Can LTC refuse to take my mom back?

In the behavioral unit she has only displayed some anxiety which they’re treating with Ativan. Taken off Zoloft and Keppra which has crazy side effects. From what I’ve been reading here, is that she has already blown it with the aggression. This aggression started happening when she was placed on isolation after being locked down for several months. She was so weak from staying in her room those months which made her legs like rubber which her confined to a wheelchair but every time she tried to get up she would fall. When they would come and help her and tell her no you can’t get up...it would make her agitated and it just escalated which made them add more Zoloft and more Xanax. One day when I talked with her she sounded drunk . I know what her triggers are, loud voices and lots of commotion, she needs a quieter setting. I have talked with her the last three days and she sounds more lucid than she has in the last month but will randomly say something totally weird, like she thinks she is there to get married and have a baby. And yesterday she was telling the nurses she went out and bought the scrubs she was wearing to wear to a funeral she was going to that day. She thought the ambulance ride from ER to the behavioral unit was a train and one evening while in bed talking to me she thought she was on the train heading back home. It’s so strange that she can be so clear on saying some things and in the next sentence it’s totally off-the-wall.

Could use some encouragement that I can really trust this behavioral unit, I’m just discouraged.
I thank all of you for helping me out here.

Take your queue from them. Planning questions is hard, they may or may not fit the conversation. And don't worry afterwards you will think of lots of questions you meant to ask. They will be there even after the meeting.

I googled and found this article that might be helpful.
https://friendshospital.com/programs-and-services/older-adults/

Any suggestions on to what to ask the at the behavioral health unit tomorrow?

NYDaughterinlaw said it all for me. You should not accept her back home, nor should you be responsible to find a level of care for her that you cannot know about. This needs to be the work of social workers now trained in this matter. I am so sorry. This sounds so impossible, and in truth it CAN be. Finances, level of care needed, and our health system all play into a nasty stew that is impossible to stomach. I am wishing you so much luck going forward; stay strong.

Mom can’t get out of wheelchair by herself without falling. This is s recent change since several weeks into lockdown. She used a rollator before and struggled with that.

Bella--

Anger and acting out in the elderly--combined with a lack of 'boundaries' about whom she's 'attacking'--well, I just read a post earlier about a woman who is pretty much beating up every roommate she gets. It was awful.

I feel for you--but if MY LO was in with someone who was violent--I'd raise Holy heck. You place your LO's in NH's and EXPECT a decent level of safety for them. If I heard my mother had been pushed around by a resident who is clearly out of it--and it was a "known" factor and nobody protected her--well---sorry, that's a huge lawsuit against the facility, and by default, you.

LOOK at the people she's 'abusing'. They have hearts and spirits and lives too. CG for angry elderly people is so depressing.

Your mom is obviously your worry and concern and that is exactly as it should be, but she doesn't get to make other's lives miserable by being, well, mean.

Stay involved in getting her evaluated. But---don't bring her home. Unless that is absolutely the only choice. Psych meds in the elderly are a challenge. What worked for someone in their 50's may not be the best choice for someone in their 90's. AND, they work slowly--up to 6 weeks for a noticeable help. The only thing that really works immediately would be a benzodiazepine and those don't stay in the system long. She'd have to be monitored closely--but sounds like she is being watched now.

Good Luck. This is hard. My own mom (still living with my brother's family) has become quite mean and her filter is pretty much gone. She can say awful, biting, hurtful things--and sit there with a sweet smile on her face while she says it.

Do not accept discharge to home. Let the behavioral health unit deal with placement.

Aggression is not something to play around with. You state repeatedly that your mother has dementia. Aggressive behavior can last a decade or more. Is your husband really okay with having her move in for 10+ years?

You have not been able to figure out your mother's triggers, which is usually what causes aggression in patients with dementia. It seems, however, that her needs are so great that any one of them not being met to her satisfaction is a trigger because her brain is broken.

Stand firm with the behavioral health unit. Ask them what care homes specialize in aggressive patients. I'm thinking any facility that handles PTSD or TBI patients may be able to handle your mother.

Bella, remember the CDC guidelines, quarantine until free of any symptoms for 3-4 days and if you have had possible exposure 14 days? Not sure that is correct. That is what is practiced here.

Hospice does not necessarily mean she is near the end of life. Some people get better and actually discharged from hospice. An evaluation wouldn't harm anything. They help with all sorts of things; there may be suggestions helpful to you. It was hospice that recommended the care home for my mom. Worked out so much better for mom. They know of all options available out there and the best ones.

There are many, many false negatives.
https://www.npr.org/sections/health-shots/2020/04/21/838794281/study-raises-questions-about-false-negatives-from-quick-covid-19-test

Bella, my mom was kicked out of memory care because of aggressive behaviors. There is no such thing as "a little aggression", that makes her a danger to herself and others, it could escalate very easily and without reason. It is completely unpredictable. Has mom been evaluated for hospice?

When my mom was kicked out of memory care, she was on hospice. They suggested a much smaller facility, a care home. It worked out great for mom, would have been better for her from day one. Each resident at the care home had been kicked out of previous facilities. Can you imagine?

