Urgent advice needed please re aggression in NH

Rosie Webros

Registered User
May 8, 2013
181
Morning everyone. I have a real issue at the moment, my sister has just got off the phone really upset. My dad has been in a nursing home for about four months and has settled in well. First let me say it is a really lovely home, all the staff are so nice and kind. We have no problems at all with the home.

There is a resident in the home who has issues with aggression. When my dad first went in the home they phoned us up to say that this resident had had a set to with dad, but it was not too bad. The resident walks around a lot and he usually has a care worker with him. He is a lovely man and very often I have a chat to him, he always likes to be doing something, they usually give him a little job to do. However, when my sister went to see dad yesterday, just as my sister was leaving, the resident grabbed my sister in a head lock and punched her in the face! My niece managed to grab his arm and pull him off her, but it hurt my sister. He is a very big, strong man. The care workers came running over and the nurse on duty took my sister into the office and she had to fill in a form. They were nice to her and offered her pain killers (her neck was very red).

It has really shook my sister up, and she is scared to go again. I am also scared to go. I had planned a visit today. We go nearly every day and see dad so I don't want to stop going just because of this, but I am scared. I am not blaming the resident, I know it is only the disease and as I say he is a lovely man.

The home tried to ring my sister last night, but her daughter had taken her out because she was shook up. Whether they will ring her today, we shall have to see.

Has anyone got any advice on what to do next?

Thank you everyone, and I hope you all have a good day. Rosie xx
 

Witzend

Registered User
Aug 29, 2007
4,291
SW London
Oh, Lord, Rosie, how scary for your sister - no wonder you're nervous of visiting. And what a problem for the CH, too- what do they do? Have him moved somewhere else, where (presumably) it's only going to happen again? Drug him? Even if he has someone with him all the time, if he's a 'big strong man' I should think it'd need to be someone even bigger and stronger to restrain him if necessary. This sort of thing must be such a worry all round, inc. for relatives of all the residents (if they hear about it).

I don't see that there can be any easy answers for someone who's going to be unpredictably lashing out like this. Presumably they know he's liable to do it, that's why there's usually somebody with him. Even if you moved your dad, which would anyway be such a shame, I suppose there's a chance that something of the sort could happen elsewhere. For a while there was a man in my mother's CH (also physically pretty fit) who could often be very aggressive, sweeping all his food off the table, chucking chairs about in a rage, etc. , this despite his wife being with him much of the time. Poor thing, I used to feel so sorry for her - even she couldn't calm him and I used to wonder what on earth she'd been through before he moved to the CH.

I must say I was concerned for the other residents, some of whom are always very frail - even if they weren't physically hurt it was frightening for them. I used to wonder how long the CH could cope with him - in fact he died very suddenly of a heart attack after only a few months. And I couldn't help thinking it was probably the kindest thing for him, rather than moving him somewhere probably not as nice, or drugging him into zombiedom.

Sorry, not much help, I know, but I don't know what to suggest if he remains there, except trying to keep out of his way when you visit, but I know that in practice this just wouldn't always be possible. Presumably the CH will tell you how they're planning to 'manage' him in future, but as I said, I don't suppose there are any easy answers.
 

Butter

Registered User
Jan 19, 2012
6,738
NeverNeverLand
There are clear rules about this. Such a resident should not be unsupervised for one second. When people are very disturbed - and that is not unusual - their care needs have to be addressed to the letter. There are times when people need two people looking after them AT ALL TIMES. And the GP or emergency services must be called in and the patient re-assessed.

When my father was assaulted when visiting my mother - the other resident and my mother had been fighting - extra staff were brought in until the lady was moved to care with higher levels of supervision.

I would go straight to the CH manager and I would get your sister to write a record of what happened. And if there is ever such an event again I would call 999. And I would tell the manager that is what you will do.
 

jaymor

Volunteer Moderator
Jul 14, 2006
12,812
England
Is it possible from now on your visits take place in your Dad's bedroom. I can fully understand your fears and I am sure the care home understand too. I would ask that when you are ready to go someone comes to the bedroom and escorts you to the exit. They can't allow fear to stop you visiting.

These things will happen when someone is really agitated and as you say they have no control over their actions. It is dementia in charge now.

Hope it gets sorted and your Sister is ok,

Jay
 

Saffie

Registered User
Mar 26, 2011
22,506
Near Southampton
I don't think you should stop going, even for a day, at all and neither should your sister. This is not your father's fault so why shuld he suffer?

There are procedures that can be followed and the nursing home should do so.
Witzend mentioned 'drugging', I think probably in a negative way, but in fact, there are drugs that can help with aggression and paranoia etc. As it is a nursing home as opposed to a residential one, they must have met such an occurrance before so will have some idea of what to do. I would hope so anyway.
I would speak to the manager, preferably both you and your sister together, and ask her what she plans to do to ensure it doesn't happen again - to anyone. good luck.
 

