How should I respond to caregivers daily updates of concern and frustration with my dad's increasingly aggressive behavior?

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How should I respond to caregivers daily updates of concern and frustration with my dad's increasingly aggressive behavior?

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My Dad is becoming increasingly aggressive and an in home caregiver was mildly injured by him pushing a table against the wall in his anger. (Her finger was jammed from him pushing the table.) I get calls and texts all throughout each caregivers shift and other than commiserating, and offering various solutions —most of which are redundant because they’ve already tried them—I’m at a loss as to how to help or what to say. That’s the job, the very difficult job of dealing with my dad who has mental illness, advanced dementia, lives at home in a rural area far from services , too poor for memory care, on Medi Cal with In Home Support Services, too physically healthy for a nursing home to take him on. He’s 6’3”. I’m his conservator living 8 hours away. There are not many caregivers in his remote location, I fear that we will burn out the few that are willing to come.

Alzheimer's & Dementia Care Decisions Home Care Violent Behavior

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It sounds drastic but he needs to be in a home that can cope with him. If he cannot afford this then put the problem on the state he lives in. Tell the carers to call police if he is uncontrollable and let the courts take over representing him.

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Unfortunately California Medi Cal does not pay for assisted living or memory-care. And only pays for a nursing home if the person require medical assistance daily.

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You need to address the issue of your dads behavior. He’s on medi-cal So he’s eligible for financial assistance for AL living or memory care. Has he had psych evaluation recently to see what’s going on? If he’s on medication, maybe it needs to be tweaked. If he’s not on medication, perhaps there is a medication that will with his behavior. Because the truth is, you either need to get his behavior under control or get him placed in a facility. He cannot be having violent outbursts with the IHSS workers. They will refuse to work for him. These workers are not trained professionals and they aren’t paid nearly enough to deal with this type of work environment.

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It’s not fair to these workers to be placed at risk for being harmed from his outburst.

Cali, I wholeheartedly agree with your post. He needs an experienced professional staff caring for him.

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I think your are justified in your fear that you will burn through your caregivers. To me the constant updates are a way of giving you notice that they can't handle it and things need to change, once it becomes clear that you are essentially throwing up your hands and telling them it's par for the course I wouldn't blame them if they walk.

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I’m definitely not throwing up my hands, nor have I given her that indication. Aggressive behavior and paranoia are part of the disease. I’m looking for resources and ideas to keep him calm.

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With advanced dementia and mental illness, seems he would be a perfect candidate for a nursing home. Or better, in a memory care unit, usually a subset of a nursing home or assisted living facility.

As others said, he either needs to be medicated to get his anger under control or moved into a facility where they will most likely do the same thing with fixing his meds to control unacceptable behavior.

This is a very difficult situation but it does need to be dealt with somehow.

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Has he been diagnosed with a particular type of dementia?
Some dementia there can be more violent episodes. This can be very dangerous for caregivers. Are caregivers with him 24/7/365?
At any point one of the caregivers may decide to call 911 due to a violent outburst.
Is your dad a Veteran? If so the VA might be able to help with either in home help or placing him in a VA facility if he qualifies. (it would depend on where and when he served)
Is his doctor aware of the violent outbursts?
Has medication been an option?
(the reason I asked about the diagnosis is LBD (Lewy Body Dementia, it has Parkinson's type effects as well) can be difficult to medicate)

On a side note please make sure that no weapons of any type are in the house and lock up any knives or any tool that could be used as a weapon.

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He needs to have a thorough evaluation for his behavior. I agree with Cali that his situation must be addressed. Yes, caregiving is a tough job but the requirements shouldn’t be that they accept abuse due to his behavior.

You will regret it one day when they file a report one day of abuse to the police. Wouldn’t you become frustrated if you were in the caregiver’s situation? It isn’t fair to them.

Has your dad seen a geriatric psychiatrist? There may be medication that could control his behavior.

I personally feel he should be in a nursing home with a professional staff. Do you have any power of attorney regarding his welfare? If you do, why aren’t you advocating for a solution to his needs?

How long has this been going on? You are right to be concerned about his caregivers burning out. I would be just as concerned about their safety. No one deserves to be at risk for being harmed.

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Darlin,

Who exactly has done an evaluation on your dad? He should have a complete needs assessment work up.

Are you in contact with his doctors? Call and tell them EVERYTHING. This situation is becoming unmanageable for you.

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Yes, I am his conservator. I talk regularly with his doctor and the several caseworkers for the myriad of agencies involved in his care.

Evaluated by the state IHSS, MD, Superior Court Investigator, private caregiving agency, and hospice caseworker.

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Sounds good, but unfortunately California Medi Cal does not pay for assisted living or memory-care. And only pays for a nursing home if they require medical assistance. The state has assessed him as only needing 15 hours a week of home care. He will not take meds willingly. A psych eval is impossible as his dementia is too progressed. That’s kind of my point... I’m in a pickle.

