How do you care for an Alzheimer's patient when they have aggressive behavior and hit their caretakers?

This is a tough problem which is, unfortunately, not unique. It seems like you are doing everything right - medication adjustment, checking for infections and other requirements to figure out what can be done.
I'm afraid a lot of this depends on where you live (their ability to cope with behaviors). A nursing home is the most likely place for him, so keep working on getting him in to one. They are probably more able to cope with these behaviors than assisted living. Either way, his assets will get depleted if they already aren't so eventually he'll qualify for Medicaid. Maybe in a nursing home, they can cope.
Good luck - we are with you in spirit.
Carol

Have you looked into dementia units (often called memory care)? It really doesn't sound like he is a good candidate for assisted living. Can the mental facility he is at now give you any suggestions for long term care placement?

This is such a very, very sad situation, and, as Carol says, not that uncommon.

If it only happens about once a month, consider the possibility that it happens only when he is extremely frustrated and that there was a trigger each time that might be understandable and avoidable. It might even be the same trigger each time. Then read "Talking to Alzheimer's" by Claudia Strauss and "The Validation Breakthrough: Simple Techniques for Communicating with People with 'Alzheimer's-Type Dementia'" by Naomi Feil and Vicki De Klerk-Rubin. It's really helpful.

My heart goes out to you. This is a fear for me also, periodically my dad hits his caregivers at the NH if they aren't doing things to his liking, tucking his shirt in etc. he yells at me and mom, I've spoken nicely and very harshly warning him that nobody has to deal with his behavior and he could get sent to another NH where the people and the place is not so nice and caring as where he currently is.
He says they are "running over him" because they have a schedule to follow and he wants to do and go when he wants to. I try not to think about it too much but I hope and pray that he will do better and that no harm will come to him.
I do the same for you and your Dad.

should ask his doctor about an anxiety med like Lorazepam

AL is no longer a place for him as it sounds. Since he has been bounced around so much. He is probably very confused and scaried. There are good medications out there like Ativan or Xanax that can be given daily or just as needed. You said he has UTI's. My moms temperment would change when she had an UTI so that might also be an issue as well. Only once my mom struck me and became enraged. I had her admitted into a geriatic mental health wing at the hospital. Only to find out that her UTI was back. They kept her 2 weeks adjusted some meds got UTI cleared up and she was fine after. Maybe once you find him a permantent location and he gets used to it things might improve.

I agree with yellowfeever same thing with my mom when she was anxious. Lorazepam is Ativan for those who don't know.

Don't know if this applies to your situation - but - Is your Dad a veteran? My husband was diagnosed with Alzheimer's - turned out to be PTSD. (wounded in WWII. exam tables, hospital beds were stretchers, personnel were "medics". PTSD "came out" after retirement. Seems this happens with a lot of older veterans. Knowing why they act out makes dealing with it a bit easier.

This is so normal, so many at the daycare went thru this when my Mom was there AND my mom. Lorazepam, etc constipated my Mom and she was unsteady on her feet, and tired. Depakote works like a charm for my mom! I try weaning her down a tiny bit and it comes right back so she stays on it. Its a common medication for this, please call his doctor or take him to a neurologist and ask about it, it works fabulous! My Mom WAS as sweet as pie as a person but once dementia and a stoke hit her, she got combative and this saved her and us. good luck

Unfortunately, like Carol said, this is not a unique problem. It is a part of the Alzheimer's disease progression for some people.
You mentioned that he was dismissed from 3 nursing homes - were any of them homes that specialized in memory care? These homes are usually better equipped to deal with this type of behavior.
Another problem is that he has been in so many different facilities in just a short period of time. This contributes to his confusion and thus his behavior... it's a viscious cycle.
You also mentioned that you were trying to get him qualified for Medicare - did you mean Medicaid? Of course, that qualification will help with the payment, but now the behavior problems.
I would really begin searching for a facility that specializes in Alzheimer's care, even if it's out of town. They will be better equipped to understand his behavior.

Blessings,

Shelley Webb

It's a lot to ask if you expect a person to soak up physical abuse from a stranger in exchange for a paycheck. The best of caregivers in the finest facilities will eventually find a point beyond which they won't go. It takes someone who loved that patient before they had dementia to love the patient and successfully separate the person from the behavior spewing from the disease. They need a loved one, someone who loves who they once were, to take on the job of seeing them through the rest of their lives and advocating for their quality of life. It's a huge undertaking and a massive responsibility. I mourn the absence of such a person in your parent's life. At times like these, one can only surrender to the obvious truth that God's plan for some people defies comprehension. From your vantage point, this will probably only get worse. My heart goes out to you, and I hope a workable solution presents itself. Good Luck. God Bless you.

