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On Christmas Eve my husband received a phone call from the administrator at the Memory Care Unit where his brother resided. She stated she would be discharging him to the ER of the hospital for a phyc evaluation and would not be allowing him to return due to behaviors.


BIL had only been a this facility for a month and we were never made aware of any current issues. We visited 3 or 4 times and no one said anything to use about any problems. Therefore, we thought all was well.


BIL at some behaviors in the past that had been attended to. At the time BIL was 4 hours away and we just could not be a part of the care team like we wished. Husband and I thought if we could get him closer to home, we could be more involved with him and his care plans. Thinking if there were anything else to arise, we could assist in what the problem was and how it could be resolved. So long to our hopeful thinking.


Long story short … We received the phone call from the social worker today that BIL is ready to be released but that administrator said she already told us he could not return. Social Worker asked us, What are our plans. I informed her that the administrator can not discharge him without a 30 day notice. SW stated she would contact administrator and call us back We never heard anything.


Is this situation illegal? Any advice would be appreciated.


Memory Care Units claim they can handle the behavior issues when indeed most can not.

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Glad I got answers this morning. Good to know everything is going to be fine.
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worriedinCali YOU are not telling the TRUTH. I NEVER messaged YOU. So go ahead and post you know I have no reason to. You are a troublemaker and you talk about things you know nothing about.

If you are going to post anything about my BIL you need to get your FACTS straight. He does NOT have a GUARDIAN.

You seem to have a BIG problem with me going on with this for such a LONG time. (3-4 years) You don't understand it do you? Let me break it down for you. I am a F I G H T E R when it comes to something like this. Since you COMPLAIN so much about me going through this for so long, what do you think I should do GIVE UP? Obviously so, you called me a TROLL.
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worriedincali You need to hush. I am tired of you coming on my post running your mouth about something you know nothing about.

Not once, have you ever tried to offer some type of encouragement. All you ever got to say is …. What I can not do. Did I not already prove you wrong when you kept jumping on here saying I had no authority so I could not get him moved closer to home but I did.

Are you so bitter is all you can do is try to offer lost hope?

Furthermore, you have absolutely no compassion for no one. And to come on my profile and send me a private message calling me a TROLL ……. You need to troll on.
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Swise02 Dec 2019
I sent you a pm
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Tell Social Worker you are unable to take him home & they must find a place for him...or else keep him at hospital. Hugs 🤗
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worriedinCali Dec 2019
No need for that. The OP can’t take him home. He won’t be sent home. He’s been institutionalized for a few years.
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Hailey, when I placed my father with vascular dementia and paranoid personality disorder into a locked MC I was _very_ honest with the director about my father's aggressive personality, verbal abuse, and occasional violent behavior when he didn't get his way or someone tried to get him to do something he didn't want to do. Dad was prescribed anti-depression and anti-anxiety medications (as well as meds for other physical conditions) he didn't want take as directed so medication management was a big concern. I chose to pay for an "transition" plan where he had extra attention and a weekly assessment for his first six weeks. I shared with the staff the things I thought my father would like: the porch rocker, 24/7 kitchen and pretty nurses since Dad was always much more cooperative with doctor office and in home care staff. The director and I agreed to be as flexible as possible and not push my father to do anything he resisted unless it was absolutely necessary. So Dad stayed in his room pouting for much of the first month. Once Dad was settled in the MC and taking his medication as prescribed, there were never any major problems; however, every time he went to the hospital and returned to the MC, we paid for additional "transitional" help for a few days to a week.

During the transitions, I asked the DON to contact me every day or so (phone call or email) at _her_ convenience to let me know how Dad was doing and if there was anything I needed to do for Dad. One of the benefits of the extra transitional care was a daily report was written and the DON forwarded those to me.

