fixation on one thing

Cheri H.

My mom was diagnosed with vascular dementia in 2015, over the last few months she has moved from somewhat happy and cooperative to angry, states of rage, throwing things at us, says she hates us, (we are her children that are taking care of her).  She does not take her daily medication, does not pay attention to her hygiene and sometimes we can talk her into taking some of her meds, if we promise to leave right after.  Is it the dementia or is she aware of her anger and meanness?

We are getting ready to activate the POA.  But I feel that we are going behind her back, so the guilt is immense.   However, even with the POA I don't know how to get her to a care facility.

How do we do this, she is so angry and aggressive. We can't even get her to calm down and talk with us. She refuses to go to doctor appts.  How can we ever get her to a care facility.

M1

Welcome to the forum Cheri. She may need hospitalization on a geriatric psych unit to get medications adjusted before you can place her in any facility. This is very common, though not ever easy. If she is a threat to herself and her caregivers, there is rarely any other way forward. The sooner you grasp the nettle, the better, in all likelihood.  And don't feel guilty, this is why you have that poa-you have to take care of her just as you would a child who cannot care for herself.

MN Chickadee

Welcome Cheri. First order of business would be a doctor visit if you can get her there (see therapeutic fibs below.)  Sometimes a UTI can cause a change in behavior, it is always best to rule  out UTI as well as other infections or sources of discomfort. However vascular dementia can often be a plateau followed by a drop off, so it could be disease progression. Being angry and mean can definitely be part of the disease as the dementia starts to degrade her brain. Dementia of all kinds is not just memory loss, it is changes in personality, physical skills, emotions, executive function, judgement, and all kinds of things. Look up anosognosia. Many PWD are not in denial, they truly believe they are fine and you are the one with a problem. The damaged brain gets to a point where it can't see its own deficit and all you can do is find workarounds. No amount of logical evidence or reasoning will get through. 

Sometimes dementia communication techniques can help . Look up Teepa Snow videos online. She is a great resource for figuring out how to not trigger a PWD  and how to approach situations. Generally therapeutic fibs and working behind the scenes is necessary. For example the doctor's appointment is a quick blood pressure check, or medicare requires a visit now, or maybe it's for you and she is along for the ride. If she has always been into supplements put her meds in a vitamin bottle and say it's ginseng or whatever. Calm and steady communication.  Some meds can be crushed and hidden in pudding or applesauce, others can come in liquid forms so consult a pharmacist on the medication issue. 

As for a facility, under good circumstances we usually use therapeutic fibs. The doctor wants you to stay here a few days to get stronger or help that bad hip or monitor your insulin or whatever. Or maybe there is a problem at the house and you can stay here for a few days while the furnace is repaired. Usually calling it temporary helps. But if she is truly combative and aggressive she may indeed need in patient stay at a geriatric psych unit for a while to find the right meds and get her stable. You may have a hard time finding a memory care facility to take her without this step if she is aggressive. A geriatric psych unit, sometimes called senior behavioral health, is not a regular psych unit. It is a separate unit staffed by doctors and nurses who specialize in dementia and getting PWD stable to move  on to their home or facility.  A person usually stays a few weeks. Some families are able to arrange admission with the person's doctor ahead of time, others get to crisis mode where they have to call 911 and the EMS staff take the person to the emergency room on a psych hold and then transfer to the geriatric unit. There are many threads on this forum if you need to research that more.  If you are in a large metro area there may be numerous gero-psych units to choose from. In my area there are only a couple in the whole state, and though the drive is nearly 3 hours from me the caregivers I know who needed it for their LO said it was worth it. Most of them were transferred there by ambulance or off duty police car. If you are able to get a geriatric psychiatrist on her care team on an outpatient basis that works for some instead of going inpatient. They do see people in an office setting, however it can take a long time to get in and sometimes you just can't wait if you are in crisis mode. You may not get far on anything until you get the aggression dialed back with medication. If you get to a point where you are going to approach bathing, here is a previous thread where I gave some links for resources and some other folks gave advice: 

https://www.alzconnected.org/discussion.aspx?g=posts&t=2147555672&boardid=77

 Try not to see this as something you are doing to her, but for her. Being a POA is hard, and full of tough decisions, but you are doing what you can and what is in your power to keep her safe and cared for, that's your job and that's why she gave you that authority when she was of sound mind. It's not fun but you can do it. Good luck and keep us posted. 

Cheri H.

Oh my gosh.  Each of you have been so helpful.  I am very grateful for the advice and experience shared.

CatsWithHandsAreTrouble

What worked for me when my mom was combative, was to accept full blame for whatever wrong she perceived. Ie when she says thing like "you moved my stuff! I can't find it! Why did you take my things," I'd say "oh, I'm so sorry! I was trying to put it somewhere safe for later. I forgot to tell you. I'll try better for next time." After that I'd offer to help get it for her and then redirect her to something else. 

Or when she'd grab me and start pushing me into the wall, I'd (try to) calmly tell her she has my hand and to go to a specific location (to the left, to the bedroom, her "spot", somewhere she knows, etc) and repeat it slowly and as clearly as possible without resisting her. Eventually she'd stop pushing me and go to wherever I said, thinking it was her idea and letting me slip out for us to cool off and then try later.

This is what worked for me and it might not be applicable to your situation, especially if things are very dire. Mom wasn't that combative and not for very long before I learned better in reading her and redirecting her before it escalated.

 Definitely see about getting any silent illnesses treated and/or having her go to a geriatric psych unit. Good luck and let us know how it's going if you're able to. No pressure, you've a lot on your plate.