My Mum's gone violent in Care Home move

[gabriel]

Just as we thought we were getting ahead, finally getting mum out of the assessment ward, a violent episode happened last night at the care home where she has been for 5 days. This is not the first time. When she was first put into a dementia care home two months ago, she attacked the staff and did damage to them and the furniture. That's why she was sent to assessment. She has been moved now 5 times since leaving her home at 3:30 am in her nightclothes two months ago. We thought they had it all figured out now with the psychotic drug to calm her down.

I know all mum wanted was to be left in her own home, which due to a next of kin's eagerness to get her into a care home, has now been emptied of all her possessions and notice given.

I dread the thought of mum being sent to a mental hospital; the care home said they cannot have their staff attacked. I agree with this. My only hope would be to make a home with mum myself, but I don't know who to approach with this. The consultant will not speak directly to me and did not answer my last letter, and saw me this morning as he left the care home (who had called him out in an emergency), but walked right on by. I feel so shut out. There are episodes of wandering at night and not wanting to go to bed until 12 which is normal for her anyway. But the violence is a big problem.

Does anyone have any experience of violence whilst caring for a family member in the home? I just want to do what is best for her, and not go by my own emotions by wanting to care for her.
Gabriel

 

[Grannie G]

Yours is a very sad story Gabriel because there will always be `if only` and `what if` on your mind, and you`ll never know.

You mum might have wanted to be in her own home but does she have the capacity to make that decision. Could you put your hand on your heart and honestly say she would not be at risk living by herself, no matter what care package was put in place.

If she is violent towards staff in the care home, would she be as likely to be just as violent to visiting carers?

I don`t know the answer and I don`t know your mother but I`m very dismissive of a consultant who walks on the other side.

 

[TinaT]

I may be wrong but I got the sense from your post that there is some conflict between relatives in the background. Could this be the reason why the Consultant walked past you, or could it have an even more simple explanation that you were not recognised as a relative?

I know the feelings of panic and helplessness and can see you feel this yourself at this present time. I would say that the care home are being rather quick to say they cannot manage your mum's behaviour. A few days is nothing in the time it can take for someone to settle. Your mum has been through such a stressful time and this could also be contributiong to her violence. To be frightened, confused and not know what is happening to your life is quite enough excuse for this behaviour.

I would have to think long before I took on the committment of bringing her to live with you. It needs a lot of planning, vast changes in your own personal life and of those you may live with. Also this total caring role could be for a very long time into your future.

Have you spoken to the care home manager and asked what they can offer in the way of managing your mother's behaviour? Has the care home manager not encountered this type of settling in problem before? If so how was it managed?

To just ship her off back to a hospital doesn't seem to me as though the care home has made every effort to make sure she won't settle with initial care and attention.

You do need to contact the Consultant and ask if there is medication which could also help in this initial settling in perod.

xxTinaT

 

[EllieS]

Hope this helps Gabriel.............

In my experience it is not unusual for someone like your Mum to take some time to "settle" (probably better terminology would be "to become institutionalised"). It is very common for AD sufferers to become agitated/angry/want to go home in the evenings. My Mum has done so for the last 4 years and at times has kicked/hit nurses and banged upon other residents doors. Of course, this is not good, but she can't help it anymore than your Mum can.

There were times when Mum's GP advised the Home to give Mum sedative to help prevent it from getting out of control. Because, clearly if the Staff are not able to diffuse these conflicts there is the horrid possibility that she could have been sectioned - which I always wanted to avoid.

However, Mum's Doctor now avoids such drugs whenever possible and it really seems to depend on which staff are on duty - some are very short with the residents others are very understanding and get Mum a cup of tea and let her sit up late.

There is hope. Is the Home a Nursing Home? Are the carers dementia trained.

I doubt if the Doctor recognised you - but there's absolutely no reason you can't ask his Secretary to get him to call you when he has a minute. I have found in the past that Mum's Consultant (when she had one) was really helpful. Mum's GP as I say, is also really helpful. It sometimes seems as if the world hates you and is against you but it's not always the case. Stay calm, talk with the Manager of the Home and your Mum's GP and hopefully you WILL be able to overcome this problem.
Get to know the night duty staff - . Thinking of you.
Gotta get home now - still at work!
Take Care
Ellie

 

[DIL]

You poor thing. I do feel the home are being a bit dismissive, but perhaps they had been assured by the assessment unit that your Mum was more stable than she is?

