I currently am caring for gentleman age 82, he did not want the help so the wife told him I was doing the housekeeping, well they have housekeeper as well.. so I do the laundry and in between loads i read as the client does not want to go out or do any games he just wants to read. so he has asked me to leave. he isnt paying me to read. not sure what else to do. He asked me to leave last time i was there was very agitated so i called the wife explained what happend and she was very understanding. just not sure what else i can do keep busy when the client is refusing to only sit and read while i am there.
My mother had bipolar mental illness and refused to accept home care help even though family strongly advised it to keep her independently living with me in CA in 2012-13. She was age 93 then and also running out of her funds. Finally after several falls without caregiver's "fired" from our residence, Mom had to move to assisted living in CA, finally for her last year with family in OR. She slept most of the time and suffered a few more falls but lived to be 95 in very failing health.
My parents still live in their home. The family has been checking in on-them for 2 years now. My mom refuses help with laundry and grocery shopping. If we step in to help, she becomes irate......never a thank you. Often I check the refrigerator and find spoiled food or very little. How can we approach our concerns without belittling or anger them?
Dear Greekgal60, I hear your frustration. Your mother is lucky to have you. Does your mother have dementia? Mine does. When we could not get her to accept outside caregivers, we told her a friend was studying to become a caregiver and needed to do an internship in someone's home for her training. Our mother was willing to accept the caregiver under this guise as she felt she was helping, rather than being helped. In fact she took to tutoring this patient woman in all the ways a caregiver should provide respect and courtesy. Long story short, this worked and we never went back from there. We did transition through several before we found a really good match, over the course of several months, but this technique broke the ice on caregivers for Mom.
I am going through this same scenario with my 90 year old mother. She absolutely refuses to accept help from caregivers and will not even consider moving to an assisted living. We have lived together for eight years now, both of us widows and the first four were fine, but these last four years have been a strain on me physically, mentally and emotionally and I need to get away. If my mother refuses this next caregiver, then she will be left alone and whatever happens...happens. I am at that stage where I really don't care anymore. She has drained the life out of me and I'm truly done with her!!!!
The focus should be on ability and capability, not on disability, incapability, and "neediness." If the caregiver has an open attitude, refrains from insulting the senior by "helping" too much, and respects the senior's wishes it is more likely to work out. I don't think such "help" should EVER be forced against the senior's will. If that happens, no wonder the senior sees the "help" as unwanted intruder! This should be a joint, mutual decision.
A simple explanation of practicalities might work better than too much emphasis on disability. If emphasis is on the family member's limitations ("I can't take off anymore time from my job," or, "I'm not very good at lifting and transferring you. I think someone with a stronger back and good training in this task might be a safer option," takes the focus off of inadequacies of the senior. No matter how you feel inside, telling another person they are incapable is an insult.
This article is all well and good but there are downsides of professional home health care. It took me 10 years of going alone in caring for my husband's advanced Alzheimer's. Finally, when I realized I could not do it alone, I hired a local professional caregiving agency. The first lady was 45 minutes late. I had a doctor's appointment that needed to be rescheduled. The second person was okay; very quiet and nice, however, she stated she was a 'fill-in' since she lived at least 2.5 hours from our home. The third person---ripped me off stealing whatever she could---Hummels, LLadro's, Japanese vases...whatever she apparently could stuff in her backpack. She was reported, fired, but nothing was recovered. So, after taking 10 years to build up trust, confidence and coming to terms that I needed help, this is what happened. Be very careful. Bonded and trained caregivers mean very little. Anyone can be bonded as long as they do not have a police record. Several of my friends that have hired caregivers have had similar incidents. Vulnerability and helplessness are often taken advantage of.
trosneb - these messages are quite old now, but I disagree with the comment that you have no legal right because if your FIL is being abused, which it sounds like he is, and not fed, he is at risk. Your MIL seems to be where ours was, too independent. She likely needs to be in a safe place.
This is what I wanted to say in response to this article:
Although many of the reasons discussed are good ones and possible ones, it is not always about fear or loss of independence. It can be a mindset, enabled by dementia, that does NOT realize despite how many times you might say it about yourself, you are NOT independent. Our mother constantly reiterated this - I'm independent, I can cook, I don't need help, yadda yadda.
