Kicking out the help

Only_child_asks_why

My mother with mixed dementia, whom I live with, had one of the worst days ever. It was the second session with supervision from a very experienced private caregiver. We had a brief initial meet and greet visit that went well. In the first session my mother asked to leave to visit a friend in an apartment on our floor. That day the caregiver's distractions worked. Yesterday my mother was angry and swearing under her breath to get this evil woman out (the caregiver looks a bit like someone my mother had a dispute with). It got so bad that I had to delay my work appointments and asked the caregiver to leave and come back in 15 minutes. Nevertheless my mother kept asking me to take the caregiver with her although I said this was my friend who I had known for years. She wasn't violent but twice made motions as if to bite me. She made statements such as the caregiver can't stay because I need to go out to meet someone (not true). For the first time my mother had a hallucination. The door was open and she waved and said hello to someone who wasn't there. I distracted her and left when she was in another room. Then my mother called me as I was driving. I distracted her by talking about food and promised to bring her baked treats. The caregiver tried to engage her in conversation but found that being mostly silent presented less of a trigger. Due to increased confusion I had her urine checked and there is no UTI. I tried to manage her back pain by giving her a strong pain killer.

Please provide any suggestions as I fear the caregiver will quit.  Thanks in advance.

Edited to add that today was even worse. The caregiver was almost struck and had the flee. My family doctor had left for the day and the receptionist said "there's nothing the doctor can do about that. They go through stages". The Geri Psych's office isn't answering and seems to be closed.

loveskitties

Since she has become a danger to others, you may need to have her admitted to hospital for evaluation and potential meds for her aggression.

Jo C.

Only child, I am so very sorry; what a stressful and terribly challenging time for you.    As I found out the hard way, my mother was initially misdiagnosed for type of dementia.  She did not have Alzheimer's, she actually had a behavioral variant of FrontoTemporal Dementia which is all about behaviors.  The dementia most often to have halluciantions, is Lewy Bodies Dementia.  Reason I bring this up, is that sometimes, the diagnosis for type of dementia changes.

It is important to have this ruled in or ruled out because meds for one type of dementia can be contraindicated in another and even make things worse.  A dementia specialist is best at making that accurate diagnosis.  I find that a good Neurologist who sees dementia patients as a routine part of his/her practice is best at the accurate diagnosis.

Of course the office staff was grossly incorrect regarding nothing being able to be done. Shame on her.  Imagine if you believed that and let it go on and on. 

There are indeed meds that can assist with this. And as someone has suggested, sometimes when things are really over the moon, an admission to a Geriatric Psych Unit can be necessary.  GeroPsych can assess on a 24 hour continuum and adjust meds while checking for efficacy and side effects.  Sometimes an effective med at home solves the issue.

Keep trying to get your specialist on the phone; AND if the office is closed, someone has to be on call; go ahead and use that on call person if you run into the same thing tomorrow; your situation is severe enough to warrant that.

My mother "fired" her care aides at the door.  It was pretty dreadful, she had FTD. It took me some time to find the perfect fit for her as to a wonderful care aide, AND since we found she had FTD, the specialist prescribed a low dose of Risperdal and it was like a miracle and restored much quality of life to her.

The Alzheimer's Assn. has a 24 Hour Helpline that can be reached at, (800) 272-3900.  If you call, ask to speak to a Care Consultant.  There are no fees for this service.  Consultants are highly educated Social Workers who specialize in dementia and family dynamics.  They are very supportive, have much information and can often assist us with our problem solving.  Might be worth making a call.

:Let us know how you are, we will be thinking of you.

J.

jfkoc

"Studies show that UTI test strips may only be reliable about 30% of the time. Other studies have bluntly concluded that UTI test strips should be abandoned as a tool for the diagnosis of UTIs in patients with lower urinary tract symptoms."

If you use a strip please get a test at an Urgent Care. They will do a test with the required culture.

Marta

I found your reference, jfkoc. My take on the article is that if people are symptomatic for UTI, with urinary frequency, urgency, burning, and blood in the urine, you likely don’t need a test at all!  (If it looks like a duck…).

Problem with a dementia patient, as we know too well, is that they do NOT have these classic symptoms, and/or be able to verbalize them.  In the absence of classic symptoms, a screening test (not diagnostic) with a test strip can be a good starting point.

Only_child_asks_why

My update is that a Geriatric psychiatrist prescribed my mother Mirtazapine for her mood and sleep on August 30. It’s too early to say if her mood will be significantly improved. The night I tapered up from 15 mg to 30 mg was a horrendous night with accusations that I was using her credit card inappropriately at 2 AM. Although sleep has improved, I am awoken at least once many nights. There has been no attempts at physical aggression because the caregiver hasn’t returned.

 I found a nursing home that can accommodate her needs and I feel guilty. I could wait for Mirtazapine to make a difference but I know the disease is progressive and even if the delusions and agitation are reduced, my mother’s care needs will increase over time. My guilt stems from a feeling that it’s still early as my mother is still a bit functional with her personal care and appears different to the seniors in wheelchairs as she is able bodied. Plus I know she will ask for me when I have left. I keep seeing her sad face in my mind, wondering how she was abandoned. How do you cope with the guilty feeling to come?

jojobaggins42

I don't think it's a given that putting your mother in a care home will automatically make her unhappier than she is living with you. She may do better there because of social opportunities. Plus when you visit her, you get to be her daughter instead of the person at home who tells her to do things she doesn't want to do.

I think there are many threads on this forum on that subject if you search for them. 

You have my sympathy, for sure. Paranoia and accusations are so difficult to deal with, not to mention violent behavior. She needs to be safe and so do you.