Can a patient be asked to leave a memory care facility due to aggression, anger, and other bad behavior with no notice?

Oh my what a stressful situation....for everyone. I know when I have visited facilities, there were places that my parents could not wait to leave because of a certain overbearing resident. If it is not a palatable environment, pretty soon customers will shop elsewhere, and residents will want to move out (if the problem isn't resolved) and the facility management is keen to resolve problems quickly. Yes I did refer to the outbursting patient as a problem, because in a facility everyone becomes qualitified, according to their needs, they have to make decisions on levels of care, and facilities want to balance the level of care "mix" with their staffing requirements. So if there is one person who's off the charts with their needs, they are going to have a very hard time meeting everyone's needs, safely. Thus the imperative to have those patients evaluated for different or more medications. Are there any treatments such as brain stimulators or implants, to help curb the outbursts? Would seem to be a worthwhile endeavour.

I imagine it's different in state to state, but the same happened to a friend of mine's husband here in Arkansas. Moving him to the hospital was the step they had to take to get him out of their facility. If they might have been able to get him under control at the hospital easily with medication, it was up to them if the wanted to take him back. However, they are not a jail with guards to help keep the other "inmates" safe from out of control prisoners, nor are they required to. They have an obligation to all their other patients as well as thier employees and an out of control adult male can, and often is, a threat to the safety of other patients and to themselves so they are, at least in Arkansas, allowed to choose not to take him back from the hospital.

You definitely want to contact your local department on aging and get some suggestions. is better equipped to deal with more difficult patients. Also work closely with the doctors where he is at to see if there are medications they can prescribe that will make him more manageable at home if he should have to go home with your mom, or at least manageable enough to be able to get him accepted at another nursing home?

My heart goes out to you and your family. This is a difficult situation, without a doubt. For you and for those at the nursing home who would like to help but who's hands are tied. Good Luck.

I would try calling your local ombudsman agency. They advocate for residents of skilled care facilities, and can advise you of patient rights in your area.

Get Adult protective services involved at once. They will get him placed or find home help & call the PCP~~Merry ho ho ho~Is he a Vet?

Samara I don't see anything in your post that would suggest that dementia patients showing aggression don't deserve good care - not at all. You're saying that dementia patients in memory care deserve protection from others' aggression, no? Nothing controversial about that, I'd have thought.

I am hoping that the OP will come back and tell us what her father's psychiatric unit recommended for his ongoing care. This is such a nightmare for anyone it happens to, and so hard to manage. You can't sedate an aggressive dementia patient, you can't disproportionately restrain him, you can't reason with him - what are you supposed to do? I hear a lot of criticism about the inadequacies of provision but very few constructive ideas. It's desperate.

Missmacintx...what a question, I'm not an OR resident, and I my self may feel as you, not wanting to be incredibly burdensome for my kids (or nurses), but please keep in mind, what a slippery slope euthanasia is. If some "elect" to ask for assisted suicide, it's just a nudge away from a societal or medical "expectation" that anybody of any age who for whatever reason is undervalued by future unknown standards they will "have to" kill themselves or be seen as the biggest problem. Instead of finding better medicines & laws to usher people into Heaven we should find better medicines & people to hold their hands while they slip into Eternity. It can be done if we decide that all lives matter. My apologies to anyone who read my previous comments and concluded that very aggressive patients were less worthy of care. Everybody deserves good and patient care & consideration.

I want to know if I become a resident of Oregon, can I pre select my own euthanasia if I get unmanageable? I NEVER want ti put my kids through this!!!

It's a sad thing and there are no easy answers, but aggressive or disturbing behavior in one person can make care and comfort for the other residents almost impossible. I work with adults with intellectual/developmental disabilities and we expect a certain amount of difficult behavior, but when it gets to a point that other clients are not able to focus on their activities and the noise level from the client with behavior issues requires 3 or 4 staff to try to get things calmed down again, the client's family may be asked to find another program. So it's kind of the same thing for a nursing home. This is one reason that nursing home staff may often rely too heavily on sedating medication, but that's not the answer either. I hope and pray you can find a quality care facility that will give your father the care he needs, but can't verbalize. Sometimes I think the difficult behaviors or outbursts stem from emotional or medical needs that are not being met, but that the person doesn't know how to cope with or explain.