This is definitely a difficult and frustrating situation from the actual cost of care to finding new nursing homes for your father. While I can’t take away the frustration, I do recommend that you ask a lot of questions when visiting nursing homes. It is helpful to ask under what circumstances can the facility no longer provide care to an individual. You should expect an answer that includes factors like health issues, challenging behaviors (like the hitting your Dad has done) or deterioration of mental health. This way you will know what behaviors or situations would remain grounds for dismissal from a future facility and you can prepare them for potentially challenging issues.

Sincerely,

Jill

I know how impossible this feels. I was in a very similar situation 20 months ago. My mother, who was always the sweetest woman you could imagine, began to hallucinate, then acted as if she were possessed by demons, literally spitting curses, kicking, biting – and all with her sweet lips narrowed to a thin, bitter line. I had to get her into a psych ward on an emergency basis. (NOT easy, but that’s another story.) As another poster said, after much trial and error, Depakote seemed to be the magic addition to her drug regimen. Depakote is an anti-epileptic drug, and her neurologist speculated that the violent episodes might be seizural in nature. We won’t ever know, but certainly a diseased brain might reasonably develop seizural behavior.
Just like you, I was told that 24 hour private care was a non-negotiable condition of her re-admittance to her care facility. I understood this, since she was very much a danger to others as well as herself, and no care facility is staffed to deal with this sort of a problem. Unlike many, I was fortunate that her estate, which I already managed, had sufficient funds to deal with the horrendous expense of nearly $15,000 a month. At least for a while.
The two things really helped me out, besides the Depakote. The first was that as a 7th stage dementia patient, she qualified for Hospice. Hospice didn’t pay for the private care, but they provided a great deal of her care while being paid entirely by Medicare. That cut down on some of her other costs, and allowed me to decline life-prolonging procedures for my beloved mother whom I know would rather be dead than like this, if she had the choice. The second big help was the willingness of her care facility to reassess her situation regularly, so that when the violent episodes decreased to a level that the in-house staff could handle to some degree, I could cut down the private care hours a little at a time.
Right now, episodic violence in dementia patients is either uncommon enough to remain unaddressed on a large scale, or it is under-reported due to shame, embarrassment, or the desire of some care facilities to deal with it as they see fit without oversight. Since the incidence of dementia is on a rapid rise, I believe we will see more cases of this episodic violence, and as we do, measures will eventually be put in place to deal with situations such as ours. Right now, unfortunately, you and I are on the forefront. It’s up to us to break new ground and see to it that our loved ones are treated well and appropriately, and that the costs for such issues can be dealt with by normal, non-rich people.
One final thought on this: I’ve run into much resistance from the medical practitioners to the simple solution of sedating her to the point that the behavior stops. There appears to be a perceived ethical conflict in that doctors are not supposed to sedate their patients for their own convenience. I suggest that this otherwise excellent rule should be reexamined in the light of end-stage dementia. Patients such as my mother, who has not known me for months and requires total assistance for all life functions, whose brain has literally melted, turning her into something closer to a veterinary patient than a human one, cannot be considered to be deprived of anything valuable by sedation. In cases where there is depression and despair, anti-anxiety sedatives such as Lorazepam, Valium, and so on should be considered humane rather than unethical. I’ve pushed hard on this issue with my mother’s doctors, and they’ve reconsidered their views on the matter to some extent. Maybe you can do the same.
Sending you positive thoughts!

fslack, I think that was me who mentioned Depakote, what a life saver!!!! The neurologist told me it calms the brain. She slept alot at first for a couple of months and then she was normal again. The depakote stopped those violent behaviors in their tracks and she not only acted better but when I asked her she admitted that she felt better. I would assume my Mom is in 7th stage, but she isnt totally bedridden, I get her up with a lot of coaxing and we walk small distances with two hands, maybe 5 feet, but we do it. MY question is to you is that I tried Hospice, she qualifed but they only had one person who would come "when they wanted" to bathe her and it was afternoon time, or when they could. My Mom needs to be bathed as soon as she wakes up as she is all urine, they did me no good. Do they supply diapers, bedpads? Thanks again.
Luvmom

Hi Luvmom, I am fortunate to live in a large city suburb where the Hospice is simply amazing. I know they are not all the same. Hospice sends an aide daily for my mom, a social worker twice a week and a nurse weekly, offers me grief counseling (and brother do I need that!) and has a doctor, a neurologist, supervising her care in the facility she's in, which is not a Hospice facility. I can only imagine that what any Hospice can do you for is limited by where you are and how well the Hospice is staffed. Mine does supply all sorts of things, including her own supply of pain medicines on site, since I have a Do Not Transport order in place for her. Their supplies, paid for by Medicare I believe, have cut the monthly bills for her medicine/supplies down to around $20 from way bigger numbers.
I know you can purchase blue pads and such in quantity for much lower prices. If you know others locally with similar problems, you might do a co-op thing.
There are so few solutions out there for us right now, we have to think out of the box to come up with our own!
Sending you hugs,
Fern

