What to do about bad caretaker spouse

OutsideLookingIn

We know that some people are better at caretaking than others.  I get that.  What I don't understand is when they are pretty aware that caretaking isn't their thing, why won't they get help?  And is there a way to convince them that the PWD NEEDS more help than can be given by the spouse.  PWD is stage 4-5.

Examples: 1) Presuming that the PWD is capable of taking medications without any supervision other than setting up those meds, and getting upset when the PWD doesn't do it.  
2) Leaving for work related or other trips for several days and not providing a caretaker or respite care.  3) Expecting memory of when to eat meals.  4) Failure to seek medical attention when it is obvious that something is wrong (does it eventually, but not in a timely manner).

Again, I'm on the outside looking in, I don't live with this 24/7, so I realize I have no right to give advice, since I haven't walked in their shoes.  I am concerned about the PWD's well-being and feel that something is missing.  Caretaker is resistant to learning about dementia and gets angry if given suggestions (a bit of a controlling, self-centered personality).

Any ideas?  Thanks for being there to let me get this off my chest.

OLI

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Cynbar

As Victoria suggested, send a letter with your concerns to the PWD's children or PCP, if you know how to contact them. Try to be specific in your observations ---- do you have evidence that the PWD is being harmed by the actions (or inactions) of the spouse? Does she appear to be losing weight? Have you observed her to be dirty or disheveled? Is her hygiene poor? Has she been found wandering outside needing help to get home? Do you have any evidence that her health has been compromised by med error or failure to seek treatment? What is happening when she is alone for extended periods, any falls or calls for help to friends or neighbors? Her doctor should be able to call her in for an appointment, check her for weight loss and dehydration and do bloodwork. But you are right, caring for a person with dementia is incredibly frustrating and challenging. A call to APS is another option, but they will look for clear signs of problems, not just an accident waiting to happen. Sometimes it takes a crisis for a caregiver to accept the help they need.

OutsideLookingIn

PWD has lost a significant amount of weight and has issues with vomiting without warning (but not enough to cause that much weight loss).  Doctor has thrown up his/her hands at the vomiting and weight loss/loss of appetite (person eats very little at most meals).

One of the offspring was the one to get in touch with us, as we are with PWD for longer periods of time.  We suggested they present their concerns to the doctor.

I fear that I must follow the advice of wait for a crisis to occur.  Hate to see that for their sake, but don't see another option.  Getting APS involved at the level it's at isn't appropriate.

Again, thanks for being there.

OLI

quartlow2

My mother is the PWD. Examples 1-4 are very familiar. Dad's physical limitations were starting to take a toll. Neither would admit that they needed extra help; let alone know what to ask for. But they were both concerned for the other one and knew they couldn't provide the help they needed. It's hard to give up independence. We finally convinced them to get help by reasoning with Dad about Mom's increasing needs and hearing him admit that he didn't know what to do for her. And the same with Mom; she understood that Dad needed help, then admitted that she couldn't help him. Neither would get extra help for themselves, but they would get help for each other.

This was after many, many conversations and (obviously) while Mom could still reason. Dad was harder to convince (men usually are because they take care of their family their whole life). It took a couple life-threatening health issues that landed him in the hospital to convince him of the risks he was putting Mom through. Calm, logical, reasoning worked a lot better than anxious, desperate, criticism (which is how I felt most of the time).

Hope this helps!

harshedbuzz

OLI-

Depending on your relationship to this couple- family friend, sibling of the PWD, neighbor- I would kick this can back to the adult children of the couple. Ultimately, it is their responsibility. One or more of them need to physically come stay with them for a bit and assess the situation. Presumably you are making social calls and are not seeing the 24/7 picture; you probably are not seeing during the times of day when she is more confused or agitated or seeing how he responds to that in the moment. If a child can't/won't step in, perhaps APS is the next step.

The way you describe the husband makes me wonder if he should be evaluated for a cognitive shift of his own. In dementia often skills like empathy and executive reasoning/decision making are seriously impaired well before memory glitches are evident to others. This could be a situation where is isn't competent to care for another.

HB