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My Father lives in a Nursing Home in South Alabama, has been there a year. He has Dementia, is blind, confined to a wheelchair. He is a Medicaid recipent. Today he became aggressive with a male Nurse. It is my understanding that he was “fighting” with him. They have had a nice relationship before. An ambulance was called to take my Dad to the hospital for his behavior, no injury.


I saw him earlier in the day, his behavior was different.


He has been admitted, maybe a stoke caused behavior. I will know more tomorrow.


Can the Nursing Home not let him return?

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If there is an adjustment to medication made or an infection found (like a UTI which can cause this type acting out) then perhaps the NH would consider it a one off event. If it is something that has been occurring and continues in the hospital, they might feel he needs a different level care. A blind man in a wheel chair sounds helpless but I know seniors can be amazingly strong at times.
I hope they sort his issue out soon. It doesn’t matter to them that he is on Medicaid.
I know this must be very upsetting for both of you.
If he has an infection then he’ll need a little time for the antibiotic to help. Let us know how he is doing.
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I wouldn't quite put it like that, can the NH not let him return.

A nursing home can have very good reasons for refusing to continue services for somebody who needs more care than they are able to provide, or different care from what their staff are trained in. So if something has changed in your father's condition which means that they cannot keep both him and their employees safe, wouldn't you agree that they would be right to say so?

But I also wouldn't get ahead of yourself. What can't happen is that your father is kicked out of the hospital with nowhere safe to go. If the hospital can find out what caused this isolated incident and get on top of it, well and good and the NH should be content to welcome him back; but if he needs a step up to a specialist memory care or dementia care unit they'll work with you to find one.

As your father's advocate, it is only reasonable that you should be given a detailed report of what exactly happened. Sudden aggression could have a clinical cause (uti, stroke) but it could also be that something freaked him out or that he's in pain. You know that the nurse wasn't a stranger to him and that they had a good relationship, so that wasn't the issue; but it would be really helpful if the nurse could describe what was going on - all clues welcome!
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I’m NOT saying that in your case, he will be removed. I only know that the NH we are hoping to get my mom in has warned us that they do not accept patients with “behavior problems” and that if they develop them, they have to leave.
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lealonnie1 Jan 2019
Ok, so we're already in an elder care crisis.......dementia and Alz is already off the charts and only getting worse. SO MANY of these poor souls WILL develop 'behavior problems', due to the nature of the disease!!! Where on earth would they be able to go if the nursing home kicks them out? It's just too much..........while Rovana is right in that other residents shouldn't be put in danger due to violence, the question still remains: WHERE does the resident go next? It all gives me the willies, frankly. People are living too long and as a society, we're not equipped to handle it! All the facilities want well behaved, polite, clean, capable people to be residents, but these DISEASES make it impossible. A real catch 22. My dad was going to be evicted from his ALF due to his brain tumor causing him to be a 2 person assist. He wound up going on Hospice care and that gave him a 'pass' to stay until he died. Now my 92 y/o mother is an on-again/off-again 2 person assist due to various issues and we're being threatened again. She's not qualified for Hospice and there's nothing much wrong with her health besides dementia and vertigo (which causes the need for 2 people to help her), so I don't see Hospice in her near future. If I have to place her in a SNF, she will run out of money in no time & then I'll have to apply for Medicaid, etc. Makes for lots of STRESS for us 'kids' who have to figure out how to handle all of it. Never mind that us 'kids' are in our 60's and 70's. Sigh.
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There could be a medical reason your dad was aggressive. It can also be that something changed or happened to make him that way. If he is blind, I would think he could startle easy. And the nursing staff could be abrupt changing his clothes, shaving him etc because they were in a hurry. Either scenario is possible.
My dad got upset when the one cna was assigned to him. He got very agitated when she walked in the room. This happened sev times. At first I thought thats odd, he is fine with everyone else. One time she walked straight into the room and shoved a hamburger in his face and told him to eat. No hand washing. Nothing. That shocked me! She threw bedding on the floor. Nursing homes get fined for that. Other times his face was bleeding quite a lot from being shaved. These were big long scrapes down the side of his face. Like someone pushed down on the razor very hard. This went on for a while. Long story short she was fired I believe. So there could be a valid reason he is aggitated. Not every cna is a good one. My dad got along with everyone else. So there was a real problem.

