Redirecting obsessions

Shan

My mother has been diagnosed with dementia and we have moved her from the assisted living she was in for 16 months to memory care 2 months ago. The move was difficult, we had to tell a fiblet that her AL apartment changed the rules about pets and if she wanted to keep her dog she had to move. After months of searching I found the needle in a haystack miracle, a MCF close to ne that would work with us to help keep my mom and her small lap dog, Angel together in their facility. The facility has a center outside courtyard that is completely safe for her to use to take Angel outside and they were willing to help her with his care for additional care charges. Other than the usual experience we all seem to face with a move to a MCF, my moms situation is challenging because of trying to keep her with her beloved Angel. I should preface that when my dad died she sunk into such a deep depression that i and my sisters decided that she needed a dog for companionship. She got Angel as a puppy and 9 years later he is her entire life and she frequently tells us he’s all she has to live for. I know, as her daughters it’s hard to hear her say that, but with her dementia, that is her reality that we have to smile and go with while it breaks out hearts to hear, but that’s not the reason for my post. Our main challenge is her obsession with feeding Angel. She is so afraid to lose him that she is in constant anxiety about when he last ate, if he ate, how much he ate, and when he can eat again. Her memory loss and anxiety over the issue causes her to forget within 5 minutes of staff helping her put his food portion in his bowl and watching him eat it. She has a moment of peace as he eats but within minutes she asks if he ate and needs reassurance that he did. This obsession causes several challenges for me and my sisters and the MC staff. First, she constantly tries to feed him from her plate at meal time and if staff redirects her, she gets mad, leaves the dining room , refuses to eat, and then goes to her room to call me or my sister to cry that she can’t stay there because they won’t feed her or Angel. We’ve tried feeding him next to her as she eats but he eats way faster than she does and when he’s done she forgets he ate and insists on giving him her food. He’s been to the vet on 2 occasions while in AL for severe diarrhea because he’s a small dog with a sensitive stomach and he cannot tolerate her feeding him her food. So letting her do it is not an option. Because we are aware that she has no ability to know what is safe to feed him and what isn’t, we don’t keep any food other than bottled water in her room and staff knows she needs constant supervision when she eats to keep Angel safe. Lately she’s started sneaking food back to her room to feed Angel. During my visits I have found Oreo cookie pieces, or oatmeal cream cookie parts, Ensure, fruit cocktail, in his bowl in her room that she’s trying to feed him; basically what ever was handed out for snack that day ends up in his bowl. I’ve told staff what’s happening but I don’t think any MCF has enough staff to watch every resident enough to make she she’s not bringing food back to her room. I help when I’m there and throw out any food I find, but now even that’s agitating my mom. Yesterday she had 2 bottles of ensure in her room and I told her they needed to be kept in the kitchen refrigerator and I would put them there when I left. She was agreeable to that idea until after I left and she went to dinner. Right after dinner I get the dreaded call telling me she has no food for Angel, that I took his food and had no right doing it, and to bring it back immediately. Because reason doesn’t not work I told her I’d bring food next time I come. That works only as long as it takes for her to dial my phone again. After 3 identical calls I let the rest go to voicemail realizing unless I want to run over there every time this happens she’s going to have to work this out with staff. I notified staff she needed some attention and redirection but after dinner is a busy time for them and the crying pleading calls didn’t stop until someone came to help her with her bedtime care.

We know there will be a time when keeping her and Angel together will not be an option either for his safety or because it’s just too difficult, but he is still so much comfort and joy for her still, and we know that when we do separate them it’s going to be catastrophic for her. So we are trying everything we can to keep them together.

On Monday we are asking her numerologist if maybe increasing her anxiety meds will help, but I know meds are not always the answer. Does anyone have any ideas of how to navigate this obsession? She does very good most of the day when she’s busy with activities. The struggle comes during and after meals and snacks. Even though Angel really would only need to eat once a day as an adult dog, we split his food into 3 meals so she can experience him eating when ever she gets a meal. But it’s not working because she forgets. This disease is so terrible. She can remember for hours and even days that I took his food and she can be so mad and cruel to me about it, but her broken brain can’t give her peace and let her remember longer than 5 minutes that her beloved Angel is healthy and eating 3 meals a day.

We have thought about the robotic pets found online, but unfortunately she’s not far enough along in her memory loss for this to work yet She notices the other residents that hold the stuffed pets on their laps and play with the baby dolls and will comment that “they are silly” and “I think there’s something wrong with that woman who plays with the doll all day”

I’m so worried we won’t be able to figure out a solution for this and this will be the reason we have to re-home Angel. Any helpful suggestions would be greatly appreciated.

