Jul 09, 2015 - 07:00 AM
I have empathy for your situation and the difficulties you are facing. I had to go though a similar discussion with a family member, and the limited options just seem to shrink the whole world.
It's very hard to make a recommendation without a truly thorough knowledge of the situation, so read into my suggestions with the assistance of your family and the nurses and support staff that surrounds you.
If your mom is currently combative and is becoming physical, the very first thing I think you should do is recommend to her Assisted Living that she be discharged to a local psychiatric hospital that cares for geriatric patients. This gives you a few options and benefits. First, the geri-psych will actively work to adjust your mom's medications to effectively balance her behavior. I don't like making this recommendation, and we use it as a last resort when an assisted living memory care can no longer care for an agitated resident.
If she is placed in the hospital, you will have two options. First, and less likely, the assisted living will not accept her to return. If there is a financial challenge, even more so. However, the psychiatric hospital will ALSO help with placement through their social services department. It's important that you remain adamant about not being equipped to handle your mother's level of care should they attempt to discharge her to your home. In a way, this becomes a kind of limbo for your mom while you are detailing the best next step.
Judging by only what you are writing, it sounds like you will be requiring a secured nursing home that specializes in memory care and accepts medicaid. Your options will likely be very, very limited, and you may be facing additionally limited availability. The reason I recommend a skilled nursing over assisted living is that skilled nursing has more liberty regarding medications and using tools to provide appropriate care to residents who experience severe agitation.
I understand that both options are not the most savory as we discuss senior living in general. Reach out for help with candid honesty to her current assisted living and anyone who is willing to provide experienced direction. You may even want to call a local Ombudsman or state representative for assistance. In Missouri, I would recommend you call the Department of Health and Senior Services to assist with finding a social worker to help you navigate the next best steps. Your state will have a similar department.
My heart goes out to you in your situation and for your mom. Please remember- if any facts of your case change the scenario, lean on your local help for the next best steps. This answer isn't an end-all response, it's just a set of steps that address your specific question. My best to your family.