DF ( Alzheimer’s) attacked fellow resident in care hone

[bathshebaeverbusy]

Can anyone offer advice? My DF has Alzheimer’s and went into a care home in March. He’s never been a sociable person and is fiercely independent. Since moving in, we’ve been told he was being awkward with personal care. They put him on risperidone for anxiety and referred him to mental health. He’s always been a challenging person - short temper and a bit threatening. He’s now attacked a fellow resident and paramedics were called. My mum 82 is going to be called and she’s upset and worried sick. Has anyone been in this position? We are worried if the home say they can’t cope with him. What might options be?

No personal experience but this has happened to a DF. If he's violent there are certain homes that will accept him I think, her DF ended up in a very good one with one to one care.

I'd keep talking to the care home to see if he's settled any after the meds and if he's going to be reassessed fir his care needs

How are things now @bathshebaeverbusy?

If the home can't meet his care needs, he will be reassessed and moved to a more suitable environment. I would think they have checked for things like infection etc if he's exhibited aggressive type behaviour before - it's not always the reason, but it can be.

Social worker should have input as well as mental health team about the type of environment that would be appropriate for the type of behaviour or issues your father is showing, to make sure he's getting his needs met - that can be part of the issue with aggression, that the person isn't having their needs met by their current environment and they become aggressive. It's not a failure on anyone's part, things can develop quickly. It can also be that some people just don't get on, people in care homes haven't chosen the people they live with, and not everyone can get on well together, and unfortunately with Alzheimer's or dementia, the inhibition that would generally stop us lashing out someone else has deteriorated.

It may be that he needs a specialist dementia unit, staffed with mental health nurses rather than a care assistant led home, or a nursing home which is usually general nurse led.

Have you spoken to the home about how the land lies and what they are thinking? And what type of home is it? In practice, there usually needs to be a bit of 'evidence' for reassessment, such as records of repeated challenging behaviour, or for the incident to have been very dangerous, before anything happens fast.

Its so tricky, He is and always has been a difficult person - we never thought it would be easy for him to settle in because he is not really a people person. He had a very high profile and responsible job so he is attaching himself more to the staff than residents....telling everyone where they are going wrong and re-engineering all their ways of working! ....although he really struggles to communicate. I genuinely think the aggression is from being lonely and unhappy rather than the illness itself - because of Covid, mum has only been able to visit for 30mins every fortnight and they have been together since they were at infant school together and she has looked after him until now. The Home wants mum to pay another £1300 a week for an observer to see if they can work out what is triggering him into aggression, but mum and I believe he is just traumatised because he is there and doesn't know where she is. So it is hard. The home have now agreed that my mum can visit every other day and he has been prescribed some sleeping pills. Alzheimers is the cruelest thing.

@Maverickess, one thing I am experiencing is that its is so hard to find information about alternative more specialist homes. He is currently in a care home with a specialist dementia unit. It is not a nursing home.

I spent 20 years in elderly care and this is pretty common.

The last home I worked in was very much a ‘brush it under the carpet’ company so nothing was ever done.

At least this home is taking it seriously.

I don’t have any advice, just wanted to reassure that you that this is pretty common.

Doesn’t make it okay, but you shouldn’t feel bad about it. It happens.

If you give the national admiral nurse helpline a call they should be able to offer you some specialist advice for your area(from a dementia specialist nurse) 0800 888 6678 it's 9-9 Mon to Fri and 9-5 weekends.

If there has been a sudden change in your DFs mood / aggression they should rule out any delirium first. Causes can include infection, pain, dehydration, constipation, medication changes.

I would be asking the current home about how they are managing his personal care, what led up to the incident with the other resident. I like this link which explains ways staff can approach these situations, it's Australian but applicable here.

If the aggression continues, consider asking for a specialist mental health review, if they are wanting 1:1 it might be worth seeing if it needs a review by MH / social care to see where his care sits. CHC funding does also consider behaviour (if you have looked at having an assessment).

It's good they have said your Mum can visit more often but it sounds really difficult and stressful for you all, I hope you have good support for you too.

Sorry you and your mum are having to deal with this @bathshebaeverbusy.

Your mum will have been told because Duty of Candor policies mean that homes have to be open about everything. However, the £1300 for an observer is utterly scandalous! Usually the incident will be recorded on a behaviour recording sheet and if it presents a problem repeatedly he would be referred to his local Old Age CMHT. However, if he is already on Rispiridone, I imagine he already has contact with them and there is no need for an observer. Further medication could be introduced with approval of next of kin for agitation, as well as distraction therapies.

If the home is unsuitable for his needs, there are others that a specifically designed for challenging behaviour, and failing that, most psych hospitals have an organic ward where meds are tweaked, behaviours observed and remedies where necessary.

Thank you to all that have commented. Much appreciated!