Marta

Hello and welcome to the forum.

Have you considered switching Angel’s food to dry kibble ? This would allow your Mom to feed the dog ad lib. She could feel in charge and any time she felt anxious she could add more kibble. I see potential for the kibble to attract critters, which happened at my house when I left the food in the laundry room (mice entered through the dryer vent), but when I moved food to a higher traffic area, this was no longer a problem.

HollyBerry

My partner feeds the cats 70,000 times a day. I buy diet cat food and dole it out in plastic containers, one per day, which barely helps because she goes searching for another container. I stopped buying treats. Can you substitute something super low cal for Angel's food so he can eat a little more without consequences? At the root of this is probably some anxiety that might benefit from medication. Can you talk to her MD about that?

Shan

Marta,

Thank you for the welcome and the helpful response. It’s a huge relief to find somewhere to be able to connect with others that are going through this challenging journey to find help and support. I think your idea is worth a try. Because mom tends to over feed because she forgets feeding him, I can’t bring a full bag of food. But I visit her often enough to bring small amounts each time. Hopefully having something to feed him will divert her from obsessively trying to feed him everything she can find.

harshedbuzz

This is a super common dementia behavior.

I would absolutely ask about a medication change to address this. PWD don't have the ability to recognize and address a situation in which they are "stuck". It is a kindness to attempt to get them unstuck by whatever means it takes.

Since you are paying extra for oversight of the dog, can you prevail on them to take over the feeding entirely and remove access to anything that can be fed to the dog. You could create a fiblet that it's a new policy at the MCF or that the vet wants feeding done by a medical professional because of a special diet. Perhaps you could substitute some other dog related activity as a replacement-- a walk, session of play or brushing-- as something she does instead.

You could try creating a daily allotment of kibble or canned food, but it sounds as though that serves as a trigger for her behavior.

If you can't get a handle on it, the dog will need to re-homed. Even if it isn't her intent, over-feeding to the point of illness is abusive. Some folks have had to move their PWD's pet in and bring it for supervised visits.

HB

M1

Agree with HB that having someone else take over feeding entirely is the only way to go, and even that may not stop the obsession, I expect the dog will need to be re-homed. The presence of the dog is itself the trigger, in all likelihood. My partner did this and threatened me when I hid the cat food and would not let her drive to the store to get more, that's what landed her in the hospital and in memory care. Interestingly, a life-long animal lover, she now doesn't remember that we had (still have) pets.

Shan

Thank you for all the suggestions. During the Easter luncheon hosted at my mom’s MCF I brought a small amount of dry kibble and set it next to her while we ate. When ever she wanted to give Angel her food, I could redirect her to give him the kibble instead. Because she had something to feed him she didn’t get angry about the redirecting and we finally had an enjoyable meal together without her obsession taking over. Because it worked so well, I left the bag of kibble with her care providers with instructions to bring a small amount to her when her food is given. Today staff told me she was much happier at meal times and stayed to finish her meal even if they had to remind her to feed him the kibble and not her food. Small victory for now.

Shan

So much for the small victory on Sunday, just two days later I get a call asking me to provide the name of the kibble and if possible the ingredients list because staff found my mom feeding it to another resident. This disease is so incredibly horrendous and difficult to navigate.

Marta

Oh good grief! Sorry to hear. Can she still feed kibble at meals when she’s supervised?

Shan

They are still allowing her to feed him kibble at meals, and are supposed to be supervising her better now that they know what she does.

mommyandme (m&m)

I wonder if a type of daily calendar can be used to check that Angel has been fed at certain times of the day. She can mark an X in a box when it’s been done and then be shown whenever needed. Possibly a special pen specifically for Angel’s Calendar so accusations of someone else checking the box might be hindered. Depends on her comprehension of course. We used this when my mom was upset about taking her meds, which helped…well until it couldn’t anymore.

so nice she can have her doggie with her. I hope you can find a working solution soon.

harshedbuzz

m&m-

I feel like your strategy could be a good one for someone in the earlier stages of dementia-- especially if they were part of the decision-making process to create a routine to remember. We, too, did something similar with dad but it was well before we needed to move him into a MCF.

I would worry that showing a person any kind of graphic organizer in the mid-stages is akin to attempting to reason with someone who can't. Keeping track of a "special pen" in a congregate living setting with 3 short-staffed shifts of caregivers, a different weekend crew and the facility's team of roaming "shoppers" sounds really challenging.