The reality? She was NOT cooking, she was relying on frozen dinners, and boxed items like graham crackers or fruit cocktail. Fresh food items purchased during one visit would be found at the next visit all shriveled up in the fridge. Freezer burned items in the freezer. With no one there daily who knows what else she was/was not doing!!
Yes, she shooed the nursing aides we hired initially as a "check", only one hour/day, just to be sure the meds in the locked dispenser were taken and see that she was okay. Some were industrious and would try a little cleaning (sweep floor, clean bathroom), but mom would always try to stop it or join in with dust pan and hand brush. She just felt in her own mind that she was quite capable and did not need help. She was not afraid of them. They really didn't interfere in her daily activities, whatever those were... The aides only lasted a few months and she kicked them out. It was not even the expense - we told her Medicare pays for this, which they WOULD if she accepted personal care, like bathing, but she said no. So we just did not tell her that she was paying for this.
She did NOT want to move either, but we had to do this by the end of that same year to protect her from herself! She was and still is adamant that she is fine and can care for herself... not.
trosenb, I don't think you have any legal right in regard to your parents care. As long as your parents are managing on their own, eating three meals a day, laundry getting done, house looking presentable, we just need to stand back and wait.
My Mom also had refused caregivers and cleaning staff, it was like she was insulted that at 98 she couldn't maintain her own home. Dad was also in his 90's and just followed along with what Mom said, as he loved her so much. He would have liked to have seen caregivers and cleaning staff come in, but Mom ruled the roost.
So we all play the waiting game. We wait until there is a medical crises or two, or three. Usually that will be the game changer for our parent that, yes, they do need help with their day lives. Usually it takes more than one crises before common sense appears.
And sadly, sometimes that crises is the downfall of our parent. It was for my Mom who spent her final 3 months living in long-term-care not knowing where she was. Dad eventually sold their house, and was living in senior living which he really enjoyed.
My mother in law is physically disabled and my father in law has dementia. He relies completely on her for his meals. She has been abusive to him by not allowing him to be in her presence, he is not allowed to walk to the store anymore, not allowed to turn any lights on or watch tv. She decides if and when they will eat. He has been reduced to a bag of bones but doesn't complain. When we ask if he wants to stay with us for a while, he responds with "I can't walk out on her" and "she makes my meals for me". This man is a Vietnam Vet and trained to 'survive' extreme circumstances and is therefore resorting to his ingrained survival skills. She berates and screams at him constantly so he just sits in the dark in the other room alone. She has been using him to do anything that requires physical movement and strength, so he feels the need to stay to keep her from hurting herself. She says she just want to DIE and will not allow any outside help whatsoever. We sent a couple of agencies out as well as professional house cleaners which she fired all of. We also took them to see 5 star assisted living facilities (for which she paid exorbitant amounts of long term health insurance for over the years). Now she says she NEVER intended to live in one of those places!) She also refuses to use a walker or cane to aid in her mobility..We are at our wits end and can't stand to see her abuse him any longer. What are our legal rights?
Normally our elders will not wish to be under the care of outside caregivers. Even we in our old age will not wish so. I have a grandmother and I'm taking care of her. I have a friend whose grandmother was under the care of caregiver. But within few weeks she said that she'll be alone, and doesn't want any care from anyone. My friend is in US and her grandmother refused to go with her. She did not have any choice, she had to leave her alone. Since I too have a grandmother, I suggested her few safety tips for her grandmother which I found in an online article. So If elders doesn't want any help from outside caregivers, give the care giving task to someone she knows very well.
I am having a very similar problem; in fact, today was very stressful. After realizing mom could not be alone for even an hour or more without being disoriented, confused, anxious and angry, I arranged for a senior companion (who is a retired nurse) to come in, initially 2 hours a day, 2 days a week so mom could get used to it. What I didn't like about the agency is that there was supposed to be an initial introductory meeting to see if it was a good fit; however, the worker called and informed me that she was the new caregiver. She even had the number of hours wrong.
