Father In Law being violent in Nursing Home rehab facility

[Anonymous]

My 90 year old FIL recently had a surgery that is requiring 2 weeks of rehab in a nursing home. He usually lives in the community's assisted living. He has gotten violent pushing and yelling at the staff. This somewhat fit his personality. I also suspect alcohol withdrawal is playing a part (he's a heavy drinker without access right now). They have moved him to a lockdown floor and he is still being dangerous to himself and others. The social worker is all but demanding we hire a 'watcher' to sit with him and prevent more issues. Basically sounds like a home health care security guard. They refuse to talk about getting in a doctor or psychiatrist and simply sedating him as an option. He's on no meds right now. This seems like the easier, less expensive quick fix until he can have a full psychiatric evaluation. Anyone been through a situation like this? What questions should we be asking as his family?

[Anonymous]

Used to work as an RN in a SNF and now do at a hospital. Generally, places like to try non restraint options first (so a sitter) before resorting to pharmacological restraints or physical ones. Plus, sedating the elderly is a risky game. "Simply sedating him" is actually far from a quick fix.

[Anonymous]

Do they know about his alcohol use? Withdrawal can be life threatening and needs to be monitored and treated with medication.

[Anonymous]

We had to get a sitter for my FIL in rehab as he was very confused and a fall risk. Sedation and restraints are used very cautiously these days for good reason, so you should be meeting with your care team to discuss options and concerns. Most of these facilities can't dedicate one-on-one resources to patients who have extraordinary needs. Agree that the team should know about alcohol withdrawal.

[Anonymous]

Medications can also backfire. My elderly relative suffered a fall, and was placed on a medication in the hospital. This medication had exactly the opposite effect of what was intended, and she became extremely agitated and agressive.

[Anonymous]

Another RN here and I agree with the previous posts. The last resort is restraints and meds. It sounds like they're doing what they can in their power to keep him there but if the sitter is not provided he will be considered too acute for the facility and you will be forced to look elsewhere for a home for him.

[Anonymous]

Anesthesia can also create dementia/delirium in the elderly that can last up to a year.

[Anonymous]

Anonymous wrote: Another RN here and I agree with the previous posts. The last resort is restraints and meds. It sounds like they're doing what they can in their power to keep him there but if the sitter is not provided he will be considered too acute for the facility and you will be forced to look elsewhere for a home for him.

I am a social worker in a nursing home, and this is the approach that was used when I had a patient like your dad. The state I work in frowns on use of medication just for the sake of sedation, so we asked the family to hire an aide/ have a family member with the patient at all times. He finally got to be too much and we sent him to the psychiatric hospital so they could be responsible for upping his meds, not us.

[Anonymous]

A sitter is a very compassionate option OP. He is likely confused as to where he in in the middle of the night, as well as a bit of alcohol withdrawal going on. I flew from DC for a week to be a night time sitter for my father when he was in medical rehab, for the same issues as yours.

[Anonymous]

Anonymous wrote:My 90 year old FIL recently had a surgery that is requiring 2 weeks of rehab in a nursing home. He usually lives in the community's assisted living. He has gotten violent pushing and yelling at the staff. This somewhat fit his personality. I also suspect alcohol withdrawal is playing a part (he's a heavy drinker without access right now). They have moved him to a lockdown floor and he is still being dangerous to himself and others. The social worker is all but demanding we hire a 'watcher' to sit with him and prevent more issues. Basically sounds like a home health care security guard. They refuse to talk about getting in a doctor or psychiatrist and simply sedating him as an option. He's on no meds right now. This seems like the easier, less expensive quick fix until he can have a full psychiatric evaluation. Anyone been through a situation like this? What questions should we be asking as his family?

Chemical sedation, as you are disgustingly suggesting, is a restraint. Something the facility will do everything to avoid. They sound more than reasonable I never asking you to provide a 1:1 sitter

[Anonymous]

Anonymous wrote:

Anonymous wrote:My 90 year old FIL recently had a surgery that is requiring 2 weeks of rehab in a nursing home. He usually lives in the community's assisted living. He has gotten violent pushing and yelling at the staff. This somewhat fit his personality. I also suspect alcohol withdrawal is playing a part (he's a heavy drinker without access right now). They have moved him to a lockdown floor and he is still being dangerous to himself and others. The social worker is all but demanding we hire a 'watcher' to sit with him and prevent more issues. Basically sounds like a home health care security guard. They refuse to talk about getting in a doctor or psychiatrist and simply sedating him as an option. He's on no meds right now. This seems like the easier, less expensive quick fix until he can have a full psychiatric evaluation. Anyone been through a situation like this? What questions should we be asking as his family?

Chemical sedation, as you are disgustingly suggesting, is a restraint. Something the facility will do everything to avoid. They sound more than reasonable I never asking you to provide a 1:1 sitter

Sorry, "I never" should just be in. And ftr, I'm an rn who does a casual position in a ltc/rehab

[Anonymous]

Anonymous wrote:Anesthesia can also create dementia/delirium in the elderly that can last up to a year.

This. My FIL just had a hip replacement at 91 - I know, we couldn't believe he was cleared - and was in a rehab on the Gulf coast during the hurricane. He was horrible to the hospital staff right after the surgery and in the rehab facility, and there was no alcohol withdrawal involved. Punching nurses. Ripping IVs out. It was awful.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Anesthesia can also create dementia/delirium in the elderly that can last up to a year.

This. My FIL just had a hip replacement at 91 - I know, we couldn't believe he was cleared - and was in a rehab on the Gulf coast during the hurricane. He was horrible to the hospital staff right after the surgery and in the rehab facility, and there was no alcohol withdrawal involved. Punching nurses. Ripping IVs out. It was awful.

+1 re the anesthesia. I cannot believe that the doctors did not discuss this with you, OP, before the surgery. There is solid research documenting this issue. I went back several times to reread your post to be sure that the surgery wasn't emergency in nature because that was the only reason I could think that no one broached the subject with you. It certainly is a problem that no one discussed possible ramifications of anesthesia with you.

I agree with other posters that a sitter is the more compassionate approach and safe approach. You definitely need to tell the docs about the drinking although that, too, should have shown up on the pre-op bloodwork and someone should have asked you about it.