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

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!

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

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.

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

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

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.

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

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.

should ask his doctor about an anxiety med like Lorazepam

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.

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.

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.

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