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Last January, I hired a caregiver for my 92 year old mom with moderate - going into severe - vascular dementia. They hit it off and within 3 months mom really accepted R***. R*** was very good at what she did and had a routine down with mom that worked well. I also treated R*** like family. The better I treated her, the more I noticed the last few months she felt comfortable enough to flip on a dime and yell at me, throw things, and then sob for HOURS. I even took R*** to a doctor with my mother in tow in the backseat! (R*** canceled the appt for herself anyhow) - She has been giving me red flags left and right. And poor mom. It is hard for her to warm up to people and she literally loved Ruby and depended on her, trusted her presence. r*** began telling me she fantasizes about slitting her throat in the mirror and has determined how she will kill herself someday by jumping off a bridge. i always knew she was a little "off" but i thought she was just immature for the longest time, and she never, ever hurt mom. mom liked her a lot. knowing this, I should have fired her on the spot. But, no... in my bad judgement I told her she probably had a chemical imbalance and I would give her a vacation or whatever she needed.... I had never seen her hurt mom and mom could still tell me if R*** hit her or something. Mom never did. She loved being with her and finally trusted someone. So... I waited because I had nobody else, and 2 nights ago R*** began flipping out on me while my mother was asleep. I asked her to tone it down before she woke my mother and she kept yelling anyhow so I told her let's not do this anymore. I will find a replacement, just please don't leave me high and dry until I get one. she agreed. The next day, I took mom out for awhile to give her a break. She told me via text she would be back at 2. That was 10:30 AM. By 11:30 she wrote that "circumstances changed and I will not be returning. I left the key and the garage door opener on the baker's rack." That was it. Nothing else. It is like being the toll collector on a busy drawbridge and saying, "hey, see ya, good luck!" and throwing the door open and leaving the traffic piled up. I consider this abandonment. She did not come from an agency. she was a personal hire privately who gave me tons of great references, resume, the whole nine yards so I have no recourse but i feel very betrayed. It is a cardinal sin in the world of caregiving to desert a sick client that relies on you. I scrambled and got help the same evening coming in from an agency, so for the moment, things were okay. then the next morning after mom woke up to the new girl, I walk over after a bit - 2:00 pm to be exact. Mom is in her nightgown still. No wig on no make-up, crumbs on the kitchen tablecloth, mom is walking alone (this can't happen) through the house wearing her SHOES UNBUCKLED with her heels coming out. Bed isn't made... Now I don't want to complain because in reality, we are getting a different girl today at noontime. But the thing is, mom wants Ruby. She said she doesn't want a stranger in the house, and by having to bring in temps, they are all switching days and hours and everyone really is a stranger. i ended up writing a 3 page schedule or routine for mom for each one to read, but bottom line, mom won't cooperate with them. she was up until 9 last night (bedtime is 7) with her shoes on and fully dressed and argumentative. And for the first time ever, she said she was going to talk to dad about this (he's been dead since '09) and she will also have a word with her mother! Then she called me her cousin. I am her only child. She has never done that before. Her eyes looked "off" to me and I ended up having to give her a mood pill before bed just to settle her down. I told her we would talk about it in the morning. Well, now it's morning and the girl just texted she won't take her morning pills. I'm like, come on... this is getting crazy. I will find a perm for her here in the next couple of weeks, but obviously it will have to be someone really willing to earn her trust and understand dementia. I am a nervous wreck and at the end of my rope. If R*** could have just maturely said I am giving 2 weeks notice or whatever, I would have had a degree of respect left for her, but to literally desert mom in a sneaky tricky way like this... is unforgivable. I am glad she is gone. She turned out to be nothing like what she acted like for the first 8 months. But I had to call the doctor, figure out the pills, and get an expensive temp agency in there fast. I am stressed to the max right now and mom is rejecting everyone that comes in. Advice?

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As a paid caregiver, I can tell you, that with all Ruby had going on, the most loving thing she could have done for your mom was leave... maybe it has thrown you and mom into an inconvenient tailspin.. and I feel bad for you about that. But somewhere in her illness, she understood she was causing harm..... and left...
I totally understand your being so upset.... and hold no blame for you keeping her after you saw the red flags..... sometimes we let things ride because we are so overwhelmed by our life, that we don't realize until later, action should have been taken sooner.... no blame , no judgement....
And yes, mom may be upset for a little while, this is only temporary.... we never get to have perfect circumstances for our loved ones.... life has a way of getting in the way.... I am sending prayers that you get a good CG that appreciates that you give people chances, that you did care for your CG.....that is awesome in my experience of being quickly 'disposed of' at the families convenience... no warning, ect.... double edged sword...