Oh thanks, I thought your Mom lived with you too, sorry. Good luck to you and your Mom, I know its hard but getting your Mom to laugh still are such treasured moments. My Mom loves to be sang to and just to put her head on our shoulders, touch is everything and I think that helps the grieving process because we do all we can do and feel good about it. Unlike, siblings who come a few times a year, lol
Luvmom

Sandiosandi, I am having the same issues with my dad, but I have him living at home with me and a caregiver during the day while I'm at work. It's like a boxing match sometimes & we're on the defense. He's in the advanced stages of Parkinson's disease with the dementia. I've been back and forth with his doctors and back again. I think their getting tired of me, but I'm not giving in or giving up. Something has got to help level him out.
Luvmom, does the Depakote make your mom drowsy or knock her out? My dad has been using Quetiapine, but I keep telling the doctors that all it does is dope him up and make him sleep all the time. That's not functional or any way to live. I will ask his doctors about this.
Hang in there Sandiosandi, prayers, prayers, and more prayers to all caregivers.

NO, the depakote doesnt knock them out once they are used to it. At first it seems to but then it levels out. I recommend you ask your neurologist or Dr for it, its fabulous and when my Mom went to daycare it was the drug of choice for most of them, safer than seraquel, etc. My Moms been on it for a long time and I give 250 mg at breakfast and 125mg at night. The dr said 1,000 mg a day is normal but no way does my Mom need that much, trial and error. I have tried to wean down to 125 in the morning and within 3 days she is a royal crab again. I now skip sunday nights and all is perfect. I had students in my class when I worked on it, the ADHD kids who needed calming down, it didnt make them sleep! lol. Write me anytime, I also have my Mom at home with me and left my job now to take care of her.
Luvmom

PS if your dad cannot swallow pills, as my MOm cannot, ask for the depakote in the 125 capsules, They are called sprinkles, I empty them into her prune mixture or you can put it on food but I prefer to make sure she gets every spec of it and the prune pudding I make keeps her more regular.

Thanks luvmom. I've sent an email off to his neuro already. Let's see what happens.

Fslack I totally agree with you. There are many of us that do not have the financial means to care for our loved ones as they should be cared for. Especially those with Alzheimer's or Dementia. It's outrageous how expensive the care can be to where alot of us caregivers contemplate giving up our occupations and do give them up in order to care for our loved ones because financially, there is just no other way. It's a sad state our elders are faced with in this country, I don't even begin to think about when I get there. Wow!
And what you mentioned about the doctor's not wanting to sedate the patient, only to the point of stopping the behavior, that has not been the case for my dad. When I have had to admit him, they are so quick to shot something through his IV to sedate him. In my perception, it is so that they do not need to deal with the bad behavior. But they tell me it is so that he does not "harm/hurt himself." Yea, OK! So why don't you send that some shot home with me to use when he gets like that again & we won't be here occupying a bed.
Sandiosandi, don't give up or give in. Ask millions of questions if need be and be firm about what you need for you father and the type of care he NEEDS, not what they only have to offer. You will find a good fit for him, just keep at it, it will come.

I agree this is common, and is very hard on families. I also have had good luck with depakote, I would like to know it any one has done a behavior log on your dad what time the behaviors are, what happened before etc sometimes this can be very helpful. If the times are late in the day at sundown time you could have aids with him at that time.And remember behaviors chage as fast as they come. Good luck

Just a quick note. Bless your heart, as I and my sister are dealing with the exact same problem with our Mom. We now have her on Depakote and Risperdal. Look up Risperdal. It is a psychotropic drug often used for teens that are struggling with psychotic type behaviors. It has helped Mom tremendously to calm down and be compliant with her care. Good Luck!

Just a quick suggestion. I feel your pain dealing with my Mom who is displaying some of the same behaviors. Research the anti-psychotic drug, Risperdal. I have seen this used with adolescents with whom I worked for many years. It is working with Mom to calm her and help her be more compliant with direction. The Haldol did not work. The Risperdal did. It is also called; Risperidone. Geriatric doctors are familiar with this treatment. I will keep you in my prayers.