On Tuesday and today, I needed to extend those hours because I was presenting a workshop. Tuesday was bad, but today was out of control (although the caregiver was able to contain the situation and stayed until I got home). Long story short, mom was demonstrating hostility, fear, psychotic traits/flashbacks and threw the caregiver's bag out into the hallway. The next door neighbour and superintendent became involved. Embarrassing, frustrating, exasperating and no solution, only resolution for this problem.
My sister and I are struggling with our mom not excepting the caregivers. We have a caregiver that comes in during the day while we are at work. We have had two caregivers in the last two years. The present caregiver is very patient with her but my sister and I are afraid that the caregiver may get tired. On a daily basis our mom tells her to get out that she doesn't want her here. It seems though that she does not want to accept anyone being here with her but my sister and I. She has a granddaughter that was very close to her before her dementia and she doesn't even want her here with her. We have had her doctor talk to her and tell her that she can no longer be by herself but the brain does not absorb that and she does not remember any of that, so she keeps telling the caregiver to leave. Our mom has gotten a little more aggressive with the caregiver and yells at her to get out of her house. We have asked her doctor for some medication for the aggression but not even that seems to help. We feel so guilty because we have thought of putting her in the health care facility. We have sat down together with other family members to explain to her that she needs someone here to help her during the day before my sister and I come to care for her, and she just tells them that she doesn't need anyone here .
Hi, even better, invest in a small home lockbox or safe for any home valuables, or keep them out of the normal flow of traffic, or have a relative hold them for you. I don't believe most caregivers have any likelihood of stealing anything, but it is unpleasant at best, to have suspicion around - everyone feels badly if something gets lost. If caregivers come regularly, you will get to know them, and they get to know your routines and often help you keep organized. You develop a relationship with them and the agency, and discuss any such issue right away, when it is much easier to solve, than weeks later.
one last thing, Castle, like that - giving kind and gentle directions - not sure entirely but certainly the issue with her and children - son, in particular - he's a government (we have a lot of those around) contract manager, who, at least according to them, have to learn to be the exact opposite - your tax dollars at work, you know, lowest bidder and all - so seems to have been hard for him to come home and be that way with his mom; she does say he seems to be doing better, think he's gotten this latest - my understanding, not caregiver, so not really sure what's going on with that, but sitter only, saying they'll do more of what caregiver's been doing, that possibly apparently still been more uncomfortable with that being done by them than realized - just been "accepting"?/resigning? but not really wanting, just that same uncomfortableness was going the other way with son, but maybe working it all out, but had been the reason why didn't want aunt to leave at all, not even go outside, when they were there, which had been really wearing on her, but now with just "sitting", he doesn't have that problem, so, in theory, at least, she'll feel free to do so, just wondering how it's been going.
and, oh, Castle, with my dad, if he didn't want to take a shower, many times his caregiver would tell him that if he didn't let her give him one, she could lose her job, which played on, like you said, his age; he sure didn't want to be the cause of that, pretty much worked every time; with other situation, the issue's become the cleaning, which was an issue before, but beyond she's saying that the caregiver is saying she's doing things she's not and she's expected to sign off on it and she doesn't feel she can, that she would be lying, but since, of course, she says she does if I'm there, I have no way of knowing what she's doing when I'm not, but my point is, not sure how important it is anyway; her house is nothing like my dad's was.
