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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


Elder Care

Updated: Aug 2, 2023

I am a member and participant on This website is where professionals from different disciplines can come together and share insight, information, opinions and advertisements. This is considered to be a professional social media site. If you are looking for a job or advice about employment there is a ton of free information, and it is free to join. You can follow people who share information you are interested in. One such person is Victoria Borgman who has a podcast about senior living. She spoke with Leslie Fuller a social worker with a focus on gerontology and asked her this question: What do you do when the one you DIDN’T expect - the one everyone is relying on…is the one who ends up in the HOSPITAL!?

This exact predicament came up for me recently while working in hospice. It actually happened twice, one planned and one not planned. The one that was planned happened when the wife of a patient with dementia had to have surgery to fix issues with her heart. This needed to be done urgently but there was no family who could come and stay with the husband. Luckily an amazing social worker found an extended respite for the patient. Once the wife was discharged, he came back home. This solution does not always work. If the respite is more than 5 days, then the patient's family must pay for the extra days since Medicare will only pay for 5 days respite in a SNF (Skilled nursing facility) while a patient is enrolled with hospice. Luckily the family had the money to pay for the extra days.

Unfortunately, at times a move out of the primary residence can cause delirium and unwanted behaviors in the patient with dementia. A change in environment, change in caregivers, change in food, change in sleep can have deleterious effects on patients who have some form of cognitive difficulties. That is why it is so important that the hospice case manager visits the patient in the SNF to determine if interventions (like antianxiety medications) are needed. If you are an LVN or RN in a SNF please pay extra attention to persons with cognitive deficits who may be experiencing difficulties because of respite, or a room change or other significant change in their routine.

The second incident also happened in hospice with a husband who was the one and only caregiver for his wife who had vascular dementia. He had a significant heart attack and had to be rushed to the hospital. Again, there was no family who could take the patient. Luckily a nearby SNF agreed to admit the patient and not get paid while the MediCal application was pending. The husband died in the hospital 2 days later. The patient in the SNF had to have Haldol and Ativan given to her due to her inconsolable loss of her home and her husband (who she thought was her father). The heartbreaking part was that every time a family member visited their loved one, she always asked, "where's Daddy?" And every time she had to be told he died. That has to be the epitome of a heart-breaking Groundhog's Day. But she was finally able to relax into her new environment and even made friends at the facility.

If you want to see a truly awe-inspiring video about a patient with Alzheimer's Disease watch this video showing a former ballerina reacting to music from Swan Lake which she danced in 50 yeas before. This clip shows a woman who probably could no longer walk, had limited language but never lost the ability to remember routines she had done decades ago. It just shows we know so little about Dementia.

What do you do when a confused patient is "acting out" and exhibiting violent or unwanted behaviors?

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