One Family's Saga of Alzheimer's Care
When my father became difficult, he was involuntarily committed and we lost control
We lost him a little at a time. In 2000, my dad, then 80, was diagnosed with Alzheimer's disease and it began: He moved off ever so slowly, calling back at us as he went, trying to keep us in his sight.
For the most part, he was joyful. Often, all it took to delight him was a ride to the grocery store, or attending morning mass, or a stop at Bruster's for butter pecan ice cream. A self-made businessman who ran his management consulting company in
Beds for Alzheimer's patients were hard to find, but someone we knew recommended Sunrise of
Sunrise was small--61 residents--and seemed a warm, friendly place, with a garden courtyard, small living rooms, cozy dining areas, and private bedrooms with windows. The resident labradoodle and cats and parakeets appealed to us since Dad had been a huge pet lover. And Jack's house, where he also works, is just 2 miles away. (My sister and I both live several hours from
Jack visited twice a day, at random. And he became friendly with a few of the nurse aides, figuring that knowing staffers and being engaged would translate into more attention for Dad. Still, sometimes when he arrived, no one knew where to find Dad. Mom visited most days, but it became harder and harder for her. She was frightened when he would grab her arm tightly and twist it, showing no signs of recognition. At first, when we left him, Dad would grasp our hands and beg us to take him along to
Things fall apart. But Dad became tougher and tougher to handle. Though the nurse aides would crush his 11 or 12 daily doses of pills and mix them with yogurt or ice cream, he would detect the medicine and spit it out. Mealtimes were a trial, since he started refusing to open his mouth. At 95 pounds, he now weighed about half of what he had before his decline. His mood began swinging wildly.
The impression we had was that Sunrise was doing the best possible job under difficult circumstances. But we observed that staffers regularly worked overtime, and the nurse aides responsible for much of the hands-on resident care seemed to come and go. Outside the building, a large sign always advertised for help. The reason, according to
But I've since discovered that high nursing staff turnover is not unusual for long-term-care facilities. According to a 2008 survey by the
After Dad developed a staph infection from an open sore on his elbow, his downward spiral accelerated. Dressing the wound daily required sedating him, but afterward he would be even more agitated than before. He started to bother other residents, trying to shake hands with them and reaching out to grab them. Finally, on
Endless wait. Jack met up with Dad once the ambulance had delivered him to the psychiatric hospital (cost to Mom for transportation:
It was then that realization dawned: Dad was no longer in our care. He had been committed for a 72-hour involuntary hold, called a "302 commitment" after the part of a
"We do everything in our power not to 302," Koch, who wasn't part of the decision, told me when I began looking into how common an occurrence this process is. "The only reason we do 302 is if there has been physical harm done to someone. It does not happen very frequently, but, unfortunately, there are times when we don't have a choice." Koch said that Sunrise wouldn't use a 302 commitment simply because a resident was being difficult, but rather because he was physically harming someone else.
But my research suggests that this is not an unusual fate for Alzheimer's residents at long-term-care facilities. It seems to happen less often at assisted-living facilities than in nursing homes, perhaps because the eviction laws are looser for assisted-living units. Generally, nursing homes are required by federal law to give 30 days' written notice and a reason when they evict someone. They also must provide the phone number for the state agency that licenses nursing homes and instructions on how to appeal the decision. A judge will hear both sides and rule. (Assisted-living facilities are subject to state law, which varies widely. Most states require giving some notice but not necessarily a reason or a right of appeal.) Some nursing homes try to evade the 30-day notice requirement and appeal process by transferring the resident to a hospital or psychiatric unit, then refusing to take him or her back, says
When a person is sent out for a psych evaluation, there's generally a short holding period of, say, 72 hours, followed by some kind of adjudication. In
Where to take him now? Although Sunrise had indicated Dad could come back if his medications were adjusted properly, we were so upset that we never asked. Jack and my brother Mike's wife visited more than a dozen nursing homes with advanced Alzheimer's care units. Each time, they were told a bed might be available. Each time, after receiving Dad's records, the home said there wasn't a room. Finally, because Dad had grown weak and had developed pneumonia, the doctor said he would refer Dad to hospice care.
When he arrived at the
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Blood clots in surface veins are relatively common. This condition -- known as superficial thrombophlebitis -- shouldn't be confused with blood clots that develop in deeper veins (deep venous thrombosis). Clots in surface veins are more of a nuisance, whereas clots in deep veins can be serious and even life-threatening.
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