castle, they do hire somebody to mow their lawn and I wish his wife would come with him when he comes, so she would come in and eat with her, which they have come personally, since they're people who used to be good friends, but when they have noted anything "amiss", what are you saying they should do, because what they've done is merely tell the family, they not realizing they were having somebody come in and certainly didn't know I was the one who got them started and she was rural, so worked out fairly well, until she retired, but she was through an agency; couldn't seem to get them away from that, though was trying with trying to get them a source of funding to do so; agency was being paid by someone else who that's the only way they would do it; is that an issue you've run into? Since she retired, not so sure agency has taken them off without problem solving first - the one that just didn't come back never really started so nobody knew, think just the so rural an area they just didn't want to do it, the others she's actually the one who called down there because of issues she had with them and told them - well, she says she didn't actually tell them this, but only if they couldn't resolve the situation, but she didn't try with the caregiver herself first before calling their supervisor, which I could possibly see in the case of the one who let him fall; think she was older anyway, but this last one she did that to really concerned me - didn't somebody mention a case of priorities? what is it you're really wanting them to do anyway? in this case, I thought the main priority was getting him a shower but she's talking now, since she's gotten him to do a little more for himself, that maybe it's not, but in the situation we have, in their mind, his care is supposed to be the priority, so...her reasoning for calling the supervisor this last time when she was, at least as far as I knew, course I only know what goes on when I'm there and she's pretty much saying that's the only time, of course, that she's doing that, that when I'm not there she's not, so how can I know? so thought she was, so has gotten her somewhat on the agency's bad side so not sure if acquiescing to her or just her doing that caused the caregiver to then just say she didn't want to come back but she hasn't been back, so has caused a real issue.
It got pushed almost to the limit when we first got dad's caregivers - yes, that agency sent 2, one for his personal care and one for his housekeeping, can't remember which was which, but of all things, the older one's daughter was having a baby and couldn't start the same time as the other one, pushing it to the very day that my youngest son was to participate in a special school program and I was 5 hrs. away and had planned to be there but, like you were saying, I felt it was important to be there when she first came, especially with this all being new to dad; thankfully she did come in plenty of time that day and got everything worked out, just in time for me to slide in to son's program.
Oh, and Debdaughter, that's funny that you had the opposite issue with the garage door...! So often, any issue can come up - and once it's into opposition, it helps to drop back, drop the issue for a bit, but then try it again with a simple direction in a little bit. Sometimes folks need a bit of warning, and they'll accept help later. And no, it's an art that has to be approached with some understanding, and humor, that many best laid plans will be thrown off. But once one has a relationship where one is used to giving gentle and kind directions, the process can go more simply so it helps to notice and affirm and try not to change the schedule unnecessarily, if you have one you like.
And Sibling3 - that's exactly a strategy that can work - it matters to try to be creative. MANY elders will not accept someone caring for THEM, but they will be glad to rise to the occasion to help another - that is more in keeping with their age and wisdom anyway, and they like it. I like that you got your elder to accept a caregiver by saying the caregiver needed the practice and referral....
I had one person who rarely let anyone into their home, and any new people especially, might spend the whole shift, waiting outside, trying a few times. One day when I knocked and offered help, she said she needed no help, I had an idea - and asked if I could possibly come in and use her phone, as I needed to call my company, and my battery was dead.
Oh sure she said, and she was extremely helpful and in the process of dialogue and agreement about a few things, as I was inside her home, I noticed a small issue untended, and said, simply, Oh, let me fix this for you.... and she was glad, and let me do it, and within an hour she was glad I was there, had no interest in asking me to leave.
Debdaughter, yes, it's harder when the situation is rural. One way to do things, is to hire someone with another home task - cleaning, lawn care - and arrange for that person to come and do a job, and just personally arrange for them to also have a snack with your father, and note anything that seems amiss. Sometimes those people show up more, better pay. I wasn't trying to say it's always easy, only to factor in and try to work with a caregiver - I hate it when an agency takes one (has happened to me) off a job, without problem solving with me first. I'm open to feedback and trying something different, but if nobody tries to work with you, some families only talk with supervisors - opportunities to build on what good sparks are there, are difficult, without support.
I have found it helpful to be with the person when the caregiver comes for at least a couple days, and to gradually introduce the caregiver into the home. When the person needing help sees you interacting with the caregiver, it can give them some confidence in the caregiver and help them feel safe.
In our case, our mother was in denial about her worsening dementia. She would not go to the senior center, for example, or socialize outside the family. We told her one of our friends was in school for home care and needed to get some work experience with someone her age, preferably who did not really need help, so Mom would be perfect. This worked.
This is a great article with a lot of insight and practical advice. You show the caring and sensitivity toward the elderly and their frailties that is often overlooked in our society. I have written a number of blog posts on this topic such as: "Grumpy Old People Deserve Consideration" Thanks for the tips in the medical and healthcare realm!