I would see what is going on with your dad's work up in the hospital first. You can always go to the hospital/that floor's social worker and talk to them. They will help you. You can set up an appt with them too. They can discuss options when he is ready for d/c. Discharge. They are very nice.
A nursing home can say he needs a different facility. There are medical ways to deal with his agitation if it is caused by dementia. He wont get thrown out into the street. The hospital Social worker can help with your concerns and where to put him if he needs another facility. Good luck.
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not if you don’t let them. If you do you’ll never be able to place them again. Hire an attorney immediately. My husband has had to represent people in this situation. They’ll be relentless but having an advocate will help your peace of mind.
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rovana Jan 2019
Surely you would not want other nursing home residents to be endangered by a violent resident?  I should hope a nursing home could legally protect both residents and workers.  Other people are not punching bags.
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Unless this has been ongoing I would doubt they would evict him.
Once he has been evaluated and the reason for the incident resolved I would think there would be no problem letting him return.
It could be anything from a UTI, the Nurse could have surprised him and grabbed him and he was not expecting it. It could have been a stroke...
The balancing act is they have to keep residents safe as well as the staff.
By now you have the evaluation.
I am sure if it was anxiety an adjustment on medication could resolve the problem. If this was the first incident I doubt that they would evict someone based on that. There must be written policies about behavior problems and what they do to correct the problem before a resident is evicted.
Please let us know how this was resolved.
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Nnccbb57 - My dad had dementia and was in a nursing home for about 4 months when he became violent toward a male CNA.  (He punched him from his wheelchair.  CNA wasn't hurt)  The NH called an ambulance and they took my father for an 'evalutation' at the hospital.  Then they sent him to a geriatric psychiatric unit for further evaluation and they switched his meds there.  

The social worker at the Geriatric Psych Unit told me that the NH cannot refuse to take my dad back.  After 2 weeks my dad went back to the NH; sadly, my dad passed away about 3 months later in September from dementia.  We are in CT - not sure if laws differ per state

I hate this disease.   Best of luck to you and your dad.
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Nncbb57 Jan 2019
Thank you! This pretty much the way it has been explained to me today. Everyone seems willing to try to get him to a place (meds) where he will be calmer. He is healthy, no UTI, blood work good. This awful disease is just progressing, that simple.
I’m sorry about your Dad.
It is a terrible disease.
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The correct answer is READ YOUR TERMS AND AGREEMENTS. Like any contract of carriage or residency there is certain behavior that is allowed and disallowed based on operational needs(Remember it's a business and NOT your or their home).

When a behavior interrupts the daily operations, causes concern for the well being and safety of employees and other occupants of the place of business a company may take action. AGAIN please read your terms and agreements. Too often we speed through the contract and don't really get to read the small print.
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Tillie69 Jan 2019
Just want to say that when a person is in the nursing that is considered their home - not the people who work there but the person who lives there.
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There is always the option of geriatric psych ward, if necessary, but beds are hard to come by. (The hospital my dad went to could not even get a patient into a bed directly from their hospital! )
It seems as if there’s medications to calm people down. Have they tried anything? Unfortunately, if he’s a danger to the staff, they might try to transfer him, but they would need to prove that they tried different strategies to alleviate the problem first. In this case, information is power. Read the contract carefully, so you are armed with information if and when the time comes.
Best of luck!
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Nncbb57 Jan 2019
He was admitted yesterday to the Geriatric unit, after another incident. I’m hoping for the 14 day evaluation to get him right with meds.
He will be able to return to his AL.
Thank you so much!
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My understanding is they can not make him leave unless there is another facility for him to go to. I know of a person who is terribly disruptive and they have asked his caregiver to find another facility - it has been 3 years and he is still there - still causing problems - I would advise reading the contract and seeking senior legal services. It appears that his behavior will follow him to where ever you place him. Do they have a psych person at the facility that can evaluate medications that may help calm him down? Have you talked to the doctor about his behavior and what steps they can take to modify it? Good luck - Hold strong
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IsntEasy Jan 2019
He's already out of the SNF. It's the hospital that can't release him until he has somewhere to go.
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One incident doesn't equal kicking him out...
He may just have a UTI. Or perhaps he requires a mood stabilizer if dementia is getting worse.

