Shay Jacobson, RN, MA, NMG, LNCC, CNLCP
Jessica Everson, LCSW, Medicare Set Aside Consultant
Barbara’s world was an interesting and often frightening place.
Snakes nipped at her ankles as she moved around her apartment.
Urine ran freely from the showerhead.
The neighbors held raucous parties and smoked pot.
A skunk in the hallway routinely “gassed” her.
This was no place for an 82-year-old woman to live.
It would have been a simple thing to move Barbara to better, safer quarters except for the fact that none of these things were actually happening and Barbara’s delusions and hallucinations would follow her anywhere.
Her delusions had, in fact, trailed her through much of her life. Barbara had a history of psychiatric treatment, per her son, however she had remained fairly functional. Later in life, though, when dementia was layered on top of her pre-existing mental illness like frosting on a cake, Barbara’s symptoms escalated, interfering with her functional capacity and interfering with other people in her life, as well. Barbara used alcohol to self-treat but, of course, did not succeed in quelling her delusions this way.
Over time, Barbara started calling her adult, married son with such frequency, and at all times of the night, that he ultimately, painfully, made the decision to distance himself from her. Barbara’s presence in his life was disruptive to him and his family. He loved her, but could not be near her.
911 x 30
The police, too, began to hear from Barbara with alarming frequency. She called 911 as many as 30 times per month. The police social worker, in cooperation with Barbara’s distraught son, took steps to have her hospitalized.
The hospitalization yielded treatment and a primary diagnosis of dementia with psychotic features. Barbara was placed in an assisted living environment where, with continued medication compliance, it was believed Barbara could enjoy activities and communal life. And, for some time, she did just that.
After a couple of reasonably peaceful years there, the 911 calls began anew, as did petty theft from the common areas, and the aforementioned reports of skunks, parties, pot-smoking neighbors and urine flowing from the shower. Barbara’s son could not bring himself to get re-involved, and petitioned at this point for Lifecare Guardianship to become his mother’s guardian.
New Dx, New Direction
Working extensively with both the facility and Barbara’s doctor, LCG advocated for evaluation of her medications to reduce her hallucinations. Through the course of this process, and a number of medical interventions, it was determined that Barbara’s primary diagnosis was schizoaffective disorder with a secondary diagnosis of dementia with psychotic features.
This change triggered the introduction of a revised medication regiment, and a new assessment of her placement. Barbara was transitioned to a facility better equipped to manage her psychiatric symptoms while still affording her social opportunities, activities and other benefits of communal life.
Throughout this journey, LCG has been a thread of connection between mother and son. Barbara’s son is fully aware of the details of her life, without having to be immersed in them, and without having to unplug the telephone at night to limit her access.
Today, Barbara is sociable and generally compliant with her medications, thanks in part to the creativity of those who provide her direct care. The delusions that once tormented her have receded, allowing her to enjoy the people around her and this new chapter in her life.
©Lifecare Innovations, Inc.