Witzend

Registered User
Aug 29, 2007
4,291
SW London
I don't think you should stop going, even for a day, at all and neither should your sister. This is not your father's fault so why shuld he suffer?

There are procedures that can be followed and the nursing home should do so.
Witzend mentioned 'drugging', I think probably in a negative way, but in fact, there are drugs that can help with aggression and paranoia etc. As it is a nursing home as opposed to a residential one, they must have met such an occurrance before so will have some idea of what to do. I would hope so anyway.
I would speak to the manager, preferably both you and your sister together, and ask her what she plans to do to ensure it doesn't happen again - to anyone. good luck.
I didn't mean it to sound negative, only so many people seem to be violently anti the mere idea. Personally I would have welcomed anything to help with my FIL - and I don't mind admitting that I wouldn't have cared if it turned him into a zombie. I was at the end of my rope. People talk about 'distraction' - as if it's possible to 'distract' someone who's turned into a raging bull you don't even dare approach.
But at that time, absolutely nothing was offered but a shrug of the GP's shoulders.
 

Saffie

Registered User
Mar 26, 2011
22,506
Near Southampton
I didn't mean it to sound negative, only so many people seem to be violently anti the mere idea
That's what was in my mind Witzend and I know that the general popular perception is of residents in nursng homes spending most of their time dozing due to drugs but I think that perhaps it has now a caused a defensive leaning towars the opposite. My husband's paranoia and aggression was eased enormously by Risperidone and he was only on it for about 4 months or so and a low dose at that. If it helps, I think it's appropriate.
My husband still dozes in his nursing home a lot but that may or may not be due to his pain relievers. Either way, as I said to the nurse who suggested lowering or removing the pain patch, I'd prefer sleep to pain any day! There's not a lot to stay awake for either!
 

Witzend

Registered User
Aug 29, 2007
4,291
SW London
My husband still dozes in his nursing home a lot but that may or may not be due to his pain relievers. Either way, as I said to the nurse who suggested lowering or removing the pain patch, I'd prefer sleep to pain any day! There's not a lot to stay awake for either!
Quite. Actually my mother spends an awful lot of time dozing, and she's not on any meds at all. By a certain stage I think it's often just a feature of the disease. Only I do think some people think there's something wrong if someone's dozing/sleeping much of the day - they should be busily doing something....

If that's what they want, leave them in peace, that's what I say.
 

Rosie Webros

Registered User
May 8, 2013
181
Thank you so much everyone for all of your replies. I knew I could count on you! I have just got back from visiting my dad - my husband accompanied me today! The Nursing home cannot be more apologetic. My sister has had a call from their social worker who has also apologised and made sure she is ok.

It is a really difficult situation, but they are doing their best. Of course the resident who was aggressive lives in this home and he also has rights. We tried to imagine if it was our dad, we wouldn't want him moved but we also wouldn't want him to hurt anyone. So it is so difficult. All the staff are watching him really closely, and of course, my husband and son don't want me to go on my own for a while, so one of them will be going with me. And my sister will do the same, take someone with her for a while.

This awful illness, it changes people so much. I am sure this gentleman is a lovely person, and then this terrible illness takes over.

Thank you so much for all your replies, you are all so caring and lovely people.

Take care, Rosie xx
 

LYN T

Registered User
Aug 30, 2012
6,960
Brixham Devon
Rosie Webros;776903 We tried to imagine if it was our dad said:
Hi Rosie

That's really good of you and your Sister to think this way. My OH has had his moments with being physically violent and verbally also and it must be terrifying for the other residents as well as the visitors.In my husband's CH there is only him and another lady who are 'wanderers'.When Pete goes walkabout one of the carers yells out 'PT' it's their signal that he needs watching! With his history they don't want to take any chances.Pete has no idea that this is the case and he really is not thought of or treated any differently from anyone else.The care staff are upfront to me with what they are doing and I agree the other residents and staff need to be protected.

It's really nice that you can see the gentleman in question is lovely; P is the same. The carers call him a 'gentleman' which, of course, he is .Pre AD days he never, ever showed any signs of violence. I also have to say that without his meds P's life would be more limited than it is at present-in my opinion they do have a place in treating dementia sufferers.

Take care Rosie and I hope your future visits are more peaceful.

Lyn T
 

Saffie

Registered User
Mar 26, 2011
22,506
Near Southampton
Of course the resident who was aggressive lives in this home and he also has rights. We tried to imagine if it was our dad, we wouldn't want him moved but we also wouldn't want him to hurt anyone. So it is so difficult. All the staff are watching him really closely,
I don't think moving the chap would accomplish much as it would only happen wherever he was moved to but I do think that his meds should possibly be looked at.
Just watching him isn't going to be enough as I presume the carers have other work to do too - unless of course he already has one-to-one care. If he doesn't then perhaps a review of his needs might be appropriate but that of course, is up to the home.
I hope your sister is ok now.
 