HB

M1

If it's any help in thinking about it--my partner was obsessed with our pets too, always more attached to animals than to most people. when she had to go to memory care, I was worried that she would miss and worry about our animals. Didn't happen. I don't bring them up now, becuase i don't want to retrigger her, but she cleary doesn't remember and never asks about them. I expect if you remove the dog it will be out of sight, out of mind. I don't mean than to sound harsh, I'm just talking from experience.

Marta

After my husband went to MC, I would bring Kozmo to see him. This was the dog who nine years prior, when he was a pup, sat in his lap and picked my husband to be his human. This was his bicycle buddy, his faithful friend. And, although Kozmo knew HIM in MC, my husband had no reaction.

I concur that out of sight may be out of mind.

So sorry you are stressed about this. As if you don’t already have enough heartbreak.

Shan

M1 and Marta, thank you for your insight from your own experience with removing a LO’s beloved pet. When the pet was first removed, how did your LO react at first. Were there tears, anger, blaming the person who removed the pet, depression? I worry about this for my mom because of how extremely attached she is to Angel. Unfortunately either the kibble or her still managing to feed her food off her plate even when eating in the supervised MC dining room made Angel sick, he had diarrhea for 2 days and I needed to take him to the vet. Because of her obsessive attachment to him, I had to enlist staff to help me get Angel out of her room because she fiercely refused to let me take him, while he was away from her for 2 hours at the vet, with me, she cried and panicked and could not be consoled by trusted staff. She goes into full blown panic mode every time we drop him off at the groomer. She will not go anywhere or do anything if Angel is not allowed to come. That is how attached and obsessed she is with him. From what you went through with your LO, does my mom’s attachment seem more severe and would understanding how she is change your advice? I am just so worried that removing him at this stage of her dementia will put her into a depressed spiral we won’t be able to get her out of. She still remembers and is very angry at my sister for taking her car away 3 years ago and she’s way more attached to Angel than her car. I just don’t think she’s far enough along in her memory loss to be able to forget Angel yet, which is why we are still trying to find solutions to keep them together safely.

Shan

M&M we did try a feeding chart for her so she had a visual reminder showing when he ate. I used a magnetic white board and drew a daily grid for three meals a day on it. Then I took a picture of his food in his bowl, made laminated copies and glued them to magnets so she could put a food magnet in each meal time square on the chart after he ate. It worked for a while and was easy to do when it was me, my sister, or a hired one on one care assistant helping her feed him and record it on the chart while she was still in AL. We hung the chart in her room when we moved her to MC, but she quit looking at it and staff was not consistent with helping her record meals. We do already have staff in complete control of angels food and feeding times, so that is also not the problem. Our primary concern is her trying to feed him off her plate while she eats and her bad behavior when staff tries to redirect her. And she’s been sneaking food and snacks back to her room to feed him when no one can stop her. She’s not actually over feeding him, but he has a sensitive stomach and doesn’t tolerate even small amounts of table food. We keep no food in her room other than bottled water, but she still manages to smuggle parts of meals or snacks to feed him. We did get a change for her meds from her physician to increase her depression med and add anti anxiety med. But it can take a while for them to start working and it’s not an exact science, it can take time to adjust them before we might see any benefit.

M1

Shan, if the dog is currently at the vet i would simply not bring him back and see how it goes. as I said, my experience was that she didn't get upset when I thought she would. You may just have to fib and say the vet wants to keep him for a few days. My partner has no sense of time.

Marta

Her attachment does seem extreme. In our case there was an emergency psych admission, then MC, so these events obscured any issues with separating DH from the dogs.

I am hopeful for you that the med adjustment will reduce her anxiety levels.

I think you have to go with your gut. As you know, there is no playbook.

CatsWithHandsAreTrouble

What kind of dog is Angel? If he's a common/popular enough breed, you might be able to get a reasonably priced stuffed toy to be his stand-in when he's away from her. I also know that there's many artists out there who make very realistic plushies of family pets if you want to go that route but it is a pretty penny for the quality. Though hyper realism may backfire depending on how aware your mom is. I have seen others on the forum mention how some PWD can tell something is off about their companion and become distressed or try to feed them directly and get food smeared all over the face.

We have a few stuffed animals that mom thinks as real—one is a muffler in shaped of a dog and occasionally mom's perplexed on why he has no legs. She's not too fussed about the toys; she has some baby dolls that she treats as real and one's an old cabbage patch doll.

CatsWithHandsAreTrouble

Also, last year our childhood cat passed away at 19 years old. Mom was sick when it happened so she wasn't aware when the cat was gone. My sisters and I had decided to go with the "out of sight out of mind approach" with our cat's passing as the kinder choice because mom was in the stage of fixating on things. Dad however told her every chance he got when she'd asked where the cat was. She'd be inconsolable for hours crying over our cat.

