Advice for seasoned professional dealing with new issue

Ssevey

I have been a professional caregiver for 10 years. My last client was my sole client for 4 years. She passed away early in December. While I dealt with some of the common issues surrounding Alzheimer’s, aggression was never a problem. I started with a new client yesterday and I understand that he sundowns pretty badly and aggression and agitation are triggered because he doesn’t know me, doesn’t believe he needs help etc. Today when I arrived, he became very agitated and was screaming and cursing at me to get out and threatening me. I kept out of sight for a bit and he calmed down after I got him dinner. I cried. It was terrifying and so upsetting for me. I have never had to deal with this before. I am questioning if I can continue to be a caregiver. I intend to try some different things to help and hoping that once he’s used to me, he will be better. Anyone have any advice on how to handle it on a personal level?

​fesk

I think the most important (and difficult) thing to remember is not to take it personally. Also, always be sure to keep him and yourself safe. 

I believe the agitation may be stemming from the fact the he is scared and doesn't understand. It is part of this disease unfortunately. Did the family offer any advice on how they deal with this behavior? Was there a caregiver prior to you that was dealing with the same behaviors? If this is a new behavior, the family should have him evaluated by a doctor.

Others will come along and offer more advice. I would recommend trying to see if there are any particular triggers, always approach from the front in a calm manner, speak softly, and explain what you are going to do before you do it giving him time to process it. 

Ssevey

The daughter warned me that he would probably not respond well. He has not had a consistent night time caregiver. I know it is difficult for him. The trigger appears to be the shift change in the evening. It is apparently not a new behavior as he has done this several times. I know better than to take it personally but the aggressive behavior is not something I’ve dealt with. I was spoiled I guess with my last client. She was beyond compliant and we enjoyed a close and caring relationship. The only advice I have been given is to stay out of his way until he calms down. From what I can gather with the very short time I’ve been here, the daughter is not interested in taking any measures to alleviate his sundowning.

King Boo

There is upset behavior that can be re-directed by dementia specific response and techniques (see the classic "Understanding the Dementia Experience"-author I believe is Jennifer Ghent Fuller) and training.

However, aggressive behavior that is a consistent by product of the disease, that is not responsive to this - can benefit from medications that are prescribed by a Geriatric Psychiatrist MD.

Family caregivers sometimes hire help and then don't always completely deal with that additional step - the old 'it's now your problem' mentality.

There is a difference between verbal outbursts that run their brief course and can be worked with after, and ongoing behavior that is a risk to you.  Evaluate this.  

There is nothing wrong with also deciding this client is not the best fit for you. 

Neverends

I'm  so sorry that you are dealing with this. It must be very scary for you. My mother sundowns almost every night, redirection use to help somewhat but she was and still is aggressive. I talked with her primary and she was started  on some meds that have helped her. There's only so much redirection,toileting, quiet time, offering food or drink, backrubs, too many lights,not enough lights,too much noise,etc, that you can do. Most of the time none of that works. I know one thing after dealing with this for years, when they sundown,they suffer and so will you. They can end up harming themselves or their caretaker. They need medicated. Might take a bit of trial and error but it's the only way.

Paris20

After I was hospitalized last year, I realized I could not care for my husband alone. My children found a wonderful live-in aide. My husband became so verbally violent toward her that I was afraid he’d become physically violent. The aide is experienced with AD but she told me she never had a patient as difficult as my husband. I could see that an antidepressant was insufficient. The neurologist prescribed Seroquel, an antipsychotic drug. What a change for the better! My husband rarely explodes or attacks his aide, or me for that matter.

Jo C.

Hello and welcome Ssevey.  What an unfortunate situation this is and I can imagine the stress and concern it is causing.  You have much experience with caring for a person with dementia and your most recent patient's dementia prior to this was different in its effects.  You have much to offer; none of this present situation is your fault.  You are a very consciencious carer looking for solutions to the problems you are experiencing.

If it were safe to do so, and only if it were safe,  I would probably give it three days to see if  the behaviors will calm down.  If so; that is a blessing.  If not, then I would contact the family member in charge and express your concerns, as a professional, regarding their father's situation.  Ask if he has been severely agitated, aggressive and threatening to other caregivers or family members. Ask if he has ever physically attacked anyone as his behaviors appear to be reaching such a possibility even though you have used the best techniques to calm him.   You can mention to the family member that not only do such agitated and aggressive behaviors cause significant issues for the care professional, they also cause terrible upset for the patient which deeply affects his very quality of life.

If he has had this problem issue, as a professional caregiver, perhaps you would like to suggest that the patient's dementia specialist can assess him and prescribe medication that will control such behaviors which will help the patient to a much better quality of life for himself and make him able to receive the care he needs.

Most often, either Seroquel or Risperdal are the meds prescribed for such behaviors.  It is true that the person having such behaviors is suffering to the point that quality of life is dreadfully affected. If a medication can relieve that for the patient, it is well worth looking into.  Also, it is a good idea to have him further checked for a "silent" urinary tract infection that has no symptoms, but is still present.  Sometimes a UTI will cause a ramping up of negative behaviors; however, since he is so far over the top in behavior, it is unlikely that the UTI would cause the severity of the problem issues.  

You can only do your best.  If there is a danger to yourself or other highly negative dynamics, there is no shame in deciding that this patient is not a good fit for your services and you need to make a change.   It is difficult to be a carer of a dementia person with such problems and trying to do it within the private home setting with no backup.

Do let us know how you are doing and how things are going.  We are all here in support of one another and that now includes you too.  We will be thinking of you.

J.

jfkoc

My added suggestion is to acknowledge the triggers and carefully figure out an approach. Therre is always more than one way to skin a cat.

Perhaps " I know you do not want or need me here but your family insists someone be here and I really need the job so please, I need you to let me stay?"