Castle, one problem we've had is living in such a rural area, it's been hard to find people to come out this far, so unless we've managed to find one that lived not too far, we've not been able to build that community; we did start off with one 2 yrs. ago who did but she was getting older as well and her husband was in bad health, which is why she was even still working in the first place, so when he had to have surgery earlier this year she started preparing aunt and uncle for her not being there for a period of time but then the very day we were going to get them some more help and they were going to try to coordinate with the help they already had they got a call that she wasn't going to come back; she was just going to go ahead and retire - maybe her husband had gotten his disability - so that's when the caregiving became interchangeable but also their children had not been involved up to that point in the hiring but the very day the coordinator was coming she missed the house and met the son, who had just left, stopped and asked him so he turned around and came back and said he would be in charge, so he and his wife made all the arrangements, later, when they'd arranged for the actual supervisor to meet with them at mom's house, much to his mom's chagrin, who wanted to take care of it herself, arranging for their longest day, where they were to do the most, be on a day when they could be around, which maybe is not a bad idea, but something doesn't seem to be working out; maybe because they do make themselves present and makes her feel as if she's not in charge, which they did do it exactly as you said; they gave the orders to the agency supervisor, who then did pass it on to the caregiver, when they got a new one, who does live in the area, after the old, who I don't believe does but was willing to come - and she was older - one let him drop to the floor so she did call and tell them not to send her again, without her being told ahead of time, so she overcompensates by attempting to take more charge on the other days when the child can't be there so then when she doesn't get done what she wants on those days she also called the agency and told them that if she couldn't do her job not to send her back, so she hasn't been back but I do think a lot of it is, as you expressed it, a lack of affirmation, but they did manage to find yet somebody else but then they didn't come on what was supposed to be the long day but came the next day, which was this past weekend but didn't stay the long time; they have started writing notes to each other, so when she called Monday and wanted me to come, they were laying on the table telling them to find another agency, something they've talked about for a while but kept being told couldn't be done, but which they may have been able to do since they did some other things she didn't know about, since there was a note from them to her saying another service was supposed to start yesterday to do something different, as in no care tasks, just sit with uncle, from what I understand son is just going to take over the care the other ones were doing, where with this one just sitting is supposed to make them feel freer for her to get out while they're there, so eager to see how this is going to go.
otoh, my dad had the exactly opposite problem; his garage door would get to where it wouldn't open, blocking his only safe exit besides that being where his car was - which is a whole other issue - but I had an uncle who knew how to take care of it - seems he was bumping the "eyes" that let it open when he was coming in and the routines is so important as well; when he got out of the hospital, his Italian Northern - where they eat much later, etc. - caregiver was just putting a meatloaf in the over at the time he'd always been used to eating so he ended up getting fairly agitated, but we were able to talk to her and she didn't let that happen again, which really made a difference, but that's another issue in this other situation
I like all the points in the article, good to see them written up, this situation does arise. I've worked as a caregiver for elders over decades, and yet have found ways to remain and turn negatives into help and care, by my own alertness to small elder comments. Responding each time, goes a huge distance to reassuring an elder, and sometimes the "response" is just to look their way and show an affirmation, when they are talking with their family member.
That's the piece I see missing in your very relevant article: having the family member make some time, to be nearby, and phase in a caregiver, can make a huge difference. Or, if a family member is not good at affirming others, is so busy and only give orders and directions to agency supervisors who then pass them on to their caregivers - the patient has no way to begin to adjust to outside help, but when the family member is nearby and shares about care tasks, written down, so there is not verbal overload - care can be gradually phased in. Many people say those with Dementia don't "learn" any more, but I find they do respond to someone who responds to them, in affirming ways, and accepts their hesitations, makes time to drop a goal. Once in my work, I won over a resistant elder, by listening to his stories, and only doing small bits of care at first. When his electric garage door opened by itself one day, he was very paranoid, longstanding fears of some of his neighbors. I knew that until that door was shut again, his paranoia would not go away. So I stayed late that day, dropping all other tasks and followed his instructions to find the code and re-shut the door, likely some mechanical issue. I stayed a bit later and saw him relax. The patient has life routines, and seeing a caregiver pay attention and help them with Their small routines, really matters.