I would talk to them further about exploring ways in which they could help. We have had difficult times with Mum in Law too, such anger , aggression and violence, and her consultant eventually called in the Community Psychiatric Team, who visited her daily in the care home for a spell, to observe and monitor her, to suggest changes in meds and strategies for the staff. Moving is so disruptive and upsetting, so they have tried to sort it out without doing that (again). I suppose whether such services are available to her depends on the health authority where you live, but I would ask the question. Also, be aware that there are many types of anti-psychotic medication, it may be that the current one isn't suitable and a different one may be better.

I totally understand your feelings of helplessness and wanting to do everything you can, but it really does sound to me that it would be very difficult for you to cope with your Mum at home, if professional carers are struggling. You would have to be very confident that you could take that on. Some people do, but I personally don't think I could.

You do sound as though you at least need to talk all of this through and be properly involved in the decisions regarding your Mum's care. Request a face to face meeting with the manager of the care home, to find out what is being done. Was there a social worker or someone involved in the placement of your mum in this current home? I would talk to them too.

Five days isn't very long though; your mum is still adjusting and settling. I do hope things calm down for you & her.

 

[gabriel]

You are all very kind in comforting me. My mum is in a dimentia EMI unit. I have talked to PALS today, who already have some of her history and now have her consultant's name and the care home address. They also have suggested that I speak to the care home manager and to ask what other things they might try to help mum settle. My poor mum I feel like I have abandoned her, especially when she says "don't leave me here with all these people". My heart breaks in two.

If only they can manage her behaviour, the care home is good and the staff I have met are very kind. My mum said today that there is no joy in her and nothing is "together right". She cannot make people smile anymore.

The care home manager was to call me back today but I haven't heard yet, then was out when I called. I will phone tomorrow morning and ask to have a talk about what plan they have. I read their guidance book today and it says there is a 2 month trial, or less depending on each situation. The news that I have had up until now from night staff is that mum is settling extraordinarily well, that is until this happened.
Gabriel

 

[gabriel]

It is very common for AD sufferers to become agitated/angry/want to go home in the evenings. My Mum has done so for the last 4 years and at times has kicked/hit nurses and banged upon other residents doors. Of course, this is not good, but she can't help it anymore than your Mum can.

There were times when Mum's GP advised the Home to give Mum sedative to help prevent it from getting out of control. Because, clearly if the Staff are not able to diffuse these conflicts there is the horrid possibility that she could have been sectioned - which I always wanted to avoid.

This is helpful to know that a care home should be able to manage violent behaviour. Mum was throwing chairs around and trying to break the glass of the fire escape door, as well as injuring 3 staff. I hope this is so here.

My mum is anxious about the "baby" or "babies" she left at home and last night said the baby was dead. This thinking is stuck in her mind and has been ever since she was taken in. Her anxiety is also about not being able to care for whom she is responsible for.
Gabriel

 

[Sandy]

Hi Gabriel,

My mum is anxious about the "baby" or "babies" she left at home and last night said the baby was dead. This thinking is stuck in her mind and has been ever since she was taken in. Her anxiety is also about not being able to care for whom she is responsible for.
Gabriel

I don't know if you've ever heard of "doll therapy" but it has been used to give comfort and meaning to the lives of some people with dementia.

There is a good article on this and it involves Merevale House, which I think was the home used as an example of excellent care in Gerry's Robinson's documentary:

http://www.dementiacarematters.com/dolltherapy_print.htm

Perhaps this could offer some comfort/reassurance to your mum?

I hope that your mother is able to settle. Even homes registered to take people with dementia have to decide if they can meet their residents' needs. Sadly, not all homes can cope with extreme or violent behaviour whilst keeping their other residents and staff safe.

At least it sounds as if the home is working closely with your mum's medical team to support her through this transition period.

Take care,

 

[gabriel]

Sandy, thank you for the information, I am going to print it off and read it tonight. The doll therapy you brought up is interesting. At the first dementia assessment hospital mum was in (out of town, no local beds), they gave her a rather large doll, so they must have had that therapy there.