The care there was better, the care ratio was lower, it was a homier atmosphere, not so antiseptic or regimented. AND it was cheaper.

Do not bring mom to your home, let the social workers do their jobs of finding a place for mom.. Don't even mutter a thought of it. Be patient, this Covid thing has slowed everything down.

Did you know that pink eye is a symptom of Covid in some people? Unfortunately a negative test does not mean she is really negative. She is displaying symptoms.

https://www.webmd.com/lung/news/20200401/pink-eye-often-a-symptom-of-covid-19

Someone please help, I need guidance ASAP

Thank you for your response it was well needed. The thing is, she’s acting nice in the behavioral unit and they’re saying she’s not meeting criteria to stay there or to be evaluated any further. When she first arrived there 11 o’clock Wednesday evening she had a low-grade fever and double pink eye. Moved her to the hospital side on the same floor as behavioral unit because of suspected Covid, test came back negative but they chose to keep her on the hospital side because she was not meeting criteria to be moved to the behavioral unit. Then yesterday I get the call saying that they want to send her back to LTC which does not want her back until she gets a med change and psych eval. She has had a sitter with her the whole time since she’s been there and she’s evidently loving it and acting as sweet as can be. They do not understand all the incidents that have occurred within the last two weeks at LTC. She has paranoia, vascular dementia, big confusion, extra stressed because of being on an isolation unit on top of being locked down before that. She fell 5 times within the last two weeks, to those times she was sent to ER and when she came back she had to be in isolation again which caused great aggression/anger. She has to have help walking, help getting up and off the chair, help to the bathroom, wears a depends everything because her legs are so weak and she’s off balance. She has flipped people off and told them to go to H*ll. Head butted her favorite nurse and scratched her, pinched, punched a CNA in the nose and left a mark, made some racial slurs, thinks everyone’s out to get her, told me she would use a gun if she had one. Sometimes refused to eat and when they did bring her food she throws the plate at them, spit her meds out, threstens to call the police etc. etc. I tried to reason with her a little bit which I usually don’t because I know that makes dementia people worse but she was acting out so bad and she finally said I was no longer her daughter. So far she’s only harmed staff but I fear that could change very easily and start acting out on residents if she had a chance to be close to any of them. The DON at LTC has been trying really hard to help me out and find out what’s wrong with her they tried to work with her and everything but she has hurt too many people now and is just trying to get her some help with this behavioral unit but since she’s not acting up they don’t see her as a problem and want to have her go back to LTC. The DON says she think she’s acting better because she has a one on one sitter and that is something they can’t offer at the LTC . She hasn’t even had a chance to be evaluated by the psych doctor there yet because all the reports say that she’s not showing any aggression. Friday afternoon of course the psych doctor has left for the day and I demanded to speak with her. Maybe she will call me maybe she will not. Prob not
I called the ombudsman yesterday and they said that her LTC cannot legally keep her out that they should have told me on paper that they would hold her bed for 10 days, is this true ? They also said that they have to get her a one on one, is this true ? Even if it was I wouldn’t want her to go back and start harming people again, my mom needs help she’s miserable. For two days she sat in the hospital next to the behavioral unit, the medical side they call it, doing absolutely nothing and nothing was happening. They held off giving her Zoloft, gave her some Ativan for a little aggression they said, her neurologist told them to discontinue Keppra and up the topiramate (sp?) some. It’s like they were just sitting there waiting for her to act out and she never did so now they’re saying she goes back to LTC. I’m really stressed out and probably not making sense but all I want is some help from my mom who’s been passed around like cattle. I absolutely cannot bring her into my home and try to care for her I’ve learned way too much on this site.

Yes and it will most likely be that they “cannot meet the level of care needed” for reason. It’s a valid way for a facility to refuse a return or not allow an admission. The place she is in now then will have to find her a facility.

It sounds like you’ve been thru this before, right? Well then you know that they will press upon you or family or friends to come and take her into their home. That they will try to guiltify whomever to come and take her and get her moved out so not their responsibility anymore. So stay firm and do not do this, unless of course you can provide the care she needs and do it from here on out. Be sure to let family know as they may unwittingly think it means just picking her up and having her stay with them for a few days till a spot opens up somewhere and not an issue,

I’d suggest that you try to think back & write down to review just what it is /was that has led places as to not have her stay as a resident.

you wrote that she’s in a behavioral unit right now..,. So I’m going to guess that she has had psych issues of some sort? would that be accurate? If it is and she has done threatening behavior to other residents and staff to the extent that they have to call EMS to take her to the ER or placed a 30 day notice and she moved due to this, it’s imho going to be very difficult to have her get is to a traditional NH. She’s going to need a locked ward type of residential care. The behavioral unit she’s at now has had to deal with this very difficult placement before. They can do it..... they know what’s available statewide; but if they get the vibe that you’ll come and get her, then it’s what they will do as their problem (mom) is now totally your problem. So if need be role play your responses for what’s coming so you are ready in letting the discharge SW at the behavioral place know that you cannot pick mom Up and you cannot provide a safe and security home and the level of oversight needed for her. They will find a place. Good luck, this is very hard situation.