Violence

A patient told me that another patient that he knew was my patient was afraid of her husband, who is also my patient. That is because the patient of mine who is the husband had been violent. He knocked down my patient who is married to him. The knocking-down patient has dementia. The knocked-down patient has blindness due to macular degeneration and had a TIA.
I told the patient who told me the story nothing. I'm not allowed to (HIPPA rules).
I called the wife and had her come in. She came today. I told her that I'm not sure she's safe. She wouldn't completely come out and say that she IS safe. She doesn't want to put her husband in a nursing home, but understands that cognition is required for impulse control. He wasn't violent prior to his dementia, and the cause of the violence is dementia. She is managing this with behavioral therapy at the moment: she makes sure that he never gets upset and that he always has things his way. She isn't sure how long this will work. She doesn't want him to go to a nursing home, but doesn't really know if she would want her daughter to behave the same way that she is currently behaving. She isn't sure about that. She hasn't told her children that he hit her and knocked her down. They are going to visit the children in June, and she may tell them at that time.

I don't know what to do about violence. I am generally opposed to violence. This sort of violence is very challenging because it comes from lack of capacity. It is very unpredictable. I'm not entirely sure that she is safe right now. On the other hand, if we were to force her husband into a nursing home (that is the only other realistic alternative) it would really destroy their marriage. That would hurt both of the patients in a very significant way. I don't know that it necessarily hurts more to get knocked down and hit than it does to lose your husband. So I don't really know what is best for her. I think it might be best for him if he doesn't go to a nursing home, although I can't be completely sure of that either.