By voiding your contract and returning the money, the AL appears to be saying that they were in error in saying that they could manage your dad in his current stage of dementia. In a way, they've done you a huge favor (I know it doesn't feel that way). They've given you the opportunity to get dad's meds stabilized while under medical supervision and the knowledge and resources of the discharge staff in getting him into a new, better suited facility. Best of luck.

A further tip. My mom is currently in a NH. Each time she goes to the hospital, we release her bed (their suggestion, she's private pay). They have a low census, so it's not a problem for her to be readmited. Saves her quite a bit at $15,000 per month.

I just went through this with my father a few months ago. All good advice here, particularly the comments about not being coerced into taking him home. The hospital will have to keep him until you find a place for him, but the Social Worker at the hospital will put pressure on you to hurry up. Take your time and find the right place for you and your Dad.

Thankfully, we found an Alzheimers/Dementia Care facility (Beaverton, Oregon) that seems better equipped to handle aggressive behavior than the last Assisted Living facility which had added a Memory Care wing as an afterthought.

The right combination of meds seems to be the key. My Dad still yells and curses sometimes, wants to leave (all the time), has crazy delusions, etc. but just not as severe. The doctor is still slowly tweaking his meds, trying to get the anti-psychotic dose as low as possible. He's been at this new place for two months and hates every minute of it. I feel guility (like most of us), but I know he's safe and I'm grateful the chaos has subsided, at least for awhile.
Take care of yourself - it really wears you down... Hugs!

Yes it is completely legal and desirable for a memory care facility to decline to provide services to a client who cannot meet their behavioral guidelines, after a reasonable length of medical assessment, if the client is not able to fit in then the facility MUST refuse to include that client. It's not being mean oe disciminanatory against that individual client....the staff can only be stretched so far in taking care of any single client. If he requires more care than they can provide then all the rest of the resident's care will also be compromised---put yourself in the shoes of some other spouse who spends $8, 000 per month o more on memory care, and how would they feel about major disruptions, after all the OTHER rooms are going to be not as nice a place to be. If I were visiting a memory care facility and some resident was being uncontrollably loud or aggressive would walk away, and if I were paying a small fortune every month and repeatedly witnessed bad behavior from another resident I would surely complain. Memory Care has limits and that's a good thing.

Not only can they deny, in many states there are laws that the patient has to be evaluated just like a new admission. If they fail to meet the admission standards, another facility must be found.
I don't often say this, but your mother should make him a Ward of the State, cooperating with the Hospital Social Worker who handles a protective custody hearing. I know this is hard, but it is the safest option for everyone.

It's terribly upsetting to have your loved one shuffled from one place to another.

There are not nearly enough facilities, much less, those equipped to properly care for patients with aggressive behaviors.
There is question not only of other patient's safety, but the safety of staff, as well.
There are laws against Patient abandonment by medical professionals.
However, the nursing home did transfer him for evaluation to a psych facility, thereby transferring care responsibility to that facility.

Once he has stayed there the time they allow, he will need transferred to another facility, preferably one which has capability to properly care for someone with aggressive behaviors, who is also a "frail elder". Those might included Alzheimer's units, Memory Care Units, Dementia care units.

===Something that frequently happens to confused elders who are transferred between facilities: The more some are transferred, the faster their dementia conditions/symptoms can progress; they lose more ground, mentally, to where symptoms might progress to the point they are then beyond acting out aggressively.
Dementias are progressive, and go through stages; not all get violent or aggressive, but many do, though if the dementias progress, they can get beyond those awful behaviors--at least to the point it is no longer a problem for those around them. At that point, a regular nursing home might yet be capable of caring for him.

Speak with your County's Area Agency on Aging, to see if they can suggest OTHER facilities which are more appropriate for your elder.
The more quickly you can find one, the better.
A Social Worker should be involved--however, if you notice the person does not seem to be advocating very well for your Dad, find another one! You need someone who is capable of focusing on what is needed for your Dad: a proper facility.

