I am currently a home health aide for a client. We call this client A. Overall, I love my job and working with a and their family. However, recently A who has dementia/PD has started with defiant behavior. Our usual techniques are no longer working and both the family and I are struggling with what to do now. Most of the defiance comes with following the very structured retinue. It is mostly around eating, drinking, and being compliant with the retinue. I am at a lost on what to do next.

Stargties that we have that were working

Putting dessert in front of the client but not allowed to have it until water and meal are gone.

Taking phone until meal and water is gone

Holding the cup until the water is gone

Putting in a chair and sitting holding a cup until the water is gone.

The other day I even tried "writing A up" to the family in order to motivate the client to drink their water.

None of these are working any longer. It is taking all day in order to get each cup of water down. A has 3 cups a day in order to meet their hydration needs. If we do manage to get one cup down it is often taking hours to do so with constant reminders that almost feel like nagging even with me saying "please drink your water", "we have blank activity once water is gone", etc.

I am lost at what to do and this dynamic isn't bringing joy for any of us; A included.

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Reply to Sendhelp

Great help and suggestions at “belightcare” on Instagram. Search her profile, then follow her she is very knowledgeable and gives visual and audio advice!!
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Reply to SpratChat

Sorry, a child should not be treated this way.

What you are doing won't work. Someone with Dementia cannot be reasoned with. Short-term memory keeps them from remembering fro day to day, minute by minute. They also have a hard time processing what has been said to them. He/she has probably entered another stage or tired at being told what to do. If he/she was in a NH they would not be treated like this. By law they can not force a resident to do what they don't want to do.

Are you a certified aide (CNA)? I agree if you are going to care for people with a Dementia your need to read up on it. Some NHs have seminars to teach family members and staff how to deal with Dementia. I have gone with the nurses to these things.
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Reply to JoAnn29

This is the most degrading and demeaning behavior for a caregiver. Treat this man with dignity and empathy. Give other options than drinking cups of water. Give him jello and watermelon. Give him other drinks.
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Reply to Becky04469

Well, clearly this "rewards" method isn't working, for whatever reason.

I also think it's a little ridiculous to treat this person like a willful 2 year old, by the way.

Have you considered the patient just doesn't like the taste of water? Did they drink gallons of water prior to dementia?

I am going to assume the patient has had a swallow test, and it has been ruled that she can still swallow correctly.

Have you/family considered a nutritionist for ideas for hydration OTHER than plain water? Low-sodium broth, tea, sugar-free popsicles, water-rich foods such as cucumbers or watermelon?

I often squeeze a lemon or lime slice into my ice water, for just a hint of flavor. Have you considered that? Or as MJ suggested, diluting juice in water?

What good does it do to "write" your client up? Just because someone might have dementia doesn't make them stupid.
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Reply to notgoodenough

The level of disrespect for this patient is astounding, even if he/she does have dementia.

Have you offered other liquids besides water? Good lord -- my mother's memory care gave everyone watered-down cranberry juice with every meal to ward off UTIs, plus it tastes better than just plain water.
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Reply to MJ1929

I find the way this man is being treated degrading.

You and his family should be ashamed for treating him like a child and a naughty child to boot.

None of you know what you are doing. Get trained or find a facility for this man.
Helpful Answer (4)
Reply to Isthisrealyreal

Do you understand anything about the dying brain of a person with dementia and PD?

The "retinue" (I think you mean regimen) may be too difficult for A because their disease process has advanced. Both dementia and PD are progressive, fatal diseases. You have to adapt to the patient's needs. Not the other way around.
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Reply to BarbBrooklyn

Treating this client like a naughty child will get you nowhere and create a situation where he shuts down even further as a result. He needs to be treated with kindness and patience and you need to learn all about dementia in order to provide care to an elder who suffers with it. Watch some Teepa Snow videos on YouTube to start and she'll train you on how to approach and interact properly with this man.

Download the 33pg booklet online called Understanding the Dementia Experience by Jennifer Ghent Fuller. It will give you some insight into this situation.

Jennifer is a nurse who worked for many years as an educator and counsellor for people with dementia and their families, as well as others in caring roles. She addresses the emotional and grief issues in the contexts in which they arise for families living with dementia.

Here is a list of useful tips from her e-book I found to be excellent:

The “Dont's”
· Do not reason and argue
· Do not demand that they reason or problem-solve
· Do not demand that they remember
· Do not demand that they get their facts straight
· Do not correct their ideas or scold them
· Do not reorient them
· Do not think that they are being uncooperative on purpose
· Do not think that they really do remember, but are pretending not to
· Do not use a “bossy” dictatorial attitude in care
· Do not act with impatience
The Do's
· Enter into their frame of reality, or their 'world'
· Be aware of their mood or state of mind
· Use few words and simple phrases
· OR use no words, just friendly gestures and simple motions
· Do everything slowly
· Approach from the front
· Wait for a slow response
· Constantly reassure them that everything is 'OK'
· Keep people with dementia comfortable 'in the moment' - every moment
· Maximize use of remaining abilities
· Limit TV or radio programs which they may feel are frighteningly real
· Maintain privacy
· Provide a safe physical environment
Language Needs
· Use short words
· Use clear and simple sentences
· Speak slowly and calmly
· Questions should ask for a “yes” or “no” answer
· Talk about one thing at a time
· Talk about concrete things; not abstract ideas
· Use common phrases
· Always say what you are doing
· If they repeat their question, repeat your answer as you did the first time · Give them a longer time to process information
· Wait patiently for a response
· Be accepting of inappropriate answers and nonsense words
· Speak softly, soothingly and gently

Care Needs
· Recognize that receiving personal care feels intrusive
· Reassure with your tone and manner
· Do one thing at a time
· Talk through the care “play-by- play”
· Be aware of your body language and use it to communicate relaxation and reassurance
· Be sincere
· Use a soft, soothing touch
· Be aware of the individual’s unique triggers
· Be aware that a person with dementia may not accurately judge whether a situation is threatening to them
· They may respond to fear, pain or anxiety by defending themselves with what we call “aggression”
· If they become distressed, stop immediately and allow them time to calm down – don’t try to restart the activity right away
You need to change your behaviour to adapt to the dementia because the person with the disease cannot.
Best of luck.

Best of luck.
Helpful Answer (2)
Reply to lealonnie1

zenna89, this isn't defiance, this is dementia. It is time for the family and for you to learn all you can about dementia. The more you know, the easier it will be to understand the behaviors.

Go to the blue/green bar at the top of the page. Click on CARE TOPICS. Now click on Alzheimer's/Dementia. There is a store house of excellent articles that you can read and make copies for the family.
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Reply to freqflyer
zenna89 Oct 9, 2022
I don't think this is just Dementia because A can drink the water down very fast when motivated to do so. Or when A hear's the phone ring and misses a call. A will suck down their water or finish their meal in a timely manner. Or when the reward is valuable enough. We have even tried timed desserts things like ice cream or popsicles that will melt if not done within a certain time frame. A can do it within a certain time period that's reasonable but is often refusing even with gentle reminders every 5 or less minutes.
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Can I ask what you mean by 'writing him up to the family' . Your post is a little difficult to understand
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Reply to Catskie62
zenna89 Oct 9, 2022
Basically, I wrote a note saying how A was acting and that the methods didn't work and that gave the timeframe it took to get water down. So almost like a behavior report.
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