The care home manager and the consultant have got together and have put her on the highest dose of haloperidol to start, to stop her attacking people, though she has only done it once. However they are not willing to risk it again. Then they will gradually bring it down. Also, in the meantime, are going to give her diazepam if she gets violent whilst this drug is taking effect. She is suffering from hallucinations which are frightening her, so in the end have to go along with what they are doing. I will see if they have a doll there at the home, or go and get one. Thanks for the link.
Gabriel

 

[NewKid]

Thinking of you

Hello again - haven't been on for a while/ caught up with how things were progressing for you and your dear Mum - or not. Feeing very very sad now for both you and your Mum, as it is heartbreaking to think of your Mum seeming so anxious to get back home and to those she cares about. I am sure you must be very upset and worried.

The doll therapy sounds interesting - there is so much theory out there about what can work/ comfort and attempts to understand and help the dementia sufferer. But how tuned in are the average EMI homes/ everyday carers? I do wonder? Kindness, distraction techniques, right drugs (ugh) ... etc but really getting in tune with the illness and the individual's reactions? Not sure?

So many moves in so short a time - this would surely justify your Mum feeling wretched, and frightened, angry? I do hope that you can work with all involved and find some peace too. (My Mum was aggressive too.. 6 months ago ... she is now considered 'abrupt' - is this 'progress' but sometimes also very sweet and accepting ... I conclude institutionalised. It's not easy. Thinking of you.)

 

[gabriel]

Hello NewKid

(My Mum was aggressive too.. 6 months ago ...

I was wondering if she just naturally stopped being aggressive?

Mum can also be quite lovely company. Yesterday though she was hallucinating and very frightened. It is that I don't know if it is the dementia or the drugs or the unfamiliar surroundings. She thinks she is just visiting for the day at the home. Today she was lovely when I was with her, quite alert and making jokes.

I asked the manager if they found what was triggering her behaviour, but she said you can't always tell, but I do wonder if they bother. Anyway they are trying to keep her at the home rather than move her to ? I don't know what would be next and hate to think of it. When you look at your mother and she is so innocent of what is happening, all the different drugs that she is being given, and not able to have a say in it, it is quite sad.
Gabriel

 

[TinaT]

There are much better and more modern drugs than haloperidal.

It can lead quite quickly to drooling, a very drugged up appearance, falls and stooped shoulders. My husband was on this drug for a while but the Consultant quickly changed to a more modern drug. He still has to have a cocktail of drugs to calm him down but at least I know they are being monitored weekly by the CPN. I would ask for a more modern drug with less serious side effects for your mum.

I'm sorry to add to your worries but I do feel that haloperidal is not a drug which needs to be given nowadays.

xxTinaT

 

[alfjess]

have got together and have put her on the highest dose of haloperidol to start,
Gabriel

Hi Gabriel

Haloperidol frightens the life out of me, especially mixed with diazepam and other drugs.

My Mum was on this cocktail in hospital, because of agitation and taking her clothes of. (agitation? drugs??)

Don't want to scare you, but Mum ended up comatose and that was after all the listing, any which way.
At one point she was bent over from the waist and this was a side effect of Haloperidol.

Mum was transferred to a NHS continuing care facility where they weaned her of Haloperidol, as fast as they could.

When of this drug, she started walking again and could feed herself, sometimes she knew me, but unfortunately, always remained incontinent, which she wasn't before being admitted to that hospital ward.

Please remain vigilant while your Mum is taking this drug and if at anytime, you feel that things aren't right, ask for it to be stopped

Sorry I hate this drug for what I think it did to my Mum, but I am no expert, maybe it helps others

Take care
Alfjess

 

[gabriel]

Hi Tina,

Mum has just been taken off risperidone, and to be frank I am quite worried about this haloperidol drug. The point is whenever I brought up my concerns about the risperidone, with the assessment ward manager and the consultant, I was quickly told that it was the best thing for her.