At NO Time, EVER, should family members, who may also be fragile or vulnerable to aggressive elder, be Coerced into "Taking Dad Home" while you wait to find another facility!
If the elder is not safe to be around other patients and staff in a regular nursing home, he's Not likely to be safe in your family home, either. He needs professional level care in a proper facility--and it does not sound like the one he was in, had that level of ability.

The facility that has the patient last, is the responsible party.
It is a sad game of "hot potato", that families need to fully understand the consequences of:
IF you allow the facility currently holding your elder, to Coerce family into taking him/her home under your roof, to wait out a waiting list, etc. elsewhere, you will likely NEVER get further help to place Dad in a proper care facility, AND, you will be submitting your immediate family to behaviors that could cause you harm, physically, mentally, financially, and legally.

Once his aggressive behaviors are on his records, that follows him everywhere, and will likely be used as one of THE largest criteria to decide whether he will be allowed to be in any other facilities. It's not supposed to be, but it is.

For decades, it's been illegal to use physical restraints or drug restraints:
there's a very fine line between what is a restraint, and what isn't.
Violent or aggressive behaviors are not considered "normal"; they can endanger others or themselves, while behaving like that.
Therefore, use of some pharmaceuticals properly prescribed and dosed, could be appropriate, as long as it does not result in drugging the elder so deeply, they become a 24/7 bed-patient: the drugs should still allow the person to be up and get around, if able, and interact as best they can, at more normal levels.
Done properly, it is not a "drug restraint".
But those depend on the patient, as some Docs consider also, the patient's sensitivity to drugs, or other meds they are on, as liabilities to dosing psych drugs...in that case, some level of physical restraint is needed, or, a locked unit.

It seems dementia care units with small populations, more like a family homes, or with smaller units, are better for helping generally calm an agitated person. But as mentioned in other posts, the locked doors on even those, can drive agitation, too.
There needs to be a yard, perhaps, so the person is still safely locked in, but has a feel of outdoors, maybe...or staff who can walk them around the block. Or, family can visit to go for walks with them.

Bottom line: person is kept safe from harming themselves or others, and gets proper care.

It's just not OK for staff to get physically harmed by a patient and I can appreciate facilities taking that stand. It's awfully tough on the family, though, isn't it? My Mom (in late Alzheimers) was getting combative (she'd hit you if you suggested she change the clothes she was wearing or take a bath) and it can really hurt. Fortunately, we found that valproic acid helped contain her, and in the right dosage did not affect her appetite or sleepiness. Talk therapy is no use with this disease, though certain techniques seem to work with some people some time. Our latest caregiver found that Mom would take a bath if she went in (with her swimsuit on) with her, like girlfriends swimming. That is not something a nursing home would have time to do.

I agree with the responses above that a service provider has the right to accept /refuse service if the clients behavior poses a risk for other residents and the client. As an owner of a home care agency, I have seen facility owners/family members going through this same scenario. My advice will be : If you love the job that this facility is doing with caring for your loved one, try hiring a part time care giver who will provide one on one care to your loved one. that way the facility will not kick him/her out and you don't have to worry about looking for a new facility. This will give you / the facility peace of mind knowing that one on one attention is given to your loved thereby reducing the risk of getting hurt /injured due to the combative behavior.

Yes they are only able to do that if he is in a safe place and is out of their care.That is why they sent him to the hospital because legally they can't kick a person out without a safe place to go. Is your dad doing this so he can come home. Is he scare when he wakes up in a new place with no family or friends. sometime a family board on the wall before them helps.

Also, make sure they do not over medicate him to keep him quiet. That is like a chemical straight jacket is not lawful. It also suppresses his systems and cause things such as aspiration.

contact your local ombudsman. They can NOT kick him out and you are entitled to a 30 day hold on his room.

