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My BIL who has dementia was in a ALF Memory Care Unit that is located 4 hours from home. My husband has been trying to get him moved closer to home but no one would take him due to him having behavior problems. Recently he had a hospital stay to have 2 surgeries and then discharged to a SNF for rehabilitation. The SNF is ready to discharge him but the administrator at the facility he was at said she no longer has a bed there for him.


Long story short, we still cannot get him into a memory care unit close to our home. We are told he is not having any more "behavior" issues but that even Memory Care Units are turning him away due to having too many diagnoses of dementia/mental health. What can we do?

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Any chance that you can have a new psychiatric/behavioral profile done, to represent his PRESENT level of functioning?

Sometimes a DOCUMENT can be much more persuasive as your anecdotal report.

Does he presently take ANY mood/behavioral modifiers? That too should be incorporated in a document that is describing his present behavioral profile.

I literally lucked into getting documented evidence to indicate that my LO was presenting with specific behaviors and needs, and handing a copy of the document to the agencies I needed to deal with was literally a Godsend. See if you can find some geriatric trained agency who will do this for you. Perhaps ask if the SNF can recommend someone - psychiatrist/psychologist/social workers anyone who can speak with authority to the behaviors being presented NOW.
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haileybug Sep 2019
AnnReid

Thank you so much for your advice. While my BIL was in the hospital, his case manager says she did not see any behavior issues. She also stated he was getting a mental evaluation while there. My husband and I stay in contact with the case manager and social worker there. They stated every referral that they sent to MC was denied.
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You will honestly then have to have him placed outside your area, as far as I can see. Do NOT attempt to take him home. You don't mention that's an option, but don't. If you can visit him less then that is the case. Tell them it will work a terrible hardship if he is placed so far from home that family can see him much less frequently. But I do not honestly see what your options are in this.
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haileybug Sep 2019
AlvaDeer

Thank you for responding. BIL is in a facility 4 hours away. We thought it would be nice if my husband could visit him and be a part of his care plan.
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I guess the SNF is going to have to help find an appropriate placement for him. It is probably his past behavior issues that are keeping facilities from agreeing to take him, as I'm sure you've figured out. There is not guarantee that it will not recur, but with proper meds, it could be fine. Guess they are not willing to take the risk.

As someone else said, DO NOT take him to your home. This will put pressure on "the system" to help. I would not worry about moving him closer to you at this time , especially since finding a place anywhere is an issue.

I have heard of instances where a patient has been "stuck" in one place while the facility searches for an appropriate placement for the patient. So it can and will be done since there is a need for it. Especially if the SNF wants him to move out, they will be motivated to find a solution.

Good luck.
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haileybug Sep 2019
Againx100

Thank you for your response. Yes, I understand what you are saying I just hope they do not send him away any further. That would be awful.
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Place him somewhere close to you, he doesn't have to be in your backyard. Perhaps an hour or so away.

Whatever you do, don't let him live with you. This behavior will only get worse.
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cwillie Sep 2019
Unfortunately haileybug doesn't allow us to easily search her past threads but if I remember correctly neither she nor her husband have POA so they don't have the authority to do anything. Complicating that is that her BIL has a history of violent behaviour and his needs are considered too great for most facilities, or at least for the ones haileybug has considered appropriate.
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Sadly I know that all states have their own regulations. But I have a thought. Is your father in law a veteran? There are some veteran nursing homes although few and far between. It's my understanding that they have to take the veteran as it was a promise made to a vet when they sign up to serve.

If he is not a veteran, I would suggest you contact an Ombudsman in the city/county were he lives. Especially because you had him in assisted living once before.

I'm sorry, this is such a miserable thing to deal with. It puts a strain on a family, and especially a marriage. My only suggestion is "don't go at this alone". There is help through Senior/Elder agencies.
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haileybug Sep 2019
We2AreUnchained

Thank you so much for responding. I spoke to the Ombudsman in the county he was in while in the Memory Care Unit. I discussed the wish for him to be closer to home. She went to visit him at the memory care unit and asked if he would like to be closer to home. He told her he did. That following Sunday night we received a phone call that he was in the hospital for emergency surgery. At that time the Ombudsman stated that this may be the best case scenario and to work closely with the discharge planner to get him closer to home. However, the case manager and social worker there stated they could not get anyone to accept him closer to our home.

Long story short …. After he finished his rehab and was ready for discharge, I received another email that Sunday Morning from the Ombudsman wanting to know if BIL was still in the same Memory Care Facility.

I explained to her the situation, however, she states there is nothing else she can do. What has she done?

Would you please tell me what Senior/Elder agents you are referring to? Thank you so much.
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When you contact the potential facilities, is there any chance you are telling them where he had previously lived? Maybe you're giving too much information. The previous facility may be telling the new one why they don't want him back. With new evaluation in your hand, the past needs to be put in the past. Don't discuss where he had been. Just that he is moving to be closer to relatives after a hospital and rehab stay and give them the newest eval that you have.

You might talk to the psychologist and explain that his past problems are causing him to be denied a new facility. Find out if they can do a report for you that addresses ONLY his current evaluation. The current rehab should be working FOR you to get him placed in a new facility near your house. They all have social workers that might be able to give you some insight. -- as well as patient notes that might serve you well to support his current demeanor.
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haileybug Sep 2019
My2cents

Thank you for responding. Great advice you gave.

I am just giving the CEO of the SNF the contact information to the memory care units near home he does the referral.
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So BIL is still in the SNF, yes? For now.

His place at the most recent ALF has now gone, so you are looking for a new placement for him.

You're not having any luck locally to you.

Where is the SNF now hoping to discharge him to next? - or will they hold on to him indefinitely, even though he does not have ongoing nursing care needs?

I don't know if this is something you and your husband would be in a position to consider, but if push came to shove would you consider moving nearer a facility if you could find one good enough to be worth doing that for?
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Have you tried getting your local Area Agency on Aging to help find a MC? Since your BIL is outside their area the local AAA may not be able to actively work his case but they may be able to give you lists of places to check and recommend ones more likely to consider someone with your BIL's history.
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haileybug Sep 2019
TNtechie

Thank you for your response. We are not having any problems locating a MC, we are just having problems with no one accepting him. thanks
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Keep a close relationship with the social workers on your BIL's case. Ask them to make calls and keep looking for places. That is their job - to help. Meanwhile consider what kinds of care BIL needs and ways to meet those needs.

Unfortunately, I am in agreement with those who say to NOT take him home with you. Behavior problems do get more difficult as dementia progresses. Those that lash out when confused/scared/anxious will tend to continue to do so.
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haileybug Sep 2019
Taarna

Thank you for responding. BIL is 4 hours away from home and would like he closer.
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Try NAMI (National Alliance for Mental Illness) in your area. They might be able to help or at least offer suggestions to you.
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haileybug Sep 2019
Debbiesdaz

Thank you for responding. I already contacted NAMI. The ED there told me to call The Disability Rights or Health and Human Services.

They all just keep me in circles.
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