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Medi-cal, the cool name that California calls medicaid, will pay for memory care. Dementia is a medical need. In fact, it's considered a terminal illness. You also mention that your dad also has other forms of mental illness. Those would qualify him if dementia does not. If the state has assessed him as only 15 hours a week, then they must think he's still high functioning.

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Darlin I hope if you are private paying you have a good insurance rider, because someone is going to get hurt here, and you could be sued . Or dad could, not sure who hired the workers as you live far away. I get that he is "too poor" for MC, but there are other options out there, let the SS know what is up, and let them help before you all get sunk by this

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It's been my experience with parents and children that when caregivers are constantly calling/texting you that means they can't/won't handle the situation and there is an expectation that YOU will DO something. If you do not do something, there will be consequences - like them walking out. It's for that reason that I urge you to try to get something else in place. Clearly the current situation is not working for him or his caregivers. I'm so sorry you're going through this. It must be so difficult to manage from far away. Any chance you could bring him closer to you?

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He needs to be gotten to a psychiatric facility so that needs can be adjusted to decrease his agitation and aggression

Talk to his doctor about thus and don't take no for an answer.

Has he been seen by ANY geriatric psychiatrist?

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Barb,

Read the response to an earlier message to me just now. She says that she is his conservator. She also mentioned hospice. Does that help or complicate this matter? Is hospice denying further evaluations or meds? I don’t know how hospice works for these issues so that is why I have to ask you.

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Make sure your dad as adequate liability insurance. Even though he's on medicaid and thus low income, if he owns his house he still needs to protect that. In this case though, since the caregiver is provide by an agency, it should be covered by the agencies business policy. Still, liability insurance is cheap. Better to have it than not. We have a million dollar rider. It only costs $300/year.

As for the reality of little injuries like this. I think it's part of the job. My grandma can be resistant in hospitals and rehab. When I apologize, the CNAs just say that she's not even close to being that bad.

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This is why he needs a new and complete evaluation. Sad situation. He needs proper medication to deal with his issues.

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Darlin,

You mentioned hospice to me in an earlier post. Is he currently on hospice? The reason that I ask is that all hospice organizations are not the same level of care. You can switch companies if you need to.

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He doesn’t qualify for hospice yet, they assessed him for it though. Also there are very few resources In his rural area.

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Better make sure the homeowners insurance includes if one of them gets injured. The caregivers probably going to demand you pay for medical expenses due to their injuries from him. You are lucky if they don’t sue for injuries & damages.
Get him into a facility that knows how to deal w violent patients. Hugs 🤗

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The caregiver and I have great communication. She is not going to be suing over a bruised finger. She is covered by the state.
my question was for people who have dealt with this issue in dementia patients.
He has cabin fever right now, as well, since there is a lot of snow there.

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This should have been placed under dementia not home care for me to get more helpful responses. I can’t seem to change the category.

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The category doesn't matter. I doubt many people even know what category it's in. People just look at posts when they click on "forum". The posts from all the categories are mixed together.

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The category does not matter. We all see every post.

YOU need to find the solution to the problems dad is having. That is not the caregiver's job. She lets you know what is going on because she is screaming out for adequate assistance for your dad. She is not qualified or authorized to do that. She needs YOU to help your dad.

Rural areas are awful for finding necessary medical services. You need to get dad out of there and into adequate care. Yes, this will mean you have to put in some effort to get dad the care he needs. You will have to dedicate some time to do this, or hire a geriatric care manager.

Before you say "MediCal does not pay for assisted living or memory care", it does not sound like you have checked into your dad's situation specifically. Are you relying on hearsay? Every state, including California, has a waiver program tlas part of Medicaid to get people like your father the care they need.

You need to be more assertive and inquiring about getting the services dad needs. Are you in denial that it could be as bad as the caregiver says? You need to tackle this problem head on to get it solved. Yes, you will need to spend some of your time to do that. And best get it done before someone is seriously injured. When finally setup then you can sit back knowing dad has the care he needs.

Sorry you do not like the answers you are receiving here. You are getting reality. Yes, it is inconvenient for now to have these problems. They will continue and will worsen with time. How long are you going to wait?

Who is the Power of Attorney? Conservator takes care of money most places, not POA decisions such as where someone will reside.

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Wow! Seriously?!
You clearly do not have have any clue what a conservator is?!!! Look it up! I spend several hours every single day on managing my dads care, and every detail of the many agencies involved.
The waiver is for just a few counties and neither of us are in those.

I was just there last weekend. I go up every two months.

I appreciate you taking time to add the links. I’ll check out the ones I haven’t previously.