Yes they can! They must keep all other residents and staff safe. This happened at two facilities with my Dad in his initial placement. Everyone above gave you good information. I would only add, that aggressiveness and agitation also seems to be a phase in dementia. What helped us, was when the first facility sent him to the ED, and that ED sent him to a geriatric-psych facility and they were able to change meds all around and help him with good meds. I am not aware that the meds were constipated for my dad, ever, but his problems with his gut were more the other way anyhow. He returned to a very nice facility that was a small converted home, with only 10 residents. I think it was the best placement he had, except that he still had some agitation and need to go walking a lot and this facility didn't have that ability without staff in attendance. Their doors were locked all the time and that increased his agitation....feeling locked in. When they sent him to the ED and again refused to take him back, the facility we found, and where he has been for almost 18 months now...has geri psych doctors and nurse practitioners as part of their plan. My Dad has been able to be followed by these doctors and have slight adjustments up and down to meds and is now in a very 'happy' place. He is even sleeping much better at night and not 'wandering' as he'd been doing for years. This facility also has 5 cottages on a huge locked/fenced grounds and the doors are never locked. Just the gates. So Dad was able to wander, even at night, go walking to deal with the agitation at will. And the case manager/social workers at the psych hospital did work with on discharge....holding him while we were checking out facilities for him to move into. If you want the choice, you have to start the looking on your own....and the sooner the better! A facility will hold a bed and the hospital would hold your Dad to coordinate the transfer, if you are actively working with the case manager.

My advice, therefore, is once your Dad gets placed in another facility, try to get him in as a patient with a good geriatric-psychiatrist that can follow him. If they will go to his facility to visit and evaluate him, that would be best. If not, then you or the agency will have to take him to app'ts. If the facility takes him, then there may be extra charges, but to get him through this phase of dementia and he still stay in one facility would be best for everyone involved, especially him.

Before you think this is for sure legal, check with your State Department of Health. Each State varies and I know it is illegal in several states to do this.
Also look in the residency agreement you or your mother signed to move dad into the community. Most communities will give a 30 day notice...However, you might be responsible for private paying a third party sitter service to be with him 24 hours a day until he moves.
It's unfortunate this happens but sometimes medications need to be adjusted and sometimes you just need to find a different community.
If a community is saying that he should move, I wouldn't push them to much to take him back. They obviously feel his level of care is beyond their scope.
Take care.

Your father's AL community is definitely within their rights refusing his return. If it's a reputable and caring community, I can assure you they didn't arrive at that decision lightly. Usually every tactic for dealing with dangerous behaviors has been exhausted before they resort to having a resident move out. There's a good chance the director of nursing has communicated with the psych hospital about your dad's prognosis.

Paying to maintain your apartment while you're in the hospital is standard. Imagine if you're renting a regular apartment and you go on vacation for three weeks. It wouldn't occur to you that you should ask your landlord to waive the three weeks rent while you're gone. It's really the same thing. In fact the AL is much more involved in your dad's life than his landlord would be, and they're maintaining that relationship, too (sorting out all the medications and doctor's orders he would have been discharged with, etc.).

Others are right when they say to stand your ground. Get the hospital's social worker involved and make it very clear that you cannot handle his behaviors at home. If his behavior can't be controlled with medication, he really needs a specialized unit where the staff is specially trained in dealing with potentially violent residents.

Any business has a right to refuse service to anyone. In your father's case, his behaviors have probably crossed their threshold in their ability to manage such care. The other patients have to be considered as well as staff, and their insurance company might be warning them their coverage does not extend to such violent patients. When they returned the money, the contract was voided. Get your father's condition stabilized, while looking for a placement elsewhere. There has got to be a medical reason for his behaviors and the doctors at the psych hospital will find out what it is. Don't give up hope. Your father deserves to be in a place where his behaviors can be addressed. Best wishes!

Do you have or know of a good GP in your area you and Mom could have a consult with? MIL had mental health issues all her life, going in and out of facilities, on and off different meds that affected her differently. She was in a pretty nice place, popped an elderly gentleman, (who was in a wheel chair), in the noggin after an they had argument. They put her in an awful place from there, (safety of other patients, staff). I phoned a family member who is an MD for advise, had stayed out of it until then, husband's Mom, not mine. He referred me to an appointment to a husband wife team of psych Docs. They knew the Social Services system, moved her into psych ward of a nice hospital, greatly fixed the meds, got her into a nice place again once they had the meds straightened out. Both those Docs continued to care for her all her life and greatly improved her quality of life. She saw the wife for talk sessions, husband prescribed/monitored the drugs. Most importantly the wife knew how to move the paperwork around. :-) Best Wishes.

