What do do...

Holly H

My mom has been at a private MC home for just over a month. Things are going as expected, though recently she's become more agitated and has hit one particular caregiver three times on three separate days. I'm told they can't really pinpoint a trigger. For example, one day the CG was putting her plate in front of her for lunch and mom hit her and said "this is MY food, I bought it!" Today I went to visit and while my mom hugged me and cried a fake cry. The owner of the company was there and said, "I told your mom she should have been an actress." and she laughed. My mom did not find that funny and popped her head up off my shoulder and said, "and THAT is why I want out of here!"

In addition, the owner is a friend of mine. She is a lighthearted, kind soul who does have a sarcastic streak.

This comment may have gone over the head of some with alz, but my mom has always been extremely intuitive and also very sensitive to anyone "pulling one over on her". My friend has commented in the past when we've discussed things like how I hate leaving her that "she will just forget anyway".

My thoughts are that regardless of what is said in front of mom, she shouldn't be hitting people. While I want to again remind staff that they need to watch what they say around her, I do believe also that mom needs some help with anxiety and agitation.

So my post is for two purposes -- do I say something about making comments around mom that seem harmless but may produce more agitation? And what are the recommendations for treating the anxiety/agitation that leads to random physical lashing out?

Thank you as always!

CaliforniaGirl-1

I feel for you. These changes and periods of anxiety and upset and even hostility are not uncommon and are very upsetting. . Have them check for a UTI and then have them check again. Also is she sleeping or does she have physical discomfort?. If she is like my LO, she is not a reliable witness about something hurting, unless it is hurting that second.

You can talk to her doctor about meds.

While it is certainly, helpful to know how she wants to be treated and spoken to, and make sure the caregivers are paying attention, focusing on the specific comments may not be productive because triggers implies that if they are avoided there will be no problem and it may be more dynamic than that.

The disease is ever changing and my experience is what sets them off in one circumstance (UTI, lack of sleep, discomfort or just an agitated period) won't set them off at another time. Paranoia and thinking something is a past trigger is not uncommon

I know what you mean about your mom's sensitivity. Certainly my LO often has all their sensitivities but supercharged.

harshedbuzz

@Holly H

I question the training of a person who would say such a thing in front of a person with dementia. I mean, to you privately given your friendship? Sure-- mom and I used to laugh mightily about some of dad's antics-- but only when he wasn't around to hear.

But it speaks volumes that she doesn't understand that many PWD maintain their emotional intelligence and the ability to read the moods of others well into the end stages of the disease. I can recall being in the ER with my dad once in the midst of a psychotic episode; the resident working with him changed from warm and compassionate to a tad judgey and all business when it became apparent dad was an alcoholic. Dad looked at me after he left and said "Is it just me or did it suddenly get cold in here?"

There's an expression in education that fish stinks from the head down. I think that might apply here. If the owner is cavalier with the feelings of those in her care, the folks who work for her probably are as well. I could see where untrained staff might be triggers in some circumstances.

That said, behavior is communication. Irritability and aggression can be symptoms of depression and/or anxiety. Both of these can be treated with medications. I would get a consult with a geriatric psychiatrist for a medication trial asap.

HB

ButterflyWings

Everything HB said. Sarcasm is inappropriate for sensitive people generally and certainly for PWDs. It can be taken as meanness honestly, and I would not appreciate it -- definitely would not pay someone to mock my LO.

I am sorry you and your mom are going through this. Friends don't mistreat other friends' moms LOL. This might be kind of like hiring family to do something and it gets messy because -- well, how to put your foot down with someone who a). should know better, b). has your LO in their custody, c). might cool in terms of your previous friendship? Complicated.

I'm pretty hard core when it comes to speaking up for the helpless. Behavior is communication. My first thought before reading the details was, what is this caregiver doing or saying to invite, trigger, or provoke her? Unless she looks like someone that used to mess with your mom, perhaps she really is reflecting the problem attitude of the owner. Maybe it is the general provocation from being picked on and this CG is just the closest or only one to lash out at, to punch back if you will. Classic "sh!t rolls downhill" phenomenon.

Very sorry this is happening, but your DM is the one least responsible in my view. Some behavior modification is in order and at least from what you wrote, I'd say its the paid professionals who are out of order and need to change. Maybe you can get them a shot or some brain altering, anti-meanness meds??

Forgive me if that seems blunt or like I am being flippant. I'm so zero tolerance for even the slightest level of mistreatment of our PWD LOs at this point in my journey as a spouse caregiver. I feel it is not that hard for people to just do their jobs with some compassion for anyone who is suffering from dementias. If not suited to this role then find a different job. That's it. Of course sometimes the behaviors can be so challenging, but there are so many tools and tactics from Naomi Fell and Teepa Snow, etc. I feel a LOT more emphasis should be placed on training the other parties in these *tangos that cause PWDs to be more stigmatized, miserable, and then medicated. (*as in "it takes two to tango").