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There is often no good answer to this. Not only are drugs and drug cocktails very difficult to titrate and manage when the patient is in a facility on the other end of town, but they are almost impossible to find a good combo for, one that allows for autonomy and alertness while remaining mellow enough to be with others. Once found, these "cocktails " don't work over time.
I can only wish you luck. This is quite honestly about as bad as it gets in elder care manner with dementia diagnosis.
You can take her out for a second opinion, of course, but ultimately, the memory care AL will decide whether or not she can stay there as a resident based on her behavior. My mother had to stay on Ativan to control her Sundowning agitation and we were fortunate in that it calmed her down for the most part. Had we needed to medicate her with a stronger cocktails, we would have bc to see her so upset and acting out was awful. I would rather have seen her calm and "doped up" than screaming for her dead siblings all day. She was inconsolable w/o meds.
We all lose with a dementia diagnosis. There are no happy endings and we wind up taking the least bad of a bunch of rotten choices. The goal is to keep your sister as calm as possible and thats how she may be able to enjoy some quality of life nowadays. The meds help take away some of the angst and mood swings that threaten the calm we strive for. Dementia is as ugly as it gets.
I'm sorry you're facing such a predicament and I wish you good luck and Godspeed.
Unfortunately, most MC facilities don't know how or don't want to deal with aggressive patient behavior. My wife's facility did. Shortly after being admitted to MC, she became quite violent. She broke family pictures that were placed in her room, tore off the room thermostat, damaged the venetian blinds, and made caring for her quite impossible for the staff. She would use vulgar and racist statements, totally out of character for her. The nursing director suggested she be sent to a psychiatric hospital for her behavior. We were stunned at the suggestion but destroying the place didn't seem to be an option, so the family agreed, and she was placed in the psych wing of a local hospital the very next day. My daughter and I were called to come to the hospital to discuss my wife's history and to discuss a plan for her. After 12 days, the staff called and said we could come and take her back to MC. I don't recall the drugs that were used, but she returned a completely different person. She wasn't drugged up and could function almost normally. The staff established a wonderful rapport with her for which I was so grateful.
So, some facilities expect and plan for difficult patient situations. Luckily, I found one.