It's an odd job, for caregivers are hired by children, who are not used to seeing their elders as individuals, but as their parents. A caregiver can respond to other small cues. And when the person refuses to get up, I learned over time, to make light of this issue, drop it, and then after a few minutes, bring up the plan again, as if it had not initially been dropped. Express the goal in the positive, like, "Let's get this bathroom trip done now, then we won't have to worry about it later."
There are many arts in human interaction, and yet hiring caregivers for a home, is too often organized by busy people, not present in the home, and too many conversations with care providers occur without the direct care person present. Most people want to do a good job, but expecting "people issues" to be solved by using medication, is over-kill, understandable when struggling family don't have enough time to observe and sift through details, but supervisors in the field should make more effort to visit, and once there, listen, and affirm the caregiver, even if that person is not a bubbly personality. One agency I know, has a rule that each client will get a team of regular caregivers, a basic team of 3 - and valuing each member of that team (including different shifts), lets the elder deal with known parties, and relationships and routines grow. Assuming caregivers are interchangeable allows families to learn little more about new routines and patterns that repeated caregivers can develop. Affirm the team, work to keep the same team for several months at a time. Peripheral people may need to come sometimes, but treat them as peripheral, help the 3 basic team members affirm each other and the elder. With fearful ones, this becomes a kind of small community that belongs to them, in their current life.
Granny, that happened with hub's uncle, too; the caregiver at that time was really in a lot of ways too old to be one, or at least for as big a person as he is who could handle himself so little, so aunt called the agency and told them not to send her anymore, so can see the trust factor with that; she won't leave him alone with them but they were supposed to be trying something/body else starting yesterday; see how that goes
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Coping With Seniors Who Won’t Accept In-Home Caregivers
A simple explanation of practicalities might work better than too much emphasis on disability. If emphasis is on the family member's limitations ("I can't take off anymore time from my job," or, "I'm not very good at lifting and transferring you. I think someone with a stronger back and good training in this task might be a safer option," takes the focus off of inadequacies of the senior. No matter how you feel inside, telling another person they are incapable is an insult.
This is what I wanted to say in response to this article:
Although many of the reasons discussed are good ones and possible ones, it is not always about fear or loss of independence. It can be a mindset, enabled by dementia, that does NOT realize despite how many times you might say it about yourself, you are NOT independent. Our mother constantly reiterated this - I'm independent, I can cook, I don't need help, yadda yadda.
The reality? She was NOT cooking, she was relying on frozen dinners, and boxed items like graham crackers or fruit cocktail. Fresh food items purchased during one visit would be found at the next visit all shriveled up in the fridge. Freezer burned items in the freezer. With no one there daily who knows what else she was/was not doing!!
Yes, she shooed the nursing aides we hired initially as a "check", only one hour/day, just to be sure the meds in the locked dispenser were taken and see that she was okay. Some were industrious and would try a little cleaning (sweep floor, clean bathroom), but mom would always try to stop it or join in with dust pan and hand brush. She just felt in her own mind that she was quite capable and did not need help. She was not afraid of them. They really didn't interfere in her daily activities, whatever those were... The aides only lasted a few months and she kicked them out. It was not even the expense - we told her Medicare pays for this, which they WOULD if she accepted personal care, like bathing, but she said no. So we just did not tell her that she was paying for this.
She did NOT want to move either, but we had to do this by the end of that same year to protect her from herself! She was and still is adamant that she is fine and can care for herself... not.
My Mom also had refused caregivers and cleaning staff, it was like she was insulted that at 98 she couldn't maintain her own home. Dad was also in his 90's and just followed along with what Mom said, as he loved her so much. He would have liked to have seen caregivers and cleaning staff come in, but Mom ruled the roost.
So we all play the waiting game. We wait until there is a medical crises or two, or three. Usually that will be the game changer for our parent that, yes, they do need help with their day lives. Usually it takes more than one crises before common sense appears.