I didn't try to tell the MC how to operate. When there were issues I asked what our options were. We always found something we thought would work out better, sometimes those ideas worked and sometimes we had to try again. When the plan wasn't followed as agreed, I asked about my misunderstanding of the action plan instead of starting with a confrontation. I completely understand your frustration and anger and the desire to confront the people who haven't met your expectations, but you really do need to remember "you can catch more flies with sugar than vinegar". Please try to stop being so critical of the MC, it's staff, and it's actions and try to find some way to work _with_ the MC, maybe especially when something is messed up. Often there no way to "unspill" the milk but sometimes people really appreciate someone who helps them clean up the mess without first bringing undue attention to their fault in the spill. "I don't understand how..." is often a good conversation starter.

Ask what conditions the MC would need met to reinstate BIL. Read his contract and be ready to use ask about any conflict resolution or eviction language you feel would be helpful to BIL's case, but be nice.
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haileybug Dec 2019
TNtechie Thank you so much for the good advice. Sounds like you did a great job keeping things going well with transitions and have DON keeping you updated.

I am not trying to blame the staff or facility. All I am trying to say is ..... Why did the staff and administrator keep telling my husband and I everything was going well if it was not? Maybe if they had been honest with my husband he could have offer advice on handling the situation. That is not what happened though.

Once again, I appreciate you advice. By the way, I already have a geatric case manager involved, so hopefully they can steer things in the right direction.
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The Nurse at in the phyc hold told me that the administrator could not refuse to let him go back to the facility unless she wants to get fined a $10,000.00 fee Nurse said that is his home and she can not just throw him out without a 30 day notice.

At least the administrator at the other facility had enough sense to know she could not just drop him off to the hospital. She thought she could discharge him to my husband in 30 days. After I picked up the phone and made a phone call, that story changed right quick.
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Swise02 You make the most sense to me. People can say so much but the truth is, unless they have walked in our shoes, they have no idea.

I am sticking to what you said. Thanks for you help.
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Hailey

My final thoughts as I would like to try and help you but I continue to be left scratching my head with your responses every time someone tries to explain how things work

- if you are in the US, you or hubs need a HIPPA release or medical POA to discuss BIL with health care providers

- please stop expecting others - the facilities - to solve the problem

I get no one wants to get involved but it takes great effort to make anything better in this situation - I know this first hand - my mother's dementia has turned her into someone I didn't know and I fought for her in order not to have her memory care facility send her out on a psych hold - how did I fight ?

I control her care - I take her to outside doctors including a neurologist and discuss med options and research the options -
this takes time and effort which you and hubs are not likely to have but the alternative is her facility would rather use their house doctor and suggest meds that will cause her to sleep all day -
there are few options for dementia with aggressive behavior

it does not matter that BIL used to be a good decent person - he now has a disease which manifests in psychosis - his brain is broken and no amount of sweet talk from staff is going to fix it or suddenly make him cooperative

we all agree that the situation is awful, care is lacking and resources are limited but if you are able please spend a bit of time today to write down three things you can do on Monday to help move the situation forward

I would guess that a lot of BIL's problems are a lack of consistent medical providers - is he bounced from facility to facility without a doctor knowing him and constantly having his meds changed ?

I'll offer up a start
- contact psych hospital social worker and ask what is protocol for diagnosis and follow up care plan and who will be providing that care - does BIL need a referral to psychiatrist or internist and will this care provider work with him in a facility ?
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worriedinCali Dec 2019
MsMadge this has been going on since at least 2016. Her BIL has been kicked out numerous facilities and moved multiple times. There isn’t any advice that hasn’t already been given. Her BIL cannot sign a POA or HIPAA release, he’s been declared incompetent and according to a previous thread has a guardian. All the questions OP has asked.....she has asked multiple times on multiple posts. The questions she’s been asked and hasn’t answered? Have been asked before and were never answered.
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Kansas? What is in Kansas?
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Swiseo2 I sent you a private message.
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Swise02 I am so sorry about the way your dad has been treated. It makes me furious.

Oh my goodness. Your dad's situation and my BIL is almost exactly the same. He too has alz. and I saw where they try to put szh on his paperwork and my husband said he was never diagnosed with that.

You are exactly right. They do try to create a monster out of them and try to claim they have mental illness when they can not get meds to regulate the behaviors.