Yes they can and will the standard for Assisted Living and Memory Care units is that the client can not be a danger to him/her self or others or they must be discharged from the facility

I understand what a worrying headache this is for you, but the facility is not being judgmental about your father in the way that it feels to you as if they are. They have to assess whether or not they are able to handle his care safely, and if they believe that they can't then they don't really have any option but to refuse his return. Don't forget, they are in this for a profit; so they wouldn't turn away business just because they can't be bothered with it or didn't like their customer, would they?

Discuss now with the psych ward what his options will be when it is time for him to be discharged. He has to go somewhere, after all; and they are the experts on what happens to patients leaving their care. This situation is incredibly difficult and I am sorry that you are having to face it. I wish I had something more useful than sympathy to offer.

While I admittedly don't have a parent(or even a family member) anywhere close to being in a home. I think I can partially relate a different situation. I have a friend who is only 22, with major medical issues as a result of being abused by a baby sitter when she was a baby. She also has some behavioral issues where it has resulted in the local Sheriffs' department using a taser gun on her because they couldn't cope with her behavior. Also, Several local mental health hospitals all individually using Thorazine and Haldol to shut her up. In both situations, this has disgusted me. Because, I know how to treat her without being combative or trying to control her with medication. Far better than the local Sheriffs' department or any of the mental health facilitys' can. She does some seemingly strange stuff at times. But the one thing she does without fail is, she leaves everyone in stitches, including the fire department and para-rescue crews who come when her BP tanks. It may seem irresponsible on the part of a para-rescue crew. But, Just yesterday her BP was bad again. The fire department got there first, followed by the para-rescue crew. She had the fire department and para-rescue crew laughing so hard, that they were falling down, and had to request another para-rescue crew to take her to the ER. A year ago is when they would have called the sheriffs' department and get tasered. Now, While the call may take longer to do a simple thing. They are in stitches because of her behavior, instead of having a combative response to it.

Also, My (late)maternal grandfather had Alzheimers in 1976(when I was 9yrs.-old and my brother was 7yrs.-old). He was kept at home where my grandmother, mother, aunt, brother, and myself, could take care of him. So my younger brother were both the 'police' and 'fire department' depending on who my (late)maternal grandfather would be yelling for.

Family can take better care of someone, than any care facility.

There should be an elder law that requires the facility to provide a list of facilities that will take an aggressive resident. It is upsetting enough to move him and starting from scratch just makes it worse. Hopefully they will find the right med(s) to give him some peace. This approach worked well for my mom. Angry Demenia patients are pretty miserable.

Margaret52, the short answer is "yes" but it doesn't seem right does it? Both times the reason that my husband was "kicked" out was that he was upsetting the other residents. I remember the panic I felt when I learned that he was "homeless". My experience taught me that there are two departments that don't always agree. There was the sales department that assured me that Bob would fit in well and that they could handle his behavior, and then there was patient care that kicked him out when they couldn't handle his behavior. Finding an affordable facility that has the appropriate services isn't easy. It wasn't until the social worker got involved that Bob was moved into a nursing home. I do believe that it came to a point that I said "Bob has nowhere to go", and that seemed so unbelievably insensitive on my part, but it was the truth. A social worker handled the move into a nursing home. Your mom is handling an enormous amount of stress I'm sure - I will keep her in my prayers.

Yes, they can refuse to take him back. It sounds as if his behavior is the problem and he probably disturbs other residents. Behavior can also become a safety issue if he is combative.

Just as the facility can refuse to take him back, your mother can do the same. Simply tell the hospital that she is not able to provide the ongoing care he needs. The social worker at the hospital will have to find appropriate placement for him. Something similar happened with a friend of mine. The person receiving care had become impossible to be cared for at home because of behavior. After talking with a number of memory care facilities and non that would take them, the only option was a State psychiatric facility and they happened to have space available just when they needed it.

That is tough. A friend of mine found it was not easy to find a facility that would take an aggressive patient. She had this problem with her husband. She eventually found someplace, but only after a lot of grief and jumping through a lot of hoops. Most facilities in Arkansas won't take anyone they conceive is a danger to other patients or to their staff. You need to talk to someone who can give you good advice. Maybe an elder lawyer might be a good place to start or at least your local government senior services or dept of aging.

Good Luck to you and your mom...