Delusional and abusive elderly parent needs treatment. Where do I start?

I think you and mom would benefit from a consult with an Elder Law attorney.

Mom needs to call 911 and have him removed from the home and state FIRMLY that he cannot be discharged home.

Forget ratings. You can always move him later.

Talk to the lawyer about getting dad qualified for Medicaid. Their assets and income need to be separated so that mom is not impoverished.

Something tells me that your mom is easily manipulated by hospital personnel who try to make her feel guilty for not being able to care for him.

I will address the combative behavior. You need the intervention of a neurologist to address this. My wife exhibited this behavior(trying to hit and kick and pinch me) toward me personally, along with the other associated behavior of Alzheimer’s such as delusions and paranoia. The neurologist prescribed a medication which made the combative behavior almost disappear. I can now handle her and deal with the other Dementia symptoms much easier. Good luck. I do not feel like I should mention the medicine by name, but it is prescribed off-label for Dementia patients with good results according to the neurologist. And excellent results for my wife.

Short answer, call 911 and tell them that he is threatening your mother. Have him taken to the ER; call the Social Worker and tell them that there is no one at home who can care for him.

How did he come to be discharged from rehab?

Did discharge planning at rehab deem him capable of caring for himself, or did mom sign for his release?

Alternatively, move mom to Assisted Living or ANYWHERE and call APS and report him as a vulnerable elder living alone.

I’m so sorry that you are dealing with this situation. You have every reason to concerned about your mother’s safety.

Your father is extremely unstable and could absolutely harm your mom.

I agree with Barb regarding calling 911. Your mom must be terrified seeing these changes in your father’s behavior.

I would also move mom to a safe place.

I am curious. What was his behavior like when he was in rehab? What was said about his progress during the care meeting?

He absolutely needs to be on meds for his PTSD. Is he going to a VA doctors and hospital for services? What reasons did they have for not providing medication for his condition?

Have you contacted NAMI in your area?

I truly hope that you will be able to find help for your parents. Best wishes to you and your family.

Firstly thank you all for your advice and replying back to me. There are no guns in the house. He has been in and out of inpatient rehab due to falling down at home several times. 3 times that I can recall in the past 4 years. He has had sepsis twice, and is a cancer survivor, my mom is as well. The last rehab/nursing home stay was when he began to have hallucinations and became delusional. I was told that he was seen by some sort or mental health professional while there but nothing was done. He was not prescribed anything for his condition, no medication, or further assessment. We were informed that he has acute ptsd but we already knew that. They inserted a catheter while he was there which left him in so much pain that he was wincing constantly. The reason that they gave for the catheter was that he could not pass urine, due to an enlarged prostate. After he was basically forced to leave the inpatient rehab center because Medicare refused to cover more than 20 days of care. My mom and a his nurse were trying to have him admitted to a mental health facility but their was only one facility in the area which has horrible ratings. The stay there was limited to five days. When my mom asked what she was supposed to do if he was not better in five days? they twisted her words, claiming that she was refusing to allow him to come home, so despite his nurse and my mom insisting he received assessment, Medicare insurance would not cover his treatment/stay. So he had to come home. My mom arranged for him to go to the hospital via ambulance to deal with the catheter because he was just in unbearable pain. They found that he had an infection again and was not on any medication for an enlarged prostate. The hospital removed the catheter and put him on antibiotics & prostate medication, but did nothing about his mental state and sent him back home. To my knowledge he has not hit my Mother but he is completely unstable and constantly threatens to. Verbally abusing her and saying things that are so terrible that I don’t even feel comfortable repeating them. He wakes up in the middle of the night yelling and demanding food. He has no concept of time. He believes that there are people trying to harm him, spy on him, and sees animals that are not there. My mom has been approved for in home nursing care but there has not been a single nurse that has actually shown up to help her since he has been home. The last aid that was supposed to help a day or two ago apparently tested positive for COVID-19 and could not come. He is scheduled for a Doctors visit with the VA on the 7th. But my mom said she is going to try to talk to a VA rep/dr/nurse sooner. Resources in the area where she lives are sparse and difficult to find, which poses an additional problem. I will definitely look into any and all of the options and consider all of your suggestions. I really appreciate the advice and support. I really feel that he needs long term inpatient care, he has not be responsive to physical therapy in any way and is just declining to the point where neither I nor my mom have the ability, strength, or qualifications to care for him. Need suggestions concerning payment for the costs of long term care. He is a veteran, is suffering, and that should qualify him for the help that he needs. I just do not have experience navigating the system and this is daunting to my mom as well in addition to physically caring for him.

You don't switch from Medicare to Medicaid. Medicare you must take at 65 and is a Federal Government program. It cannot be dropped its Dads health insurance. Medicaid is subsidized by the Federal Government but also by each State. The States need to follow certain Federal guidelines but each State can also institute their own criteria. If Mom is trying to get Medicaid for health insurance, Medicare stays in place and Medicaid becomes secondary.

Yes, you need to see an elder lawyer. For Dad to be placed in a Long-term facility on Medicaid, Mom needs to have any assets they have split. Dads split will go to his care and when almost gone, Mom will apply for Medicaid. Once on Medicaid Mom will be able to remain in the home, have one car and enough or all of their monthly income to live on. An Elder Lawyer will be able to explain this better.

Maybe you should call your Social Service office and speak to a Medicaid caseworker. They can tell you how Medicaid for insurance purposes work.

To get Dad help it has to be while he is hospitalized. He really needs to see a Neurologist. He needs medication to help with the symptoms he is having and he needs to be in a facility. Rehabs are for getting people back on their feet after a hospital stay. PT and OT are offered. They usually just follow what the hospital did. They are not skilled nursing. They do not take the initiative to evaluate someone unless the family requests it. So Mom could have asked for Dad to be evaluated and told why. If it was found that Dad needed 24/7 care then she could have refused to take him home and have him placed in a Long-term care Unit. Then start the Medicaid application. Again, if there are assets, see an elder lawyer to split them. Only a lawyer can do this.

Medicare insurance did not run out after 20 days. Medicare pays 20 days 100%. From day 21 to 100 they pay 50%. The other 50% the patient pays or if good secondary insurance, they pay the other 50% or partial. Your Dad was probably not cooperating with Rehab or hit a plateau so Medicare had him discharged. At that point Mom could have refused to take him home and had him transferred to LTC.

I know that she is trying to switch him from Medicare to Medicaid to cover costs, is there anything that I can do to help her with this process? I totally agree that she should contact an elder law attorney. Is it within my rights to consult with one myself on her behalf or do I need POA or something else first before I can do that? I too think that she is being manipulated by hospital/nursing home personnel, but her main problem with his care from what I have experienced is the Medicare insurance coverage refusing to cover his treatment. I think that she should call 911 when he wakes up in the middle of the night having hallucinations. If she did that would they take him to the hospital? If she cannot get the insurance to admit him to a mental health care facility for assessment, I am guessing that the hospital may admit him to their psychiatric care unit. If she goes to the hospital with him, what would be the best way for her to help him be admitted rather than just taken to the emergency room, sedated, and released? This is actually my main worry about calling 911, because if they simply sedated him and released him it would just make this whole situation worse.

Depending on location. The VA hospital might do an intake. Social services need to place him in professional care. This sounds like a precarious and urgent situation. You can contact your local EMS, your own dr., lawyer, and call the nearest hospital about having him baker acted. The 20 days is supposed to buy him time to get placed somewhere via the social worker at the nursing home. You might have to play phone tag and get info but in this case, baker acting him could shift the gears. Ask the cops and ems and fire department right away via non emergency phone numbers.