I have two caregivers, one from Monday through Friday and the other on Saturday and Sunday. My mother liked the one during the week more than the one on the weekend. I like both CNAs and think they are wonderful with my parents (my father has dementia and is bedridden and my mother has mobility issues). My mother tells the caregivers to wake my father up to eat or to change him. When they wake him, he becomes angry and lashes out. So it is best to let him wake up naturally. But he may sleep past breakfast or past lunch. The nurse has even told my mother to let him sleep. My mother prods the weekday caregiver to wake him up and my mother is sometimes, no most of the time, not very nice to the caregiver over this. Well, this evening when I went to give my mother her evening medicine she mentioned how she does not like the caregiver because she doesn't do what she asked for my father. I asked my mother does she want to get someone else and she said no. I can't rely on what she says because she switches things around, one week she likes this one and the next week she doesn't. My mother got very angry at me because I told her I don't like to hear negative talk about the caregivers and I will investigate myself. She said I was a bad daughter and exclaimed, I am your mother! Like how dare I disagree with her. She talks to me as if I were a child and does not want to hear anything that is a contrary opinion. I do a tremendous amount for my parents but I find her to be rude. Every single day, either morning or evening, we have some sort of tiff over what has transpired during the day. I believe that the caregivers have a very difficult job and I don't want my mother to be rude to them. How can I handle this? Any suggestions would be very much appreciated.
I was hospitalized three times during that flareup, each time for two weeks. I would have been hospitalized even longer, but doctors don't want people with Ulcerative Colitis in the hospital because we are on immune suppressants to shut down our immunity so our bodies will stop attacking themselves. So our doctors send us home as soon as our condition stabilizes even if we are still in extreme pain. They don't want us to pick up a virus in the hospital, which could end up being life-threatening.
There was a point in which my colon was so swollen that I was hooked up to an IV in the hospital for a week not consuming anything and I was down to 90 pounds (I'm 5'7"). I was extremely dehydrated and malnourished. During that flareup, I had one blood transfusion, six iron IVs, countless potassium IVs, countless magnesium IVs, tons of fluid IVs, Remicade infusions, oral 6MP, steroid IVs, oral steroids, rectal steroids, oral 5-ASAs, rectal 5-ASAs, pain killers, immunizations to protect against viruses, ... I also had a silent heart attack sometime during that flareup due to not having enough water and electrolytes, which were not being absorbed by the colon. So, yes, I know a lot about under-nutrition.
After my last hospital stay, one of my GI's (gastroenterologists) recommended Ensure. I looked it up and checked the ingredients and saw the high amount of sugar and processed ingredients that Ensure contained. When I told my GI about the maltodextrin, she was shocked. Maltodextrin is pro-inflammatory, I have an inflammatory disease, and she was recommending Ensure. She told me that she didn't know because she hadn't read the ingredients. Ensure was being marketed to them [her and her fellow doctors] as a "nutrition" drink for people who are malnourished. That's why she recommended it.
BTW, maltodextrin is put into sports drinks because it is so quickly absorbed into the blood stream. That's what it means to have a high glycemic index. And this is what makes maltodextrin so harmful, especially to those who suffer from inflammatory diseases and diabetes.
I switched from the Low FodMap Diet (for gastrointestinal issues) to the Autoimmune Paleo Diet (for autoimmune diseases) and Specific Carbohydrate Diet (SCD) (for digestive diseases) and gradually got better. I consumed homemade bone broths and then homemade bone broth soups containing meat (such as ox tail and chicken) with bones and veggies such as carrots and cabbage. Ox tail is quite fatty. It contains calories. As I got better, I added homemade coconut smoothies, which are made from coconut cream, bananas, and berries. Plenty of calories. I then added bananas with homemade macadamia nut butter. Again, plenty of calories. Later, I added homemade avocado dip with homemade carrot chips. Again, plenty of calories.
The last flareup I had, the extra-intestinal, systemic one (muscles, tendons, joints, right eye, and kidneys), I got from consuming maltodextrin. I had a slight cold and was chewing herbal cough drops--the ones that have a picture of herbs on the package. Starch sugar and sugar are listed as inactive ingredients. I assumed that meant less ingredients. Not. It turned out that more than 99% of the cough drops were starch sugar from corn (maltodextrin) and sugar. I know this because I contacted the company after I found out the pain I had was due to inflammation.
Almost all chronic disease today is due to SAD, the Standard American Diet--a diet high in sugar and processed ingredients, and the lack of exercise. Ensure is a processed, sugared drink with added vitamins/minerals. It's convenient. It's not healthy. For the life of me, I can't understand how anyone can think refined sugar would be healthy.
