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The caregiver did leave the house and since I was nearby I told her to leave and I was home in 10 minutes. Wife was confused and anxious, but did not recall the caregiver being there. She walked next door to ask a neighbor if they knew where I was. She took 0.5 mg of Ativan at 1:00pm and the incident with the caregiver occurred at 5pm. The caregiver arrived at 2pm. Any suggestions? Thanks.

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The caregiver works for you, so she shouldn't leave unless you tell her to, so that was good.

You may have to have the caregiver with you there for a while until your wife gets accustomed to her. She may not ever get accustomed to her, unfortunately, but she should never be left alone. It might be time for a memory care facility.
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You will have to make it clear to all who care for your Wife that she isn't responsible and cannot direct them to leave, cannot fire them or make them leave and that leaving her represents a danger to her and neglect of their duties to her. Make it very clear that they cannot leave until you are notified and arrive to take over.
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As already stated, caregivers need to understand that they are to take direction from YOU, not the patient with dementia.

The caregiver can back off and go in the kitchen to do some dishes or some other project until hopefully your wife calms down. Did your wife walk next door in the 10 minutes that you were on your way home after caregiver called? This is a little disturbing. Doesn't sound safe to me. It would have been nice if caregiver were still there to at least shadow her and make sure she wasn't in danger.

I have told my mom's caregivers not to ask mom many questions but to be assertive and lead her to the choice she "should" be making. Like, don't say "do you want to have a shower" but nicely say "OK, it's time for your shower now".

Did you give your wife the ativan? I just had to pull all medication from my mom's reach cuz she made a minor mistake but don't want it to be one that could actually hurt her.
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I hope u have a Caregiver there more than 3 hrs a day if your still working, running and playing golf. Golf alone is a 3 to 5 hr game depending on how many are playing and how many holes ur playing. My husband is a golfer.

From what u posted, ur wife should not be left alone at all. Dementia is very unpredictable.
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In 10 minutes, your wife could have burned the house down, wandered off, or done any number of dangerous things.

How long has the person been your wife's caregiver? Is this caregiver experienced with people with dementia?

Any caregiver should not leave the house until you arrive back home regardless of what your wife tells them. Caregivers experienced with dementia know the therapeutic fibs that can help the episode to pass.

5 pm is common for when sundowning begins. I doubt it had anything to do with the ativan, which was a small dose. What was going on at 1 pm when she took an ativan?

It's great that you have in-home help with your wife so that you can remain active. It's very important for you to have time and space for yourself.
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The caregiver can leave the ROOM instead.

From another room it should be possible to hear & discreetly supervise.

In 5 mins or so, knock on the door & re-enter with a smile.

If this fails & your wife chases them out the front/back door, the caregiver can wait just outside the door. Again, wait for her to cool down & attempt to re-enter.

If your wife is LOCKING the door behind the caregiver, the locks will need a re-think - that is a potential danger if the caregiver cannot get back in.

The caregiver may need to be creative - By 'leaving' but needing the bathroom first... By keeping calm & stating YOU had instructed them to stay, so they will be & that's that... By a sudden *re-set* eg like accidentally spilling some water on a table that needs cleaning up.
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rosadelima Oct 2022
YES this is awesome advice.
My mom would yell at the caregiver to get out of her house.
The caregiver would say ok - and hide in the next room where she could peek to see that my mom was ok. After 10 min she would cheerfully enter with a hot coffee and a smile and all was ok.
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Try and determine what precipitates this, Confusion about why she is there; time for a shower?, fear of her? I agree she should not leave the house. Is there a personality problem between the two? Does the caretaker's approach need to change, that may help, or change the caretaker. I see a lot of different ones in our facility with very different involvement with their clients. Is yours a "fit" with your wife?
Do you need to investigate placement in a memory care facility?
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I go with the flow anything to deescalate the situation. Fortunately in a little while they will not remember a thing. I find the trick is to be quick and find the right answer to the question or situation. It can be difficult when they talk about things from their past you do not know about. I also try to avoid mentioning friends who have died. The attitude I take is to play the game but be extremely careful not to make promises. Carefully steer conversations back to reality. Use simple logic to your advantage. For example my wife wanted her friend to come over to visit I had to remind my wife they live in mi and we live in or and airline flights were difficult to get with the holidays coming. She had not seen this person in 30years. She quickly forgot about it a few hours later.
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I would recommend the caregiver say something like:

Okay (to acknowledge your wife's request), I'll leave soon. First, I need to finish XXX or give you XXX (meds, juice, a magazine... whatever). The key is realizing that your wife will forget soon enough and that she doesn't mean what she says. Your wife is saying "leave me alone" (out of confusion, frustration, feeling uncomfortable with who she perceives is a stranger).

When 'putting off leaving,' your wife will forget about her request, telling the care provider to leave.

Another way to handle it,
1) have the caregiver ask: Is there anything I can do for you before I leave? I enjoy (a) helping you or (b) talking / being with you. This MAY help your wife feel cared about - and it may not, depending on the relationship they have or how your wife feels about a particular caregiver in the moment.