Last edited:

Rosie Webros

Registered User
May 8, 2013
181
Thanks Lyn and Saffie. Yes my sister is fine now thank you, it just shook her up a bit. The home have been so lovely, they sent her a big bouquet of flowers this afternoon.

Yes Lyn, the staff are much the same as they are with your Pete. They let him walk around a bit, but then if he goes close to anyone there is someone there watching him and distracting him. They are doing a great job in very difficult circumstances. We are just going to be very careful from now on and not take any chances. Social Services rang my sister this afternoon and asked her if she wanted to make a formal complaint. Of course she doesn't, he is such a lovely man and it could just as easily be our dad next week!

Thank you so much for your replies, and hope we all get a good day tomorrow.

Take care all. Rosie xx
 

catherine1970

Registered User
Nov 25, 2011
2
Aggression and violence with Advanced Alzheimers

I am hoping that someone reading this forum will be able to give advice....
My dear Dad has advanced Alzheimer's and following 3 weeks in the Dementia Assessment Unit he needed full time nursing care in a DN Home.
He has become violent and aggressive in the last few days and understandably the DN Home are calling in the Psychiatrist for Dad to be assessed tomorrow.
The likelihood is that he will be admitted to the Assessment Unit again and medication adjusted.
Is there a DN Home that caters for Alzheimers patients that are violent or do they remain in hospital in a Dementia Psychiatric Unit?
I have to add that my Dad is the loveliest man and would be devastated if he knew what her had done....it isn't his nature...it is the cruel illness.
He has had Alzheimers for 8-9years
On Memantine,Respirodol,Lorazepam,Diazapam.
Can't speak..mumbles.
Not incontinent
No memory whatsoever
Doesn't recognise anyone
Mobile and very strong
I hope one of you will have some answers?
Thanks in anticipation
 

Butter

Registered User
Jan 19, 2012
6,738
NeverNeverLand
Welcome catherine - and I am very sorry to learn about your Dad.

Yes there certainly are nursing homes and care homes which can care for dementia sufferers who are really ill. There are also EMI (Elderly Mentally Ill) homes.

All being well your dad will be stabilised when his medication is fine-tuned. My mother was in hospital for 8 months until she was well enough to be discharged to a care home. People can settle down even after than length of time. And she had been violent in the extreme.

You will get more responses if you decide to start your own thread, I think.

But in the meantime, I wish you well and hope you find this website as helpful as I have done.
 

alannah

Registered User
Jul 7, 2013
16
Cornwall
Hi,
I work on an EMI unit in a nursing home, where I assist people much like the gentleman you have spoken about. In my opinion this man needs to be placed on level 3 observations, known as 1 to 1 which means that a carer must be with him at all times. For everyone's safety.
Where I work, we get to know the individuals' triggers to violence. For instance, a man I assist will clap or whistle when a violent or aggressive outburst is on its way, another person I help usually goes into 'foreman' role, bossing people about and giving them work to do. When we see these triggers we must take action, either taking them to a quiet area to calm down,where they cannot harm anyone, or by asking the nurse to give PRN, such as lorazepam.
Your fathers care team need to put a plan into place, in order to reduce incidents like what happened to your sister. You have every right to enquire as to whether this is being done. You shouldn't have to be scared to visit your father or worry about his welfare.
I hope your sister is OK, and im sure the home is already taking steps to ensure this wont happen again. Best wishes to you.

Alannah x
 

jaymor

Volunteer Moderator
Jul 14, 2006
12,812
England
Hi and welcome. (Catherine 1970) have sent you a private message.

Jay
 
Last edited:

catherine1970

Registered User
Nov 25, 2011
2
Thank you for your advice..
Dad has now been put on Hespiridol however it is not making a difference.
He won't change for bed and was restrained by 3 members of staff when making an attempt to move another resident from a chair. This is so out of character for my Dad's history of the illness. He has only been in this care home for a week so it's difficult to know whether the violence is caused by the move or the illness.
How cruel this disease is.
Thinking of you all
 

alannah

Registered User
Jul 7, 2013
16
Cornwall
Thank you for your advice..
Dad has now been put on Hespiridol however it is not making a difference.
He won't change for bed and was restrained by 3 members of staff when making an attempt to move another resident from a chair. This is so out of character for my Dad's history of the illness. He has only been in this care home for a week so it's difficult to know whether the violence is caused by the move or the illness.
How cruel this disease is.
Thinking of you all
I usually find that it takes a good 2-3 weeks for someone to settle in when they first arrive at the emi unit I work at. For them to adjust to their surroundings, and for us to get to know them, learn behaviour triggers etc. If this behaviour persists the staff will look into ways to avoid negative outbursts.
It must be so hard for you, but hang in there, I'm really sure that things will improve.

Also, meds can take a while to work effectively, I'm not sure about hespiridol, but it may take time to work into the system properly.
 
Last edited:

Recent Threads

Members online

No members online now.

Forum statistics

Threads
113,557
Messages
1,662,171
Members
64,659
Latest member
pegleg