I attended a seminar on dementia and the presenter had done a study about pain relief and combativeness in dementia patients. Often we forget that many of these patients have pain(arthritis and stiff joints) and when we manipulate their extremities or move them their natural reaction is to resist because they are being hurt. During the study they noted that pain medicines(Tylenol, etc.) were ordered for them but they needed to request it so they seldom were medicated. When staff started to give the pain relief medications routinely with their daily medications, there was a decrease of over 30% reported incidences of combative behavior. So they suggested that caregivers remember to move patients gently and slowly to decrease discomfort as well as routinely administer pain medications. I give both my parents Arthritis Tylenol twice a day because they both have arthritis and I want to ease their discomfort. They both have dementia and would not remember to take a Tylenol if it was not added to their daily medications. Perhaps this might be something to try?
You should bring this to the admins and have a brainstorming session as to how they can do it differently to see if she is any more cooperative. If not, she needs meds since she has lost her ability to use reason and logic, judgment and memory. She now needs help to get herself to a calm place in her mind. This is merciful.
This may not help, but I wonder if the aides are talking to her about what they are doing, what they are going to do, as they move towards the toilet. As W has dementia, she may not remember the whole procedure. I can imagine how frightening it could be to have someone remove your clothes (particularly panties) if you had no idea that it was normal and happening frequently.
Caregiver should always introduce herself with a smile and warm feeling. Make her feel happy before asking to take them to the bathroom and always explain each step with reassuring.
I visit a woman in my church 'family' who has been in a care center for a year, since a brain surgery went wrong.
2 times I was witness to her needing to be 'changed' and the situation could not have been more different.
First time, the aide closed the door, talked in low, calm tones to the woman. made sure she had a warmed blanket on her and gently and efficiently removed the wet depends and was able singlehandedly to roll the woman from side to side. Her tone of voice didn't change and she was so quick! Got the lady changed and tucked up with another fresh, warm blanket. Took 3 minutes, tops.
Second time, the aide acted so put out. Went out and yelled down the hall that she needed a 'diaper change' in room 'such and such'. While she was waiting, she just yanked the patient's gown up over her face, and began just--well, manhandling her to roll her over. (Patient was 3 weeks out from hip replacement)...the aide left her bare bottomed, facing the door. I got up and stood in the door to afford a little dignity. The other aide came and they yanked the wet depends off of her and threw it on the floor. Slapped another one on her. Rolled her back onto her back, gown still all rucked up and uncomfortable--and simply left her. No conversation, no calming words--just doing the job as fast as possible.
I asked friend if she was cold and she said 'yes'. I went out and got a warm blanket and smoothed her nightgown and tucked the warm blanket around her.
Poor woman. She must have felt so diminished by this.
She was moved the next week to a different facility.
I am not family. I didn't say anything to anyone as I am not a part of this CG dynamic, but I'll tell you, the difference between the two incidents was night and day.
Yes - the tone of voice and gentleness (or lack thereof) has a lot to do with calming a combative person down. Staying neutral (hard as that can be) is way more effective than escalating the situation by rough handling and raising your voice. The two incidents you describe are evidence of that. Also, in the second one, it appears they did nothing to clean or protect her skin from breakdown. That whole approach is not only mentally upsetting, it is completely unacceptable from a medical standpoint. That is how UTIs and bedsores get started. They should be reported for the rough treatment and failure to clean her skin.
I agree with all the answers I've seen here so far. I care for a spouse with brain damage as a result of a stroke, and I still (after 8 years) need to explain what I'm doing every step in the process of changing diapers, washing, and transfers. We haven't had much success with medical intervention, as he fights it when he feels drugged, and is even more agitated and combative. A meeting with the care staff is also a good idea. It helps to have open discussion and input from everyone involved to try and find a workable solution.
Address her fears. She may have a history of being abused / violated. Or feels 'now' that she is being violated / disrepected. She is / feels vulnerable. Address her vulnerability. She may not know what they are doing - undressing her. She may - very likely - feel embarrassed.