You are on point. I have been telling my husband all along that I feel like my BIL is only trying to defend himself not having true perception. Yet, they want to call my husband so angry and act like he is some animal. They are supposed to be loving and caring yet they dump him in a hospital and leave them there. What is wrong with these people?

If I could, I would snatch him out of their so fast and he would never go back in a facility. They do not care. Society will throw a label on you so fast that you can scrub off. Pure ridiculous. Once again, I am so sorry what you and your dad has been through.

Oh, I forgot to mention. My BIL was like your dad. Before alz took over, he was like a genious, extremely smart and reserved. Thanks dear for replying.
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I have had some suggest that BIL may have some phyciatric going on. He has had several phyciatric evaluations and the doctors have never suggested anything different than MC. Never behavioral care.
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Swise02 Dec 2019
My dad has been the most mentally sound person I have ever known until Alzheimers and placed in memory care. I have since watched my dad that can barely speak be interrogated by police and treated like a crazy person restrained tackled down and injected etc. These are memories that haunt me because in every situation that my dad has acted out it was more of self defense because his perception is off and was not medicated properly. I feel like I have ptsd from watching him be treated like an animal at times. It’s weird how they want to put “mental illness” on them when really for my dad it is just Alzheimers. On his last paramedic transfer sheet I saw that they had dementia and schizophrenia listed as his diagnosis. I alerted every single person caring for my dad and told them I had no idea where the schizophrenia came from he had never been diagnosed with that!
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gladimhere You would be surprised what they care about being legally. I could say a whole lot but I will not.

No, the APS is not involved at all. I already checked with them.
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Kansas?! Like CM asked, what is in Kansas?

Hailey, we are all running around in circles trying to be helpful. I just do not know what else to say. Behaviors run the gamut, from yelling, pushing, threatening, hitting. If staff cannot control the behaviors BIL will be asked to leave. And I as child of my loved one, also a resident, would expect this to happen.
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haileybug Dec 2019
gladimhere So why is it called a special care unit? Why do they claim they are specialized in caring for someone with behaviors?

By, the way. He is not a bother to the residents. If he were, I would be terrified.
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Also on a side note...I kind of came to the conclusion with my dads last facility that it is very easy for places to accept a resident knowing they have had previous behavior problems...they take your registration fee (which was $4500 for last facility and non refundable) and they discharge them once behaviors are displayed rather than really investing in them and learning them. We have lost so much money in memory care it makes me physically sick and my dad was not even getting proper care. He was filthy, not medicated properly etc!!
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haileybug Dec 2019
Swise02 I am so sorry about what your dad went through.

When my husband and I met the administrator of the facility, she told us if he had behaviors it was no big deal. Now she throws him out.
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Haileybug...my heart goes out to you. It’s never ending! I’ve been through it and it’s always something. My dad has been kicked out of two MC due to behaviors. The last time it came out of the blue just like your BIL. The hospital will have to keep him there until you find a place for him. Nowhere would take my dad and I went to visit a state facility in North Carolina that has a floor for combative dementia patients. It was not good at all. Long story short I found a private care home that said they would accept him. That is where he is now. It has been a nightmare of a year dealing with all of this. He has really declined here lately and now is unable to walk which is not good but at least it allows people to care for him more easily rather than him being so hard to handle. It just seems like a helpless situation and I know what you are feeling completely!! I have wondered how your BIL was doing in his new place and I really hoped he was doing well. It’s mind blowing though that these facilities do not keep us in the loop about what’s going on and then BAM they are being discharged...crazy and so frustrating!!!
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haileybug Dec 2019
Swise02 I am so sorry about what your dad went through. It should have NEVER have happened.

Unless, someone has been through what we have been through they just don't know.
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There isn't a suitable unit close enough for you to be able to there on the ground for BIL.

DH's health is not good enough for him to put in the travel or the hours.

Doing this successfully will take not just a lot of love but also a lot of continuous hard work. So that's what worries me - wants to be involved and is able to be are two different things.