My mom just entered a nursing home from an Assisted living two weeks ago. She had just entered AL last July. Her dementia got so bad that she just went downhill from the AL. Went to the hospital since she got really combative and they discroved that had a really bad UTI. She has dementia and is in a wheelchair since she was so weak from the hospital. she's just about forgotten how to waslk. Medicare cut off her NH funding after 10 days since she's combative and keeps fighting with the PT's and doesn't want to try to get better. She always sundowned around 3 to 7 at night. Yesterday I went to see her around 10 a.m. and she was totally combative threw a glass of water at me, cursed and screamed and told me to get the hell out. They couldn't get her to take her meds. Finally yesterday afternoon she took them but was still not calm. All I could do was cry, not for me but for her. The nurse told me that she was having a bad mornign and it wasn't personal. She told me to call before I go over next time so that they could tell me her condition at that time. Called again this morning and she was the same way. What do I do? Do I not visit her when she's this way? I don't want her to think I've deserted her? Any insight would be greatly appreciated. Thank you, Rita

Hello there!

I am a nurse here in canada and prior to taking my licensure i was able to work as a caregiver for patients with dementia and Alzheimer's disease. I had a particular patient who had Lewy Body Dementia. Lewy Bodies are abnormal protein deposits in the brain that disrupt the brain's normal functioning causing it to slowly degenerate. Its effects include degradation of cognitive functioning and degradation of motor control. Symptoms also include recurrent visual hallucinations and various sleep disorders. There are also behavioural changes, decrease in judgement, confusion and disorientation. This client was particularly difficult to manage because he was very aggressive and combative whenever he was disoriented.
It is very important for the caregivers to:
1. Establish trust and let the patient be familiar with the caregiver.
2. Create a routine. It helps dementia and alzheimer's patients to have predictable routines, especially around meal times and sleep times.
3. Modify Tasks. Break tasks into easier steps and focus on success, not failure.
4. Make behavioural changes. To help minimize the risk of fall-related injuries, you can help stabilize blood pressure. Help the patient stay well hydrated, exercise, take in adequate sodium and avoid prolonged bed rest.

You should better contact a psychiatrist, and also a neurologist. The first one is better suited and prepared to treat mental health patients. Also knows what medications can interact with the ones taking right now, and how to avoid possible secondary effects when the new medications are combined with previous ones. (You can make a better team if you add an Internist MD to this combo.)

Hospice has been a life saver for us. Our aide comes at different times, but she is normally there by 4:00 in the afternoon. She comes Monday thru Friday. We have developed a great relationship with Tomeka. There are days where she may finish with other patients early and she will call us ahead of time. Sometimes, we go ahead and bathe dad if he has had an accident. But they will still come to provide, diapers, bed pads, etc. All medicine is delivered to my dad's home. Mom calls about once every two weeks and all his medicine is delivered right to her door. We have a sitter who comes twice a week so mom can get out and just regain her sanity. We have tried Lorazapam, Ativan, etc for those times when dad gets a little beligerent. Does not do much good for him. I think he would have to have a horse sized amount for it to affect him. We started on this journey with one thing in mind. To do the best thing for dad. Our sitter came a few times for a couple of hours. Now she comes two days a week and stays for 8 hours a day. She cooks (at her leisure) and leaves the meal for my mom. She folds laundry and takes good care of our dad. She and our hospice aide have become part of our family. I would have no hesitation whatsoever in leaving either one of them alone with my dad. AT some point, you have to relinquish some of the caregiving responsibilities. There is no way a regular human being can manage this horrid disease by themselves.

I fought back tears when I read your post and the other post. I am in the same situation with 2 parents taking turns doing the same things in Nursing Home care. When I go I feel bad, when I dont go I feel bad. I can't help their behavior, there's no talking, listening, pursuasion, compassion for me or others its just about them and they don't care or cant care less how they treat me or the staff when they are in this way. I feel terrible for their mental and physical health but its not my doing therefore I'm not in control of nothing other than seeing that they are well cared for. Mom and Dad are both on hospice care now and I am so thankful for their help. Dad has been to the Hospital twice in 3 weeks and this doesn't help him at all. He's back to refusing foods, meds, andytype of help he's hitting and wants to be left alone. Alone to what??? It's in-humane to just leave him alone. Here comes the tears!

My mom also is at her last stage of dementia & is starting to be aggresive. I have a question about hospice because i am not too familiar w/ dementia or heard too much until my mom. i research on the web, but i dont know what to believe.My mom is really young(only 60) and has a rare , fast progressing ,form of dementia. Is hospice a form of treatment used for dementia patients? Can anyone recommend it for their loved ones? Or it has to come from the doctors? She no longer can speak, except giberish, can barely walk with assistance & is starting to have difficulties swallowing..

My mom is also at her last stage of dementia & is starting to be aggresive. I have a question about hospice because i am not too familiar w/ dementia or heard too much until my mom. i research on the web, but i dont know what to believe.My mom is really young(only 60) and has a rare , fast progressing ,form of dementia. Is hospice a form of treatment used for dementia patients? Can anyone recommend it for their loved ones? Or it has to come from the doctors? She no longer can speak, except giberish, can barely walk with assistance & is starting to have difficulties swallowing..