And sadly, sometimes that crises is the downfall of our parent. It was for my Mom who spent her final 3 months living in long-term-care not knowing where she was. Dad eventually sold their house, and was living in senior living which he really enjoyed.
On Tuesday and today, I needed to extend those hours because I was presenting a workshop. Tuesday was bad, but today was out of control (although the caregiver was able to contain the situation and stayed until I got home). Long story short, mom was demonstrating hostility, fear, psychotic traits/flashbacks and threw the caregiver's bag out into the hallway. The next door neighbour and superintendent became involved. Embarrassing, frustrating, exasperating and no solution, only resolution for this problem.
I had one person who rarely let anyone into their home, and any new people especially, might spend the whole shift, waiting outside, trying a few times. One day when I knocked and offered help, she said she needed no help, I had an idea - and asked if I could possibly come in and use her phone, as I needed to call my company, and my battery was dead.
Oh sure she said, and she was extremely helpful and in the process of dialogue and agreement about a few things, as I was inside her home, I noticed a small issue untended, and said, simply, Oh, let me fix this for you.... and she was glad, and let me do it, and within an hour she was glad I was there, had no interest in asking me to leave.
otoh, my dad had the exactly opposite problem; his garage door would get to where it wouldn't open, blocking his only safe exit besides that being where his car was - which is a whole other issue - but I had an uncle who knew how to take care of it - seems he was bumping the "eyes" that let it open when he was coming in and the routines is so important as well; when he got out of the hospital, his Italian Northern - where they eat much later, etc. - caregiver was just putting a meatloaf in the over at the time he'd always been used to eating so he ended up getting fairly agitated, but we were able to talk to her and she didn't let that happen again, which really made a difference, but that's another issue in this other situation
That's the piece I see missing in your very relevant article: having the family member make some time, to be nearby, and phase in a caregiver, can make a huge difference. Or, if a family member is not good at affirming others, is so busy and only give orders and directions to agency supervisors who then pass them on to their caregivers - the patient has no way to begin to adjust to outside help, but when the family member is nearby and shares about care tasks, written down, so there is not verbal overload - care can be gradually phased in. Many people say those with Dementia don't "learn" any more, but I find they do respond to someone who responds to them, in affirming ways, and accepts their hesitations, makes time to drop a goal. Once in my work, I won over a resistant elder, by listening to his stories, and only doing small bits of care at first. When his electric garage door opened by itself one day, he was very paranoid, longstanding fears of some of his neighbors. I knew that until that door was shut again, his paranoia would not go away. So I stayed late that day, dropping all other tasks and followed his instructions to find the code and re-shut the door, likely some mechanical issue. I stayed a bit later and saw him relax. The patient has life routines, and seeing a caregiver pay attention and help them with Their small routines, really matters.
It's an odd job, for caregivers are hired by children, who are not used to seeing their elders as individuals, but as their parents. A caregiver can respond to other small cues. And when the person refuses to get up, I learned over time, to make light of this issue, drop it, and then after a few minutes, bring up the plan again, as if it had not initially been dropped. Express the goal in the positive, like, "Let's get this bathroom trip done now, then we won't have to worry about it later."
There are many arts in human interaction, and yet hiring caregivers for a home, is too often organized by busy people, not present in the home, and too many conversations with care providers occur without the direct care person present. Most people want to do a good job, but expecting "people issues" to be solved by using medication, is over-kill, understandable when struggling family don't have enough time to observe and sift through details, but supervisors in the field should make more effort to visit, and once there, listen, and affirm the caregiver, even if that person is not a bubbly personality. One agency I know, has a rule that each client will get a team of regular caregivers, a basic team of 3 - and valuing each member of that team (including different shifts), lets the elder deal with known parties, and relationships and routines grow. Assuming caregivers are interchangeable allows families to learn little more about new routines and patterns that repeated caregivers can develop. Affirm the team, work to keep the same team for several months at a time. Peripheral people may need to come sometimes, but treat them as peripheral, help the 3 basic team members affirm each other and the elder. With fearful ones, this becomes a kind of small community that belongs to them, in their current life.