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Client is physically fit and able to shower, dress, & groom herself and takes two walks a day with her dog. Client refuses caregivers and knows us as her roommates. We split the week for 24 hour caregiving: cooking & serving, cleaning, medication management, & safety monitoring. We are sometimes successful at providing companionship engaging client in stimulating activities, both mental & physical. Challenge is that along with Anosognosia dementia, client most likely has two personality disorders, paranoid and schizoid and is known to have been negative "all" of her life. Because of this combination of disorders, client becomes angry and anxious about "roommates" being in her home and wants to live alone so that she can maintain her privacy. Client is unable to live alone due to her confusion from dementia. Client is angry with family for "interfering and running her life" and has made threats of harm to self and others and cameras in the home record client swearing with frustration and confusion when left alone for even short periods of time and most recently, punching self in the head, possibly over confusion or effect of new medication Buspirone, first time.


Clients neurologist has recently introduced Lexipro for depression and anxiety, and Buspirone and sublingual CBD oil drops for more immediate anxiety and anger reduction. Client often does not accept CBD drops due to paranoia and wanting to maintain control by saying, "No."
Client has been receiving 24 hour live-in care for going on 4 weeks and reluctantly allows us to stay with firm instructions that she doesn't want the "next person" to show up.
States that it is her house and her car and she chooses who lives there or not and it's her car and she can drive it. Car has been disabled.
Thank you for any advice or suggestions. Family and client both want client to stay in her own home, even though at times the client is confused about it being her home, of which it had for 20 years.


Client is not a happy person and ALWAYS has and still does, see the glass as half empty. If looking at a beautiful flowering plant, client can only see the dead messy flowers and not the vibrant and colourful hibiscus flowers.


Question is how do we address people living in her home, "roommates" or caregivers, when the client has Anosognosia and can't recognize her condition? Her undiagnosed personality disorders scream her need for privacy and being alone and her Anosognosia and paranoia make it hard to justify to her why we are there in her home.


How can we achieve a more peaceful situation as 24 hour care is necessary?


Thank you again.


AlwaysBeKind

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Sounds similar to my mom. The therapeutic lies are necessary. There is no way to convince her she needs help or make her see reality. If you are hired to be a caregiver, then this is your assignment, even though it is challenging. Peaceful is probably a pipe dream. Imagine how hard it is for your client and play along.
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You are describing my mthr perfectly, except she was also a hoarder. We rescued her and put her in a care home where they had many of the same behaviors as you've seen. She too went on an anti anxiety and anti depressant.

What worked best for her was therapeutic lies... You're just here until the doctor oks you for release. For you two "roommates" who are so kind as to "help," that might mean telling her you are there until something out of her control happens, but "we've just got to get through this hard time." Even that the government mandated you live there for now, and you can both trash talk "big brother."

Mthr taught at a nursing school and would get up really early to catch a bus to the school... Except she was in the care home. The nurses convinced her it was vacation week, time after time. She even attended a continuing Ed class taught in the cafeteria, took the test, and was one of the highest scores... But she didn't know what year it was. White lies really did make her reality less painful.
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