - she seems to only lash out at me or my sister if she stays over to give me a break. My mom has no clue that there is anything wrong with is heartbreaking and I am at a loss....... So, that is my input......any suggestions??? Kindest regards!

Frena answered...

i would suggest you get a further diagnosis.

a person can have dementia but can also have a mental illness, such as a psychosis or paranoid illness, or can be acting out PTSD issues (common both those who have served in wars and in those sexually abused as children).

continual and wild aggressive behavior, emotional turmoil at night and making plans to kill people is NOT a sign of dementia, especially since people with dementia are brain-incapable of making logical memory-based plans.

there is something else also going on here, and a more accurate oir additional diagnosis will help get truly helpful medication that may bring peace to very troubled minds.

unfortunately, in our current medical thinking, we have demonized dementia illnesses so much that people with dementia are assumed to be capable of any degree of crazed behavior but it's just not so.

i've worked with dementia for over 20 years and these extreme violence situations are connected to mental illness issues. and, yes, a person could have a double diagnosis, it's true -- dementia AND mental illness.

sometimes, it can actually also or instead be linked to adverse response to medication issues. either way, to get the help needed to be able to make the best care decisions, further diagnosis is needed here. that way, perhaps everyone can get help so future care needs can be more accurately designed.

psychiatric examination and medication review is a good start for figuring out what's going on here. do try for that. it will be worth it. get a referral from the doctor and follow it through. it's all cpovered by medicare or VA benefits.

Mom's sweetie answered...

If the agression is tied to hallucinations or paranoia, try depakote. This has really helped 99% of my mother's aggression after trying seroquel, zyprexa, addavan (yikes on that one--terrible--she no longer uses namenda--she is in a moderate servere stage (can walk and feed herself, but incontinent, cannot dress or clean herself or brush her hair and communication is jumbled--doesn't know most family members now).

Plumkrazzy answered...

My father has Alzheimers and Diabetes so finding the right meds were a trial and tribulation. I also have my father on Namenda and while trying to figure out the right combintion and doses of meds, realized that I should read those papers that the pharmacy hands out when I filled the prscriptions. When Seroquel was prescribed, it turns out the side effects were not for him. Even when I asked the pharmacist about the side effects, they only read the first page! A more extensive list was on the second page. It took us about a year to get the right combination of Medication to keep him more calm and sleep all night. He would sometimes be awake 3 days and nights, there by keeping us awake with him. Needless to say, it was a challenge. Some meds had side effcts of sleep walking, hallucinations, bed wetting, aggitation, suicidal tendancies, erections and so on. I now read those papers thoroughly before I purchase the medications, because I know that neither the doctor of pharmacist won't take the time to read ALL of them. Unfortunately for us we were dumb enough to trust them and purchase the meds first then read the papers, so we lost our money and drugs are NOT returnable. Money down the drain. Have faith! If you have the strength and will to work it out, it will happen. And read everything!

Frena answered...

it's possible your mother is one of the roughly 10% of alzheimer's folks who is genuinely incontinent, but more usually the apparent incontinence is due to a) not remembering where a bathroom is and or b) no longer recognising what certain body feelings mean.

a bathroom schedule can save a lot of trouble. getting the person to the bathroom say every hour and a half can actually solve the problem. plus working with natural elimination patterns of the person.

if someone is living in a care home, then the care conference should address this issue and relatives should ask that an active bathroom schedule is put into action.

Dear one of mort answered...

With Alzheimer's you do not have a year to regulate her medication for aggression. The disease also is changing and her responses to medication could change. In my opinion, it would not be safe to have her at home. If you are the only caregiver and you are disabled, she could very well hurt herself and even kill you.

Gail99 answered...

I was in your place a year ago. Today my Dad is back home, with help of a home health care aid. Today he rarely gets agitated maybe twice a month and if we back off and give him space he calms down. He was hosptalized twice to evaluate his medication. The second hospital was Rush in Chicago and they told us he could go home once his medications were working correctly. They really taught us about the disease and showed us medicating an alzheimers patient is not a one pill fits all patients, everyone is different. I would take him to a professional geriatic Doctor from a reputable hospital for treatment.

Daug-in-law answered...

To Gail99.

When you say your Dad is home... do you mean in your home? And you are hale and hearty and have others around?

The original question was regarding bringing him home to be looked after by his spouse - who I suspect is older (41 years of marriage) and weaker than him, without others in the household, which could be very dangerous.