But....Your words are harsh and lack compassion. That is NOT helpful. Assuming I am uninvolved and not putting in effort is a stab in the heart. Ask my husband how much effort I am putting in!

This forum is too support each other not shit on each other.

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Link to waiver program in California.

https://www.payingforseniorcare.com/california/medicaid-waivers/assisted-living-waiver

This may offer more information for you if dad is n Medicare.
https://cahealthadvocates.org/low-income-help/medi-cal-for-people-with-medicare/

https://cahealthadvocates.org/hicap/

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The assisted living waiver has a long waiting list I was told.

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Exactly...if you fear losing them, they are calling out for you as next of kin to help. I'm sorry for the remote location, but clearly you need to connect with some better resources and possibly consider a move where he can be monitored and better taken care of.

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My tiny well mannered mom became violent and used swear words I didn’t know she knew. The dr suggested she go into a psychiatric unit to try different meds and do some diagnostic tests. They found her vision and hearing had declined. Her medication has been changed to mellow her out and the cares givers have been trained how to approach her. I do believe she was scared and startled with the caregivers.
It might be worth a try

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This has been the most helpful answer— thank you!! Someone that has dealt with this is what I was hoping to find.

My dad would have to be tied down to be in a hospital. This was our experience 4 years ago. The courts demand I keep him in the least restrictive setting.

If this continues or worsens I imagine this it what his doctors may suggest.

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Psychiatric evaluation...
A psychiatrist ( or others, depending on the state) or the court can determine that he is a danger to himself or others... in our state two witnesses can go to court and swear out an affidavit if necessary... and get him a (full ?) evaluation to determine what needs to be done.
A case manager/social worker/etc should have other ideas for ways to approach getting the correct care for your dad....
Area Agency on Aging ?

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The state court Investigator was there 4 weeks ago and IHSS case worker the beginning of December. I can ask IHSS to come again.

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Darlin; is there a guardian involved?

Have you asked dad's doc about a psychiatric committment?

We are trying to help. You are not answering the question.

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In my state there are conservators that watch over money and expenses, as was learned through a court battle.

Guardians watch over health and residential placement. Not all states are the same. I guess darlin's state is different than mine.

That is why we often see recommendations to consult with an elder law attorney.

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You have been given good advice. However you seem to not want to believe it. The caregiver, if serious incident occurs, should call police to attend. This will very likely involved a hospital stay in adult mental health ward where he will be evaluated. You father cannot stay at home anymore. Is it his dementia that is the problem or his other issues.

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I had a similar thing with my father. Turns out he had ALZ. He too would become physical to the point of punching the nurses. At some point he actually was able to overturn both my mom and himself over in the walkers they were using. I called 911 for help, and they took him to a psychiatric facility. There they were able to change medications for the better. After that they tried to move him to a rehab center, but instead he went walking out of the place in his PJs. It was quite the journey. Next time something happens and someone gets hurt, call 911.

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Is he a vet? If so, call the VA and explain the situation, see what they might offer.

In any event, it sounds as if he needs a new evaluation. Calling 911 and getting him in to a hospital when he has another outburst might be the only effective way to do this. We had to do this with my 80-pound mom when she went berserk about her meds one day.

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Darlin, is this behavior fairly new and escalating?

Has he been checked for a UTI? That was my 1st thought, he is going wonky because he has an infection.

When was the assessment done for your dad? I ask because facilities do a care plan every 3 months because things change so rapidly with dementia. I would request a new assessment if it has been a while, things have obviously changed.

Best of luck getting this sorted out, it is the most difficult thing to do, care for a non compliant parent that has aggression! Ugh!

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Thank you for your advice. He can get cantankerous if overly confused or tired. But the ‘bad days’ as the girls call them have been for the last two weeks, really without any good days. So UTI is definitely a good thing to check for. I sure hope that’s it and this isn’t his new normal.
His last assesment was the beginning of December

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When my sister gets agitated or overly anxious, I've begun giving her CBD oil with THC in it. I mix it half and half with a liquid B12 vitamin that she takes, so she doesn't even know she's getting it. It's 1 part THC, 10 parts CBD. It takes about 45 minutes to be effective, but it settles her down so she's able to just sit and watch tv. It doesn't debilitate her at all, just calms all that stuff going on in her brain. It's been a God send for both of us!

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Have you had him diagnosed? If he has Alz, and one of the symptoms just happens to be aggression, then explain it to the caregivers before they start.... and iť won't be such a surprise. You should also use that as an excuse to get him into a psychiatric facility where they can get him on some meds to help out a bit. Next time call 911 and explain that he's out of control and can hurt someone or himself. Three state may pay the bill - but don't let that concern you. He is personally responsible for iť... not you.

Been there done that.

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How should I respond to caregivers daily updates of concern and frustration with my dad's increasingly aggressive behavior?

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