ANOTHER IMPORTANT REASON NOT TO HAVE CAREGIVER LEAVE...
You need (a) the break(s) you get, be it work or out doing other things, including socializing, which is extremely important to your well-being. You need to give yourself some time away. If your wife continues to be insistent, have the caregiver go into another room for 2, 5, 10, 20 minutes "Out of sight"-and then return... she could say, "It is nice to see you again ... (address by first name or Mrs...) - and continue on as usual.

So, the key is to have these options ready to go. If needed, write them down for caregivers. You DO NOT want them to leave. You DO NOT want to (set up a situation where you) run home, based on your wife telling someone to leave.

BE SURE to do what you can for the caregiver(s) to be familiar with your wife. Giving a hand massage or just holding her hand (if wife is okay with this) is helpful - this physical connector / connection.


Touch Matters
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I've had this many times over the years working as an in-home caregiver. It takes time. The client may not remember who the caregiver is or why they're in the house, but in time they get used to the caregiver being there and they become familiar to the client.
How long has this caregiver worked for your wife? If she just started then having her alone with your wife for three hours is way too long in the beginning.
I always told the client something like their spouse/adult child/grandchild hired me to clean the house. Or that their doctor sent me to help them do their exercizes. The caregiver can tell them anything they want, but never leave.
There have been times where a dementia client would order me out. Or threaten. Or even attempt to get physical. I always told ones like this that I was hired by their family to help out and that they will not speak to me that way. You have to be a little hard sometimes.
You should have a cellphone and the caregiver should call you to talk to your wife about why she's there. That caregiver shouldn't have to go asking the neighbors if they know how to reach you.
Get a cellphone so the caregiver can reach you.
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Isthisrealyreal Oct 2022
The wife walked next door after the caregiver left at OPs direction.
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The caregiver can do any of the following
Leave the room then come back. (if it is safe to leave the room.) If possible come back in through a different doorway.
The caregiver can tell your wife..I will leave but I was going to make a cup of tea and have a little cookie would you like to join me?
or
I will leave as soon as I finish making your bed, or doing the laundry (or whatever task needs to be done)
Find an activity that your wife likes, get the caregiver to get your wife involved.
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PatienceSD Oct 2022
That’s an excellent suggestion.
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How about you and the caregiver spend sometime with your wife? Having strangers in the house is unsettling...........it's supposed to be everyone's safe place. Imagine being in a state of confusion and wondering who the person is and why your husband isn't by your side? Add medications to that confusion and it becomes a threatening scenario. Make sure you have an experienced caregiver and an alarm system if there is any emergency or violence.

Be careful with that medication; it is only for short term usage and very addictive::

https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Lorazepam-(Ativan)
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My mom did that a few times. Once, when the director of the agency came to substitute for the usual caregiver, who was sick. The director called me and sat on the porch until I got there. I asked my mom why she told her to leave. She said "I don't like her". I said that I didn't like her either (agreeing works best), but that it wasn't nice to do that and she had to pay her anyway. It was quite a struggle to get her to stop doing things like that, but the not being nice and the cost were the 2 things she would respond to. Maybe you can find through trial and error what your wife will go along with. Eventually she will stop, but go on to other behaviors you'll have to find ways to maneuver around, but it's best to not allow the caregiver to leave your wife alone.
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I’m wondering why she takes Ativan. It’s a benzodiazepine. Very addictive and Ativan (Lorazepam) is usually prescribed for epileptic seizures and can cause paranoI’d or suicidal ideation, impaired judgement and memory.

https://www.webmd.com/drugs/2/drug-6685/ativan-oral/details

talk her doctor and her about the side effects and maybe try to find a different drug for whatever she’s taking it for.
Personally I don’t thing anyone over the age of 70 should take benzodiazepines. But that may be the problem. Talk to her doc. And if he insists that’s the best drug for her get another opinion.
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BurntCaregiver Oct 2022
Ativan (lorazepam) is a miracle drug for anxiety. Like any drug, don't abuse it. People can take it for years at a time and they are fine. It works great for elderly people too. My mother takes it and she is 85 years old. Her life and everyone else's would be unbearable if she didn't. The ativan is not the wife's problem.
The dementia is. Often times what happens in situations involving a spouse with dementia, is the other spouse doesn't realize how out of it they actually are. This happens all the time. The OP's wife is too far gone with dementia to have the responsibility of being left alone in the house for even a few minutes. Once the refusing to let the help in and the ordering them out because they don't remember why they've come or who they are, it's time for placement or 24 hour care and supervision.
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cjljml: Perhaps the caregiver should be reminded that her patient suffers from dementia and as such, she is to take NO direction from her patient. Perchance the caregiver could state something to ease your wife's anxiety if this were to happen again.
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BurntCaregiver Oct 2022
Llama,

That's pretty much what ends up happening. After all the redirecting and hand-holding and trying to calm them down in the end the caregiver has to just ignore what the client's direction and continue.
The wife sounds out of it enough to me that she should not have the responsibility of letting the caregiver into the house. The husband should wait until she arrives. That way no one is left sitting on the porch.
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Please get your wife evaluated and treated by a psychiatrist - preferably one that specializes in geriatrics. He/She can evaluate and treat your wife's anxiety with medications. It may take a few days for the medications to be effective, but they work long-term and should help with this problem.
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