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.
Just a reminder...
We are not here to punish the patient/client/parent.
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.
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.
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.
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.
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.
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:
· 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
· 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
· 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
· 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.
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.