Fortunately for her we have a second cat, a four year old, that we would constantly redirect her to whenever she started thinking about the other cat. Whenever mom would say "here's this cat, where's the other?" we had a scapegoat for that. Mom had twins and when we were young, a neighbor girl would often come to the front door and fuss over the baby twins saying "which one's this one? Where's the other one?" That was one of mom's favorite stories to retell to others so we would often quote the girl to redirect mom.

Mom more or less has forgotten the other cat or has at least combined the memory of that cat with our current cat. Just wanted to give you an example to help inform your uneasy choice.

Shan

As much as it hurts to think, I actually wish my mom’s memory loss was to the point where she would not notice the difference between Angel and a close replica. He is a black and white havanese which could pass as the cocker spaniel version sold in the Alzheimer’s store. However we are not to that point yet. She comments on the other residents that interact with the dolls and stuffed animals at her MCF, so we can tell she still recognizes the difference. I am very aware that the time will come to rehome Angel, I just wish we could buy some time so that maybe it could be stalled until she will unknowingly accept a fake alternative. While we wait to see if her medicine change will have any effect on the obsession, in order to keep Angel safe, i have been visiting three times daily during meals to sit with Angel to keep him away from her while she eats. The original goal was to try to set a new meal time routine where she leaves Angel in the room during meals. However, since she vehemently refuses to even let me keep him in the room with me there, and instead insists on him sitting with me in the adjoined tv room where she can still see him, I’m doubtful she will ever accept him staying in the room during meals. And he will not stay in the tv lounge without me keeping him there. He whines and wants to go to mom. While I know this is not a long term solution, it is something I can do to help my mom to see if there is a chance that the meds could work to keep them together a bit longer. My friends think I’m crazy for doing this, but my rational is this ; many family members give the ultimate sacrifice and care for their LO in their home no matter how hard it gets. I thought with my self employment and ability to set my own schedule I could do that for my mom too and tried it. Unfortunately my mom was combative and refusing to stay at my house with even a hired care attendant that was her favorite if I even left for an hour for a client meeting. It was clear that she was not going to tolerate me working unless I was always in the home, which being an interior designer doesn’t allow. So, while leaving work three times a day to sit with Angel to keep him safe and make sure my mom will eat, is much less of a sacrifice than trying to keep her in my home full time. I am taking it one day at a time, and I know with this diagnosis it’s all I can do. Thank you so very much for everyone trying to help me figure this out. I truly appreciate each and every one of you.

mommyandme (m&m)

yes, the feeding chart or calendar idea only works for some things and only for awhile, thru stage 5 for us, I guess. I think all possible solutions work for some and not others. Almost anything was worth a try for us.

many ideas suggested in these forums are from personal experience working at some time in our journeys. Take what you need and leave the rest.

good luck.

harshedbuzz

Shan-

In many respects I found this phase of my dad's dementia the most difficult. On one hand he was somewhat aware of reality-- so strategies like fiblets and redirection were of limited value in manipulating his behaviors. But on the other, his poor reasoning, lousy short-term memory and executive function that became MIA led to behaviors that had dangerous consequences. It was easier in the later stages; he seemed more settled as well.

I might create a fiblet about a stay at the animal hospital and keep the dog at home for a week or so if the meds don't kick in soon. While you describe her obvious devotion to this pet, you are also describing a degree of anxiety and hypervigilence that is not enhancing her quality of life.