And Kansas? What's in Kansas that they want to send BIL there?

About assessments: these are snapshots, it is not reasonable to expect them to be definitive. At work, we do an initial assessment followed up by reviews every three to four days. And this is only for reablement in people's homes! - it's nothing like as complex and fluid as a person with mental illness moving into a completely new environment and having to make so many adjustments all at once.

It would certainly be no bad thing to have allies, allies with experience of your local system and resources and possibilities. But there are things you need to do first. You need to have a much more complete and accurate understanding of BIL and his current condition and his care needs; and you, more especially DH, need to have a clear goal in mind. What's going to work? What kind of arrangement are you looking for?
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haileybug Dec 2019
Countrymouse Thank you for responding.

Yes, I know what BIL needs. Since my husband and I can not be at the facility everyday and we can not rely on anyone in the facility to alert us when something is wrong, what he probably needs is a monitor so we can monitor from home.
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Wondering if this is something I should let a geatric case manager get involved in? I have reached out to one and she is ready to help.

I am just not very familiar with their services.
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gladimhere Dec 2019
A geriatric care manager would be a very good idea. Make sure that person is bonded and insured and authorised by the court to work in guardianship role. That would be able to happen very quickly.

Every place in this country has laws on releasing medical information. Not abiding by those laws is an invitation for law suit. And the facility could very well have legal reason to not supply information due to those laws. HIPPA is a federal law, everywhere in the country is subject to it.
https://www.hhs.gov/hipaa/for-professionals/privacy/index.html
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gladimhere Thank you for responding. You do not have to have any of that where I am from. All parties involved are ok with discussing things with husband and I.
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Look at the intake contracts. Whoever had POA on admission should have copies. Yes, a memory care can refuse a patient they feel they cannot safely or adequately care for.
As to the Social Worker tell her YOU have NO PLANS and hope that she does, as you were in no way prepared for nor aware of any of this. The Social Worker is in charge now. She wishes she were not. In fact she would give ANYTHING to discharge BIL to you and have YOU do the work. Do not accept discharge. Tell the social worker that this is entirely in her hands, that you have ZERO answers. That will get her working on placement right away. Do not under any circumstances let them discharge BIL to you. Who has POA for health? What happened in the memory care unit? What was the diagnosis in the hospital? What has been DONE about that diagnosis? This will be in the hands of the POA, the Social Workers and the Memory care. But no, they do not have to accept this resident back and to do so when they feel they cannot adequately care for him safely would in fact be negligent.







Loo
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haileybug Dec 2019
AlvaDeer You gave me some very good and intelligent feedback. Thank you.

I will need to do exactly what you told me. Need to follow up with what he was diagnosed with and what was DONE about the diagnosis. Very good information.

The sad thing is, he has a lot of evaluations in the past and nothing is never DONE. At one point, a doctor at another hospital refused to see him any more for evaluations. He stated because once BIL gets there he acts like an angel.

Also, when the staff went to do an assessment on him, shouldn't they have know then if they were able to meet his needs or not? They accepted him there.
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Haileybug I am on your side and I'm sorry because I know you're not going to like this; what's more I agree that the facility should have been a great deal quicker about liaising with your DH when problems began to emerge, I don't know why they didn't do that. But.

You moved heaven and earth to get BIL into a facility where you and DH could be more closely involved in his care. Good, I agree, I have supported you all along on that.

And yet in the first month you've visited three or four times. I'm sorry, that is nothing like enough. This was a time of huge transition for BIL, there were bound to be teething troubles, you needed to be in there monitoring his progress really closely until he had settled into a good routine. Phone calls are useless - you're talking to members of staff who realistically at that moment will be thinking "which one is he..?" while they assure you he's doing fine and he's a poppet. You were just out of the loop and things happen too fast for that to work.

If you seriously want BIL to return to this facility you will have to stop blaming them and find out exactly what happened. From there you will be able to see if the problems could have been defused or avoided, but you can only do that rationally if you first accept the possibility that maybe they couldn't, and this facility has bitten off more than it can chew. In which case, you do not want your BIL in their hands and the search will be on again; but that will be the Social Worker's problem.