"Undernutrition is a risk factor for increased mortality in older adults. Therapeutic intervention includes the administration of liquid dietary supplements."
academic.oup.com/ajcn/article/75/5/944/4689411
Once again, you are talking about otherwise healthy adults. For someone who is not eating enough and can't or refuses to, nutritional drinks are the difference between life and death. While you personal experience might apply to you, if you aren't a elderly person who refuses to/can't eat and weighs 75 pounds, then it surely doesn't apply to them. In their case, starvation is the problem.
nps.org.au/australian-prescriber/articles/malnutrition-and-nutritional-supplements
ncbi.nlm.nih.gov/pubmed/24154647
And, yes, refined sugars are very harmful to the health. Ensure contains maltodextrin, which can have the highest glycemic index among all the sweeteners. Two and a half weeks of consuming maltodextrin gave me systemic inflammation in my muscles, tendons, joints, right eye, and kidneys. I ended up being housebound/bedridden for six months. I could not lift my right arm. I could not move my neck. I felt like I was walking on stones. If I hadn't figured it out in time, I'd be dead. That was from January to June of 2017. Once the inflammation past, I started training for a triathlon. I completed my first triathlon in November 2017. I don't consume any refined sugars. I don't consume starchy vegetables, and I can do a triathlon. The elderly simply don't need that much sugar. If you want to give them calories than add coconut oil or avocado oil to the drinks. These oils are healthy fats that will help with cognitive issues. If they can consume solid foods, then small, fatty fish is very high in omega-3s and very beneficial to the brain.
sugar-and-sweetener-guide.com/glycemic-index-for-sweeteners.html
Nutritional drinks are not harmful to health. While they are not the best thing for a healthy younger adult, they are basically expensive sugar milk afterall. For a elderly person who can't or won't eat enough, they are a lifesaver. In that case, "bone broths and green vegetable smoothies" is the fast lane to starvation.
I have had caregivers tell me how much they care about the patient even when they only just met the patient. Clearly, they aren't being truthful. I have had caregivers try to watch TV or be on their phones most of the time. I have had caregivers try to feed the patient Boost or Ensure, processed drinks that are basically made of pro-inflammatory refined sugars, pro-inflammatory vegetable oils, and a vitamin/mineral pill. I even had one caregiver tell me that she had one patient survive 10 years consuming only Boost. I thought, "In spite of consuming Boost." These drinks are harmful to health, especially the elderly who often times have diabetes. If the elderly can't consume solid food, then they should be fed things such as homemade bone broths and green vegetable smoothies, not sugared junk.
Yes, the elderly can be stubborn. When I was hospitalized not that long ago, I was put on a ward that had a few elderly. They were VERY difficult. The woman next to me would refuse to be changed. She would try to hit and bite the nurses. One women down the hall peed all other herself when she first came. She screamed constantly for days. There was always at least one nurse with her. I was told that she wasn't in pain, that she was confused and didn't understand where she was. We lived with the noise because we understood.
They only way to fix the situation is to look around for a good agency, establish rules, and fire the ones who don't follow the rules.
Sad to say. It doesn't sound like your parents have that much longer to live. Try to make the best of it.
eldercarelink.com/In-Home-Care/a-good-in-home-service-has-a-cell-phone-policy-for-caregivers.htm
Sundowners (yelling at the caregivers, especially in the late afternoon to early evening):
sundownerfacts.com/treatments/
I have found light therapy to be very effective. So I never tried the other treatments.
saying let's do whatever until your husband wakes up, then we'll sit with him for a while or while he eats. In other words, GIVE her a perk and a job that continues to help mate instead of trying to take one away. I like that you are so appreciative of the caregivers - so many fail to understand what is involved.
Each one is part of the team and needs to be heard, then support
the group agreement. If agreement cannot be made, then all need
to follow Doctor's orders. Open communication is so important.
I have found most strife is basically a failure to effectively communicate.
My sister went through the opposite. Back a good 10 yrs ago now.
We knew my Ma wasn't well both mentally and physically, I was keeping my distance, as I had a fair idea what was happening, but because Id been a nurse, for some reason Pa decided I was the enemy, I guess he knew I knew he had early dementia, so left him to it.
Anyway Ma came out of hospital unwell so to help her get some decent nutrition it was organised for meals on wheels, for her but Pa stopped them within a week, saying it wasnt food he liked and it was too much. Despite my sister telling him that the food wasnt for him but Ma and it was a diet she liked, he refused. Same with caregivers they stopped them and many swap arounds.
