New here-help re caregivers

Tracyruv

My mom is my dad’s caregiver she is 83 and he is 90 in late stages of dementia. He is from Italy and often reverts back to speaking only Italian on bad days. My mom finally accepted help from a care giver who comes 4 hours a day for companionship. However when she leaves he sometimes starts in with my m very nasty putting a fork in his pocket to stab her with, telling her she’s a whore cheating on him. Then the next day he is docile. I believe she needs 24/7 in home care or memory care. He is incontinent as well. But right now she is making lunch and dinner for the care giver and I’m not sure this is helping. I’m afraid for her well being. Has anyone tried 24/7 Care before MC?

SunnyAB

Sure, you can do 24/7 care at home instead of Memory Care. The question is whether your parents can afford it and whether your Mom agrees since she is likely the one in charge of such decisions. I don’t understand why she is preparing meals for the current caregiver. That should stop immediately as the role of the caregiver is to reduce your Mom’s burden. One of the duties of the caregiver can be to prepare extra large meals during her shift to be frozen or eaten later by your parents. That is to save your Mom work even when the caregiver is not there. Also, caregiver and Mom need to be keeping an eye on Dad and his access to anything that can be used as a weapon. Finally, I think the threats or acts of violence should be reported to your father's doctor as this can be treated with medication. A geriatric psychiatrist is especially good at managing dementia behaviors. I think your Mom’s situation can be improved even without drastic changes such as memory care or 24/7 care at home. If it is her desire to keep him at home until the end, you can support her with this choice. It can be done but some help is needed. 

harshedbuzz

A couple of thoughts--

1. Dad's aggressive behavior needs to be addressed immediately. First thing is that your mom needs to secure anything that can be weaponized in the home- guns, knives, cast iron pans, gold clubs, small tables, etc. She needs to have a charged phone on her person 24/7 and needs an escape room she can lock behind her.

2. Ideally dad needs to be seen by a geriatric psychiatrist for psychoactive medications to relieve whatever anxiety or delusions are driving this aggression. This can be done outpatient, or your mom could have him transported by ambulance to the er with a geripsych unit. This probably needs to happen before you can even consider a change in the caregiving situation.

3. WTF? with your mom preparing meals for the caregiver-- it's generally the other way around unless there's some sort of live-in arrangement where this person is engaging a challenging PWD.

4. Home care is tricky. Especially since COVID times and many leaving the profession. I know a woman who recently had her 4 year old son with cerebral palsy admitted to a residential program because she could not get warm bodies to fill the hours to which he is entitled for care. Staff would quit on her, not show up, many were poorly trained and not very good.

5. Home care 24/7 is much more expensive than care in a facility. Five years ago dad's agency HHAs were just over $30/hr. You could find private HHAs through care.com or word-of-mouth but they were $20-25 and you had to do the background checks, payroll and taxes and check the homeowner's policy for coverage if they are hurt working in your home.

6. Two other downsides to in-home care are that it doesn't necessarily offer dad socialization. A quality MCF will have pro-social dementia friendly activities he might enjoy. Plus, if your dad is one who shadows he might not willingly accept care from others if he knows mom is home.

The other downside is that it turns your mom's home into a nursing-home-for one. Is that what she wants? 

HB

Ed1937

This is a tough situation. Do you have durable POAs for financial and medical? If money is to be spent for his care, it needs to be paid from his banking account. This is important if Medicaid might be in his future. Your mother or you need to see a certified elder law attorney (CELA) ASAP if that hasn't already been done. Even if you don't think he will meet the criteria for Medicaid, that possibility should be addressed by the lawyer. Whatever the cost is for legal counsel, it will likely be well worth it. They can protect a lot of assets.

I agree that Mom needs to stop cooking for the caregiver. It should be the other way around unless he needs constant attention. If he does, the caregiver can make sandwiches. Mom needs a break.

And since he might become aggressive with a fork, forks, knives, or anything else he could use as a weapon need to be out of his reach.

Ed1937

Tracyruv wrote:

telling her she’s a whore cheating on him. 

Tracy, I just want you to know that delusions of unfaithfulness are a pretty common thing with dementia. My wife thought I had a girlfriend. We were married 64 1/2 years, and she never had reason to think that in her life. And she never thought about that until dementia walked in the door. I hope that eases your mind a little.

HappyCatCA

I am sorry you are going through this. We just started with live-in 24/7 caregivers about a week ago for our dad (Stage 6b mixed dementia) and it is working out great. One caregiver is on 4 days and the other is on 3 days. When not at my dad's they are at their own home with their families. They support my dad with all his ADLs, cook his meals, provide companionship, help him with his exercises, etc.  We tried my dad in AL/MC and it was not a good fit.  He kept trying to leave, got combative and the facility said we would have to hire a "babysitter" for him as staff could not give him the level of attention he needed. It didn't make sense to pay for MC and someone to sit with him. We decided to bring him back home, and he is doing so much better and is much happier being in a familiar space. He has warmed up to his caregivers and, for our family, this has been the best solution. Now when family visits, we can actually visit and have fun and hang out and not be in "caregiver" mode. Perhaps you could try a live-in situation for a few weeks to see how it goes. We went through an agency so we would not have to worry about payroll, taxes, insurance, background checks, etc.