The consultant has not returned my last phone call about the risperidone, and now I'm faced with calling again about the haloperidol. I will contact the consultant again tomorrow. I don't feel I stand a chance and I wouldn't know what else to suggest either.
Gabriel

 

[mowood]

While my mum was in hospital she became 'disruptive' at night (according to the nursing staff) and one night they gave her Haloperidol. The next day when I went in to see her I thought she'd had a stroke. She was drooling and slurring her words and she couldn't find her mouth with a cup. When I looked at her records and found out what they'd given her, I hit the roof and demanded that they NEVER give it to her again. They never did. I had already told them that I would go in at any time day or night to look after my mum if they couldn't manage.

Please be vigilant and ask questions if you're feeling something's not quite right. Keep on asking until you understand their reasoning and don't be intimidated by them.

I hope things improve. x

 

[gabriel]

I saw my mum today at the care home and she was like a zombie and her hair a mess and her blouse on backwards, slurring her words. I'm afraid it all became a bit too much for me and I called the consultant, spoke to secretary, told care home manager I did not intend to put up with my mum in that condition, then broke down.

Care home manager said Mum was out in the garden last night with no clothes on, that this morning at 7:30 she had thrown furniture, torn up papers and broken dishes. She'd had no sleep last night either. They had given her diazipam to calm her, on top of the haloperidol she had last night. The consultant did not call me back but called the manager, I was there when he called. Basically the care home (dementia EMI unit) will not keep her in her condition, want her to go back for further assessment to get rid of psychotic state. The consultant doesn't want to move her, says after 5 moves since Dec 20th. another one would be wrong. He is sticking by the Haloperidol, says it works, and she is on the lowest dose (contrary to what the manager said to me). Mum is seeing babies dying and dead outdoors, and anything or anyone that gets in her way to rescue them gets it. She threw a chair at the window to get to them.

So, after many tears and pleadings about the drug, the consultant telling me they were after the best for Mum, I could not take it any longer. After years of caring for mum, and abuse from family member for doing so, to the point of cannot say one word without a comeback, I have decided to let them get on with what they are doing and go and have a rest for 2 weeks.

Gabriel

 

[Winnie Kjaer]

I am so so sorry to read about your dilemma, No advise but lots and lots of hugs (((((( ))))))
This is such a sad situation for you all.

 

[Goingitalone]

From a newbie

Oh, Gabriel,

How I feel for you, Love. I have a brother with schizophrenia who has been on Haloperidol and Respiridone and I do know of the side effects of both. In some cases they do seem to work. I think the trick is to find the smallest dose which will relieve the symptoms, so minimising the side effects.
My Mum has just been diagnosed with dementia and I know I may have all this to come. I would reiterate what others have said about not being intimidated by the 'authorities.' It sounds as though your Mum relates to you and tells you what she is thinking. Yes, have some time off to give yourself some space to get your peace of mind back. You need that just now. Then spend as much time as you reasonably can with her. Maybe she will settle if she is reassured that you will continue to visit.
As for the doll therapy, my Mum has a toy dog which she thinks is real and it does seem to give her real comfort. Maybe a doll with eyes which open and close would distract her from the babies she sees outside and would give her something to be comforting and gentle with.

You are in my thoughts,

Maggie

 

[Grannie G]

Try to have your rest Gabriel and then check how your mum is on the prescribed drug.
I hope the doctor is well aware of the side effects of the medication he insists is the best for your mother at this stage and she will be monitored carefully.

 

[Margaret W]

You clearly need a break, so take it, and don't feel guilty, just have a rest and get your strength back. You are not superhuman, and why should you be?

Perhaps by the end of your break, the drugs will have kicked in and mum might be more content.

This business with the dead babies bothers me. I read something a few months ago that intimated that the hallucinations etc that dementia sufferers have are all connected to something that really happened in their past. They should not be just dismissed as completely imaginary. So maybe at some point your mum experienced the death of a baby - maybe not hers, it could have been a neighbour's baby and was never mentioned by her before, but the memory has just come back. My mum used to say that my dad had brought two men and a woman to their house (in 2008), and I scoffed at it, but my much older cousin remembers my dad inviting two work colleagues (brothers she thinks) and the wife of one of them to Chrismas Dinner, cos dad had just killed a nice fat chicken and his two colleagues had nothing to eat for Christmas Day. Maybe that was the cause of mum's recollection. I guess it was. But I didn't learn that until after she died.

Have your break Gabriel, and let us know what happens later.

Love

Margaret