HB

Shan

I thought I would post an update for everyone who generously helped me figure out how to help my mom with this problem. When Angel got sick and I was at the vet with him, I strongly considered not bringing him back to her and ripping the bandaid off right then and there. However, fate has a different plan for now. We live in a state that is having an outbreak of canine flu and the urgent clinic that could take us for a same day appointment had 5 cases that day. The vet cautioned me that Angel , by being at the clinic, could be exposed and we should keep him away from other dogs until we knew for sure. That meant I couldn’t take him to my home because I own a dog, my oldest sister’s daughter brings her dog to their house while she works, and my youngest sister, even though she has no pets has not been willing to help out especially with Angel because she wanted to place my mom in a different MCF that didn’t allow dogs therefore she thought we should have separated them months ago. So, bringing him back to my mom was my only choice at the time, which is what I did, which meant I was now responsible for being at every meal to give Angel his meds and to keep him safe from my mom giving him her food for the next week until his meds were done, which I did. During that week I worked with staff to try various accommodations to see what would work for staff to implement when Angel was done with his meds and I no longer had to be there to give them to him. We tried getting mom to let him stay in her room while she ate, nope that didn’t work. We tried having Angel sit in his stroller in the adjoining lounge during meals, which worked because she could still see him, but it didn’t work without me sitting there with him because he would whine and complain not being by mom, he didn’t trust staff enough to stay that far from her. Yes, my mom’s obsession with Angel also makes him have separation anxiety from her too. The last thing I tried was sitting next to my mom as she ate with Angel in his stroller on my other side. They could see each other but she couldn’t feed him her food when I was a barrier between them and she liked visiting with me while she ate which curbed her worries that she needed to feed him. Because it worked so well we decided to have staff take over my place between her and Angel at the next meal. I don’t know if it was one factor or a combination of multiples, but that meal did not go well; Angel was whining and anxious which made mom anxious and eventually leave the table part way through her meal because of it. I was so upset and frustrated that after a week of being there for three meals a day, Angel was now healthy again but it was looking like the only way to keep them together and keep Angel safe while helping calm mom’s obsession was for me to continue that arduous routine, which just was not feasible: I was exhausted and my health, my family, and my business were suffering. A conference with the head of nursing and facility director, lead us to try one more Hail Mary, we had an order on file to administer an anti anxiety as needed and decided we might as well try it before the next meal to see if it could help her calm her obsession. The good news is, it actually worked, it allowed my mom to have a very enjoyable meal visiting with her table mates and the staff member assigned to her at the meal, and because she wasn’t anxious, Angel was calm and quite the entire time too. They noted no side effects with my mom after adding the med, and when I visited with her after that meal I could see a major difference in her overall anxiety level and not just regarding Angel. Her cognitive functioning was still at her base line before administering, and she was more calm and peaceful than I have seen her in several years. She even seemed to feel better because her brain was not in such a heightened anxiety state. It’s been two days of staff being able to sit between mom and Angel at meals and her being completely cooperative with it. I know we are just buying time and there will be a day when for Angels well being we will have to separate them, but for now we finally have a working solution and they have only had to give one dose a day between lunch and dinner because breakfast is her most agreeable meal.

Marta

Shan: I’m very glad you found a solution. Meds often are a saving grace.

BookBuffBex

@Shan - I just read through this whole thread and am so happy that you found a solution that works for now.

HollyBerry

I'm so glad to hear this! I've thought of you several times and wondered how Angel and your mom were doing. Fingers crossed this solution continues to work!

Shan

Thank you everyone for your caring thoughts and helpful advice. I’m so glad I found this discussion group: it helps so much to try to get through all these lows with this horrible disease. As we all know, it’s a revolving door of never ending problems that are left for us to try to get through to help our LO’s find as much joy and peace as we can while not losing ourselves in the process.

The update today is both good and bad news. The weekend went very smoothly. My oldest sister visited both days and I only visited one and took Sunday off since I had been there three times a day for over a week. My sister said she seemed happy and not anxious and I was relieved to not receive any crisis calls from staff about bad meal times. Yesterday was a different story. When I stopped in for a visit after work, I was pulled aside by the nurse who told me lunch was terrible, she said my mom got mad at her care giver, smeared her garlic toast in her face, called her evil, and left lunch in a huff without eating. I asked if she’d been given her anxiety med and was told she did so good all weekend they didn’t think she needed it. I asked her how they plan on deciding when she needs it and when she doesn’t because waiting until she is uncontrollable at a meal is much too late to do any good, and since dinner was 45 minutes away, are they planning on giving it so she can hopefully have a calm dinner? They did give the med and dinner went well with no outbursts. Had I not stopped after work I’m not sure the staff would have given her what she needed to be calm. And while I visited with mom before dinner yesterday she was more confused and anxious than I’d ever seen her. She actually remembered that she acted out at lunch, didn’t tell me exactly what she did, but kept worrying about her bad behavior and was upset that I was not with her anymore at meals. She said “it was working so good, why did you stop coming?” Talk about a punch to the gut. I wish I could have unlimited energy, patience, and time to commit to being with her every meal every day, but that just is not sustainable, and I’m so sad I’m not able to do that for her. But the reality is she’s anxious and depressed all day not just at meal times, and the medication does seem to mellow her out and bring her brain some much needed peace. The nurse changed her anxiety med to once a day instead of only as needed so she will get it consistently from now on. Here’s hoping for better days ahead. I’ll be stopping after work tonight to visit, and am hopeful to find a much happier mom than yesterday.