Only ones Pa liked were the ones who broke all rules and accepted extra payment etc[ so he could Lord over them] He died and then the true extent of the problems came to light
fast forward to now.
It really sounds like one your mother doesnt understand that someone with Dementia needs to be allowed to sleep and live in their own clock. Their feeding time isnt the same as hers. And a grumpy aggressive dementia person really isnt worth it, more damage is done.
IF there are no skin problems, that he has no pressure sores that he is maintaining his weight, that he is kept clean. Then your mother needs to back off
Meanwhile have a meeting with not only the carers but the agency supervisor. What are the rules for cell phone use, its very boring doing an 8 hr duty when your client is asleep for 6 of them. [no they dont do housework or polish the silver]
what is acceptable, but playing games isnt.
My Ma is in the dementia unit as she is still mobile and would escape if she could, shhe is awake most nights and sleeps the day away, I can go visit hoping to find her awake but now its nigh impossible. I dont wake her and neither do the staff, she becomes very aggressive and upset to the point of a danger to herself and others. She is weighed monthly so they do see she gets sufficient to eat, her food and snacks are kept in the dept.
That is acceptable
So for you to survive, Demstress, get a physical status on your father, explain to your mother why its actually best for him to sleep as he wants and to forget the usual clock,
IF she cant understand or forgets within a day or two, then sadly I think you will have to realise that she is reaching the elderly state of not comprehending and understanding.
Which often happens when one is relieved of their responsibilities and is hoping for the past to remain.
You dont have an easy task, and certainly dont get in the middle, but do organise meetings and standards of expected care, what points and flags will measure those standards.
Despite his grumbling she got him up anyway to feed & change him so it appears to your Mom as though they are lazy & not doing the job they are being paid for. Especially if she is asking them to do so & they are on their phones instead! Imagine the daily frustration for your Mom. And when she brings this to your attention you are "siding" with the caregivers. Your Mom feels ganged up on.....remember she is "old school"....when folks did the job they were paid for and then some! You will always be your Moms daughter/child. Yes please do "cut her some slack" as someone else pointed out. We sometimes forget how VERY difficult this is for them.
I experienced this issue with my Mom& caregivers. As soon as I acknowledged (agreed) with Mom rather than dismissing her VALID concerns we were able to "bond" & discuss those issues as a team. Afterall its you & your Mom who have your Fathers best interest at heart.
The conversations would go something like this: Yes caregiver A is so good at this & that but yes I'm not so sure about the other thing either. But don't really think its a dealbreaker do you? Neither one of us wants to deal with training a new CNA @ this point when she is so good @ this & that. And yes Caregiver B is on her phone alot....I don't like it either! I should speak to her about it. (And you should! It will only get worse is my experience.)
I am guessing your Mom has seen other caregiver behaviors that she hasn't even mentioned. An old boss of mine once said yrs ago "Very few folks can work effectively & actually do their job without direct supervision." He was so right!
Take this opportunity to share with your Mom & agree on something.........your little secrets together.......perhaps like you use to do. Give her the wink or secret eye roll when Caregiver B is doing what you both decided you would "put up with" for the sake of the much needed help!
This is what worked for us & its worth a try .....good luck ...xxx000
Tell your mom a theraputic fib that the dr. says dad is to wake up naturally - she probably wants company at the table - when possible ask the careworker to have a coffee with mom at those meals - the careworker has to eat lunch so would she be willing to eat at same time as your mom when dad is not there? -
It's normal for the elderly to yell at their caregivers. By the time they need caregivers, they are physically and/or mentally impaired. They can get confused easily. They can have sundowners. Most caregivers understand this. It's part of their job.
However, if there is a particular caregiver who your mom doesn't like, then you should let the company know. You can tell the company that the caregiver is just not a good fit. It's normal to try several caregivers to get a good fit.
Your father should be woken when the caregivers arrive. If he is allowed to sleep late, then it will be easy for him to get sundowners, which is a common condition among the elderly. To help manage his sleep, it's good to get a full spectrum light for his room. Turn the light on in the morning and keep it on during the day. The full spectrum light will help him wake up. It will help prevent his body from building up melatonin during the day when he should be awake. Then turn the light out after the sun goes down to help his body build up melatonin so he will sleep through the night and be ready to be woken up the next morning. You should also do this for your mom. She should not be sleeping during the day unless she is also sleeping soundly throughout the night.
I also agree that your dad should be woken up in the morning to move him, change him, check for bed sores, etc. And, yes, this is a common protocol. Many caregivers don't know how to do their jobs. The requirements for being a caregiver are quite low and include things such as being at least 18 years old, owning a car, and being able to lift someone, and not much else.