I do hope that his caregivers communicate very well with him before touching him or anything! The elderly can become so sensitive with age.

It sounds like an isolated incident. He could have just been having a bad day or something....

All the best!!
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I do believe a private nursing home, like a private school, can evict a resident for behavior issues. I ran into this problem myself. My father, with only mild dementia but confined to a wheelchair, was creating quite a ruckus because his assisted living fired his favorite nurse. He drew up a petition for residents to sign, yelled and complained. Eventually, during a resident meeting, he slammed a door so a staff member could not leave and then said he would rather die than live without the nurse that was fired. This admonition that he would rather die was their excuse to have him committed. I was called and told I could take him or they would call an ambulance. I took him. He was in the psychiatric unit over night. The next day he threw a fit on me about being in the "looney bin". I concluded that it definitely was not the place for him, but doctors there did not immediately agree so I took him out Against Medical Advice. That may have been good for him, but it sure was not for me. The AL would not take him back without a written release from the psychiatric unit and the psychiatric unit would not write one, nor take him back, because I took him out AMA. I then took him to our local hospital who would not admit him to their psychiatric unit because he did not meet the criteria! After a week of Hell caring for my demanding father and on the phone trying to figure out a way to get my Dad back into the AL they agreed to sit down with us and discuss it. They were very firm with my Dad and spoke to him for an hour or more. I think they kept him out just long enough to make a point with him and to let the other residents settle down from the chaos he had created. That was 2 years ago. He has been there a total of 7 years. As long as it is a private institution I believe they have every right to evict them. That may not be true of a facility that accepts Medicaid.
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YES! Should a resident become physical with the staff and/or other residents, the person can be removed for safety reasons.
If there is any question in your mind, have a nanny cam placed in your Father's room.
My step-father has always been non-aggressive his entire life. His Alzheimer's/dementia effects him most often when his Sundowner's starts. Both my husband and I have experienced this prior to placing he/Mom in their new residence. He has had to be "talked" down and the easiest for him is to tell him Jesus does not like him acting like whatever he is doing at the time. His children refuse to accept this behavior, they say he has been like this since they can remember.
It is stated in the contract that he can be removed as well as Mom should she become too difficult to handle.
This is when the person is placed behind the "double locked doors" with specially trained personnel to handle.
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First, I think you need to find out what the problem is. He may have a UTI. He may have had a stroke. He maybe entering another stage of his Dementia and need some medication. Besides having Dementia the poor man is blind. I really don't think they will kick him out because of one episode. And if they do, I would think they would have to give you time to find another placement. They maybe private owned but they are under State regulations.
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Yes, it is possible that they would refuse to allow him to return. However, since he's been there a year and they know him to be normally non-violent, they will likely give him another chance, particularly if he gets a diagnosis that explains his change in behavior.

But, they cannot endanger their staff nor their other residents. If he has had more subtle incidents and this was an escalation, they may not let him return. He would have to be admitted to a specialized unit. The hospital or his SNF can refer.
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The short answer is yes. The second answer and correct one - as donkeehote stated - is read your contract and work with the facility to keep him there if feasible. Good luck.
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Nncbb57,
I am sorry you are going though this! I know it can be stressful! Hang in there. Here are a few quick ideas/thoughts.
Yes, the NH can refuse to take him back. However, since he is in the hospital they cannot discharge him without another place to go. The discharge planning department can help.
First, ask to speak with his case manager, social worker or discharge planner. She/he can call the NH to determine what their thoughts are moving forward regarding placement. They can also explain what is going on medically so the NH can better understand where his behavior is coming from.
If it was not an outright medical issue, he may need an evaluation from a geriatric psych doctor to see if his medications need adjusting. Either way, if this information is explained to the NH they should consider taking him back if it is an isolated incident. If they don't want to take him back you can work with the discharge planner to determine what other facilities are options for him. This can all happen quickly so the sooner you speak with someone the better!!!
Good Luck!
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