How much aggression is acceptable?!

[DIL]

Odd question, I know, but my MIL has worsened considerably since moving into full time residential care.

She has been there 9 weeks, and her condition has deteriorated a lot. Prior to this she was in an assessment unit for a few months. She used to slip in & out of lucidity but now can rarely converse at all, is very frail and unsteady and has become increasingly verbally aggressive to all family members when we visit, which is very upsetting.

The staff kept telling us she was just settling down, but at the 6 week review they announced that they couldn't meet her needs fully after all. She has also apparently been verbally aggressive to staff, and has upset and frightened other residents.

So, she has just moved to the dementia care with nursing unit.(same care home) and we have started another 6 week trial period. The home manager said she felt the staff there would cope better "as long as she doesn't become violent". But I'm worried this will happen. She has struck out at me during a visit recently, but we were in her bedroom and nobody saw, I managed to laugh it off (as you do!) and calm her down. And she has been wandering in the night.

My question is, really - how much will they put up with and what would happen if they do feel they can't manage her? She has been in an assessment unit previously, would it be back to there? Then what? Or would they suggest a change in meds? TBH, she already has Haliperidol & Zopiclone, after trying so many others, so I don't think there's much further to go down that route.

We have all accepted her "challenging behaviour" (lovely term) but I don't know where they will draw a line. At times I think I am asking too much of the staff, and at others wonder if it is me who isn't very patient & understanding!

 

[Vonny]

Hi DIL,

I'm sure carers are familiar with a certain amount of aggression, but as you say, when does it go beyond the bounds of the acceptable?

I don't know, but I would hope they would wheel in a consultant to look at options for your MIL. Medication will almost certainly be considered and I hope that you are consulted about any prospective change to meds.

Sorry I can't help, just wanted you to know I'm thinking of you and hoping that your fears are unfounded and that your MIL stays stable in the CH for a good time to come.

Vonny xx

 

[zoet]

Quite often carers will tolerate a certain amount of agression directed against themselves, but i must warn you that agression towards other clients is not generally tolerated beyond a couple of incidents. Some sort of review and action would be taken. This is obviously to protect vulnerable people as you will appreciate. There are strategies which help depending on the reasons for agression and the circumstances in which it is displayed. The best thing to do would be to talk to the home manager BEFORE any serious incident.

 

[Nebiroth]

My question is, really - how much will they put up with and what would happen if they do feel they can't manage her? She has been in an assessment unit previously, would it be back to there?

I think that the actual staff will be able to tolerate quite a lot short of actual violence but the home's main concern will be the other residents. There's the legal duty of care towards them and to prevent them coming to harm (which would include mental distress). There is a danger that the home could be left open to charges of neglect.

If the current strategy can't be made to work - for example, if no obvious triggers for the agression can't be found and avoided, or the behavior escalates, then I would suspect the next step would be a hospital assessment ward whilst an attempt is made to find a medication regime that works.

What happens after that depends on thr outcome of assessment and treatment. If improvement can be made, then the home would normally be willing to accept mum back, but if not then it would likely have to be something like an EMI (Elderly mentally Infirm) unit. They are secure, with a small number of residents and a higher staff/resident ratio and all the staff will be specially trained to deal with challenging behavior and if necessary a resident can be separated until they can be calmed down.

 

[Natashalou]

My mother was asked to leave her care home and admitted to a mental health unit where she remains to this day 6 months on . She is no longer as aggressive as she is heavily drugged. Not ideal , but as she had reached the stage of attacking people I can understand why .

 

[DIL]

Thanks for your replies. It is something I will have to keep an eye on.

I have asked that a consultant review her behaviour & meds.

I understand perfectly about the other residents; I'd be very concerned if somebody was upsetting her.