Realize people in memory care have feelings and they respond to respect and, in general, how a person approaches them and talks to them.
I had a client in memory care for the last couple of years. She never forgot me - week after week of visiting. She spoke 'gibberish' so I rarely understood what she was talking about - but that didn't matter. I connected with her emotionally. I remember when I told her (a few times) "I love you M" - and she would "light up like a Christmas Tree."
In other words, she got it. She understood what I was conveying. Caring for her. Loving her.
All the answers you have gotten for this are so good!
Memory Care workers should be specially trained to deal with the outflow from dementia, and combativeness is certainly one of those. When I was moving my mother from AL to MC, I was speaking with intake personnel and I told them she had assaulted a nurse at AL and she had been asked to leave. I just didn't want it on my head for her to hurt someone because I didn't give them a heads up, even if it meant they would not accept her. To my surprise, they never blinked an eye at that and told me they train their staff as to how to manage anger issues. I was skeptical, but relieved that her violence wasn't a deal breaker for them. They did mention that it sounded like her meds were not adjusted properly and they tackled that as the very first thing.
They changed her anxiety med and then upped it a little and that alone made a huge difference. Then they put her on a prn Rx for Ativan. Turned out to be a lifesaver. They assured me they wouldn't make her so drugged up she couldn't communicate, but honestly, I didn't care if she was. Maybe that's wrong, but I just didn't want to see her go through every day angry and lashing out at everything and everyone. I wanted her to have peace. Now she sleeps a lot, but overall she is pretty easy to deal with and she is in a good mood most of the time. She is rarely lucid these days, but that's the disease not the drugs.
I've also noticed that the workers at our MC are geniuses at manipulating her. She has a couple of workers she just doesnt like, so those people don't work with her. They seem to understand that it is just the way of dementia patients. They also take the time to come at her with a request gently and kindly, and if that doesn't work, they use deception ("Mrs. Xxx, I've been trying to perfect my pudding recipe. Would you try it and tell me what you think?" On a day when she was resistant to taking her meds). Ive also noticed that they touch her frequently on the arm or shoulder and they hug her and tell her how good she is (and she has never been the soft grandmotherly type everyone loves to love). If I'm there, they bring me into the conversation and I engage with them until they've managed to do what they needed to do, often without her even noticing. I watch them change tactics on the fly if one doesn't work on a given day, and I've seen them move on to the next resident and start all over with different strategies with each. I can't help but wonder if maybe staff at your MC isnt trained as well as they could be. Turnover in those places is horrendous so unless training is deliberate and scheduled, it might be being neglected. It would be worth going to the management and asking them how they expect their staff to handle the specific cases when she becomes combative, and if you don't get good answers, perhaps look for a different facility.
Someone mentioned the possibility of pain causing her to be combative and I had never thought of that. However, as I sit here at home while it is cold and rainy outside, I can tell you that my own arthritis is killing me and if I couldnt say "ow! You're hurting me!" I might be a little combative too if someone tried to make me move too fast.
2 times I was witness to her needing to be 'changed' and the situation could not have been more different.
First time, the aide closed the door, talked in low, calm tones to the woman. made sure she had a warmed blanket on her and gently and efficiently removed the wet depends and was able singlehandedly to roll the woman from side to side. Her tone of voice didn't change and she was so quick! Got the lady changed and tucked up with another fresh, warm blanket. Took 3 minutes, tops.
Second time, the aide acted so put out. Went out and yelled down the hall that she needed a 'diaper change' in room 'such and such'. While she was waiting, she just yanked the patient's gown up over her face, and began just--well, manhandling her to roll her over. (Patient was 3 weeks out from hip replacement)...the aide left her bare bottomed, facing the door. I got up and stood in the door to afford a little dignity. The other aide came and they yanked the wet depends off of her and threw it on the floor. Slapped another one on her. Rolled her back onto her back, gown still all rucked up and uncomfortable--and simply left her. No conversation, no calming words--just doing the job as fast as possible.