When your DH spoke to the administrator on Christmas Eve, what did he say? Did he ask any questions? Has either of you attempted to reach her or her managers since?

Will the psych unit not let you visit BIL?

Key question: what does DH feel now about participating in BIL's care? Are you sure he really feels equal to this?
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gladimhere Dec 2019
CM, I think a big part of the problem is not having POA's in place. We don't know if BIL has signed a HIPPA release or if would be even competent to do so. The facility, because of privacy rules, would only be able to contact POA and hailey's hubby is not it.

The only option, Hailey, if you want control of BIL's health decisions would be to pursue guardianship through the courts. If you want that the psych hospital may be willing to help you obtain that relatively quickly on an emergency basis. Is there a chance APS has become involved? I would think that very likely. If so, APS may be pursuing guardianship that will allow them to make decisions for BIL and that would not require input from you or hubby to determine appropriate placement for him.

If APS has become involved this is for BIL's benefit and is not anything personal against you or hubby.
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Administrators of the facilities are so lazy that if the resident does not just sit in one place and stare, they will slap something on their wrist. That's what I see.
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Hailey

this post is going no where to help you with BIL

from what you've indicated -
he has a mental disability
numerous psych placements
unspecified behavior issues (pushes aides)
several discharges from memory care facilities

In our state, memory care facilities may not admit anyone with a mental illness other than dementia -

I've seen men and women for that matter push aides - they get hurt

remember, these places pay min wage and hire folks - some teenagers - without any experience and show them a couple of videos, and put a name tag on them saying they're a dementia care specialist
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haileybug Dec 2019
MsMadge Thank you but I never mentioned he had a mental illness.

I just reread the admitting documents of the facility and it clearly states there has to be specialized training to care for patients with mental disabilities.
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My husband and I have been through a similar situation before. After I had already explained to an administrator of a Memory Care Unit that my husband could not care for his brother due to just having a triple bypass surgery, she still had the guts to send my husband a 30 day discharge notice, that she would be discharging BIL to him.

I contacted the Long Term Care Ombudsman right away and she told me that was ridiculous of the facility administrator. She told me not to worry, she would be going to the facility within a day or 2 and that she would handle it.

Received call from Long Term Care Ombudsman that he was not my BIL that was the actual problem. She investigated and stated the staff had been disrespectful to BIL and was not giving him his meds.

Wonder if the same thing has happened again?
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cwillie Dec 2019
Although the facility administrator was willing to give him a chance given the history undoubtedly on file somewhere this may have been a case of one strike and you're out. It may not be fair or professional but these places often have a waiting list and aren't terribly concerned about customer satisfaction.
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FloridaDD No, he does not have to have one here.
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FloridaDD Dec 2019
If your DH does not have a POA, the facility is very limited in what they can discuss with your DH, or you.  If you and your DH believe that your BIL is not competent to arrange his own care, you can go to court and asked to be named guardian.   If you think he is competent, but can persuade him that you or DH can do a better job of dealing with medical or financial issues, you or DH can ask him to sign medical and financial POAs
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Kids do get expelled from school Hailybug, or at least suspended so often they may as well be expelled.
What you don't seem to get is that even if he is an angel 90% of the time nobody wants a loose canon in a facility, the families of the other residents shouldn't have to fear for their loved ones safety because they are too demented to be wary of your BILs hot buttons and the staff shouldn't have to fear being abused verbally or physically just for the privilege of earning a (meager) paycheck.
Dementia care facilities do handle most common behaviour problems very well but there are always exceptions to the rule - unpredictable violence and/or sexually inappropriate behaviours are examples of problems too difficult for the average facility. Yes, if we all lived in a Utopian society there would be specialized one on one care for all the people in memory care, unfortunately this is the real world and if he needs one on one care somebody has to pay for it.
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haileybug Dec 2019
cwillie Thank you for responding. I see what you are saying to a point.