I asked friend if she was cold and she said 'yes'. I went out and got a warm blanket and smoothed her nightgown and tucked the warm blanket around her.
Poor woman. She must have felt so diminished by this.
She was moved the next week to a different facility.
I am not family. I didn't say anything to anyone as I am not a part of this CG dynamic, but I'll tell you, the difference between the two incidents was night and day.
We haven't had much success with medical intervention, as he fights it when he feels drugged, and is even more agitated and combative.
A meeting with the care staff is also a good idea. It helps to have open discussion and input from everyone involved to try and find a workable solution.
She may have a history of being abused / violated.
Or feels 'now' that she is being violated / disrepected.
She is / feels vulnerable. Address her vulnerability.
She may not know what they are doing - undressing her.
She may - very likely - feel embarrassed.
Realize people in memory care have feelings and they respond to respect and, in general, how a person approaches them and talks to them.
I had a client in memory care for the last couple of years.
She never forgot me - week after week of visiting.
She spoke 'gibberish' so I rarely understood what she was talking about - but that didn't matter. I connected with her emotionally.
I remember when I told her (a few times) "I love you M" - and she would "light up like a Christmas Tree."
In other words, she got it.
She understood what I was conveying.
Caring for her. Loving her.
Spouse may need to be medicated. Discuss with MD.
Gena / Touch Matters
Memory Care workers should be specially trained to deal with the outflow from dementia, and combativeness is certainly one of those. When I was moving my mother from AL to MC, I was speaking with intake personnel and I told them she had assaulted a nurse at AL and she had been asked to leave. I just didn't want it on my head for her to hurt someone because I didn't give them a heads up, even if it meant they would not accept her. To my surprise, they never blinked an eye at that and told me they train their staff as to how to manage anger issues. I was skeptical, but relieved that her violence wasn't a deal breaker for them. They did mention that it sounded like her meds were not adjusted properly and they tackled that as the very first thing.
They changed her anxiety med and then upped it a little and that alone made a huge difference. Then they put her on a prn Rx for Ativan. Turned out to be a lifesaver. They assured me they wouldn't make her so drugged up she couldn't communicate, but honestly, I didn't care if she was. Maybe that's wrong, but I just didn't want to see her go through every day angry and lashing out at everything and everyone. I wanted her to have peace. Now she sleeps a lot, but overall she is pretty easy to deal with and she is in a good mood most of the time. She is rarely lucid these days, but that's the disease not the drugs.
I've also noticed that the workers at our MC are geniuses at manipulating her. She has a couple of workers she just doesnt like, so those people don't work with her. They seem to understand that it is just the way of dementia patients. They also take the time to come at her with a request gently and kindly, and if that doesn't work, they use deception ("Mrs. Xxx, I've been trying to perfect my pudding recipe. Would you try it and tell me what you think?" On a day when she was resistant to taking her meds). Ive also noticed that they touch her frequently on the arm or shoulder and they hug her and tell her how good she is (and she has never been the soft grandmotherly type everyone loves to love). If I'm there, they bring me into the conversation and I engage with them until they've managed to do what they needed to do, often without her even noticing. I watch them change tactics on the fly if one doesn't work on a given day, and I've seen them move on to the next resident and start all over with different strategies with each. I can't help but wonder if maybe staff at your MC isnt trained as well as they could be. Turnover in those places is horrendous so unless training is deliberate and scheduled, it might be being neglected. It would be worth going to the management and asking them how they expect their staff to handle the specific cases when she becomes combative, and if you don't get good answers, perhaps look for a different facility.
Someone mentioned the possibility of pain causing her to be combative and I had never thought of that. However, as I sit here at home while it is cold and rainy outside, I can tell you that my own arthritis is killing me and if I couldnt say "ow! You're hurting me!" I might be a little combative too if someone tried to make me move too fast.
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