Lets just say I have several years experience getting a look into services for children/teenagers who have mental disabilities along with behavior issues.

I have seen upfront these children hitting, biting, kicking, etc. etc. innocent children, staff and faculty. Was this right? NO, but it happened. At least I can say for the most part, the school would try to have a meeting and come up with a plan of action, intervention, manesfestation, so on. The child was not just throwed out the school because of a danger to others or the acts they committed.

That is all I am trying to say in the same case scenario. The only difference is, this is an "adult" in an adult facility.

It would make a lot more sense to me had the administrator called our home and made my husband aware of any behaviors not suitable. In the short time he was there, my husband and I made at least 4 visits. No one said a word to us about anything wrong. Had my husband been aware of something, he and I would have gladly had a meeting within the facility for everyone to have a clear understanding and maybe come up with an action plan.

I mean, was the administrator there trying to cover something up? Why was my husband not made aware of any issues? Was there a particular reason behind her calling at lunch time on Christmas Eve? Regardless, she did not handle things professionally or right.
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If these administrators want to act WACK then maybe they need to define their definition of danger to someone or oneself.

Otherwise, they are saying children in daycares or schools must be kicked out due to behaviors. They push, kick, bite, etc. ectc. each other.
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FloridaDD Dec 2019
Depending on age, kids may get kicked out.  Administrators may be faced with staff threatening to quit if they get pushed around.  Would you like it if someone got physical with you at work?   I asked before, does your DH have a POA?   Can the admin have a serious discussion with him?
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Haileybug....the bottom line is this, and it's not something you'll want to hear. These facilities make their own rules. As a residents and family members, you must abide by their rules, whether you agree with them or not, whether you find the admins to be professional about their handling of your BIL or not, you are at their mercy. Your BIL may be an 'angel' in your presence, a 'teddy bear' in the presence of the various psychiatrists and doctors he's been evaluated by, but while alone with aides and others in the MCs, he apparently changes into someone who's not an angel or a teddy bear. After a few of those incidents, the administration decides whether or not they want to continue keeping him as a resident and whether it's safe for the REST of the residents or the STAFF to have him housed there. If their answer and their determination is NO, then he is asked to leave. You may have one idea of what is 'safe' while they have another one entirely.

Remember...........these places like to keep residency at 100%.......their goal is never to 'lose' residents but to 'keep' residents. Only when it becomes 100% necessary is when a resident is asked to leave.

Best of luck finding a good location for your BIL.
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haileybug Dec 2019
Lealonnie1 Thank you. You are correct in some of what you said.

However, the staff is the one who stated he was a 'teddy bear" while at the facility, not my words.

Remember, these are specialized care units. Meaning, they must be able to care for someone who may present a mental disability or behavior issues.

I am just referring to common behavior problems. I'm not talking about slapping someone, punching in the face, choking, spitting on, biting, kicking, throat punching, pulling hair type dangers.

The administrator better proofread her own documents for admitting someone.
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FloridaDD Thank you for responding. We tried a fresh start a month ago at the Memory Care he was at.

In my opinion, it is time to get better Memory Care units that can actually do what they claim they can do.

Such as the one he was at. Before, we decided if we thought placement was a good fit for BIL, my husband and I met with the admin. She had a lot of BIG TALK.

We going to do this and we can do that. If BIL has behavior problems that no big deal we can handle that too.
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Haileybug I am just about certain the staff were told to document every adverse behavior from BIL. I can also bet there is plenty of documentation already. Also centers have internal protocols to follow that are written as company policy in this situation as well for the staff to follow before they discharge.

This isn’t their first rodeo, unfortunately.
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haileybug Dec 2019
Shane1124 If my husband is the one that signed him into this Memory Care, then why didn't the administrator/staff make my husband aware of any behaviors? When my husband and I went to visit him, we were told "he was just a big teddy bear"? Anyway, don't you think the administrator should have showed some type of professionalism and made my husband aware of any issues? Maybe, just maybe …. my husband could have told her how to handle the situation.

I think it all boils down to approach.
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