It will work out..... it's ok for mom to be stubborn right now.... you are doing the absolute best that you can to remedy the situation.... have some faith in yourself that it will all work out for the best....hugs and prayers for you and mom.
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Step back for a minute and set aside the abandonment issues. Ruby obviously had severe mental problems. You admit you saw instances of this and other than take her to a doctor didn't realize the complexity of her mental disturbance.

Someone who fantasizes and discusses suicide (absent debilitating conditions such as ALS), is not perhaps immature but has serious mental issues.

It does no good whatsoever to analyze her behavior or be angry at her given the demonstrated emotional problems. You made a mistake in not addressing these when you first discovered them, that didn't happen. Just admit it and move on. Ruby probably has enough to deal with as it is and doesn't deserve criticism for abandoning you given that she's considering suicide.

I would try a therapeutic fib and tell your mother that Ruby has become very ill and had to be hospitalized indefinitely, and has been advised by her doctors that she'll never be healthy enough again to care for anyone else. That takes her out of the picture permanently.

If your mother doesn't believe that Ruby will not be coming back, use another therapeutic fib and write a letter from Ruby explaining that she has developed a serious illness, something medical that can't be cured, that she really enjoyed working with your mother...whatever...so your mother can recall those positive moments, cherish them, and be primed to move forward, eventually.

I assume you've spoke with a few agencies and explained the situation, as well as the fact that your mother wants Ruby, isn't cooperating, and needs someone with a great deal of skill to have the insights to handle her?

I think when a new person enters the home environment, it's best to just sit down, chat, get acquainted, and let your mother become used to this person before any actual "work" takes place. Find out about your new caregiver's backgrounds and interests, channel the conversation toward those interests so she can be enthusiastic.

And brief her on your mother's interests as well so she knows how to play to those. Maybe even buy something your mother had wanted, a bottle of perfume, special lotion, book...whatever...wrap it and have the caregiver present it to her as a present. There's always the possibility your mother will throw it on the floor in anger, or something like that, but she may also moderate her position after the caregiver has gone.

It isn't easy acclimating an elder to these changes; we discussed this in the Alzheimer's Creating Confident Caregivers class: older people are uncomfortable with changes, with new people. You have to find away to acclimate her to the caregiver, perhaps even pretend that the caregiver is visiting you, pretend it's a friendship, let your mother participate if she wants, but don't even mention the concept of caregiving until you mother begins to warm to the new person.
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I would move on from the former employee and say a prayer that you both got a way from that situation safely. I would take with me the lesson that comments about self harm are very serious and should always be taken as an emergency. People can harm others when they are thinking of harming themselves.

There are some great ideas above on how to acclimate a new caregiver to your household. Introduction visits, kind comments, gifts, etc. are very nice, HOWEVER, I would keep in mind that trying to please a person with severe dementia is not easily done. Some patients are extremely difficult and no one may please them. Your mom may not be happy and content with another caregiver. But,that's okay. I would do my best and then just accommodate as best you can.
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update: Mom's temp caregiver, Marlene, called me tonight to tell me she is a contractor for visiting angels. she said that she sees how hard I'm trying with mom, and that if she leaves before our permanent caregiver arrives 1st week of Jan, mom will decline with another "strange face" and she won't do that to me. she told me she has the choice (not the agency) on how long she stays with mom, and that she will stay with her until Holly (new perm lady who is a long-time friend of family) gets into town and she will buffer her the first few days. I feel like Christmas came early right now. Now, if only mom will settle down.
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BTW, Ruby might have been crying for help with her comments on suicide.
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To be honest with you, you are very lucky Ruby did not harm herself or your Mother in her current mental state. You dodged a bullet there. And for caution sake, I would change the locks on the house and get a new key. Someone as unbalanced as Ruby ("she fantasizes about slitting her throat in the mirror and has determined how she will kill herself someday by jumping off a bridge") may return to your Mom's house if she determines she "made a mistake and now needs a job/money" and will attempt to re-establish a relationship with you or your Mom. For piece of mind, I'd change the locks.
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I am hoping that people will someday learn more love and compassion towards people with suicidal depression and mental illness. I am pretty shocked by the things being said here, shocked at the lack of compassion for Ruby who gave great loving care for the mother until she couldn't hold herself together anymore, and then left so that she would NOT harm anyone else. No wonder suicidal people go through with it with this lack of compassion.
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Hi Nikki. Ask her doctor about Xanax, which can help take the edge off. And because you can give it to her when needed, it may be the calming help she needs to accept new caregivers. If she's calm you'll feel better.
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NYgirl, Xanax doesn't seem to touch her. Sunnygirl, I'm so overwhelmed just because I keep getting phone calls from the temp agency that mom won't let the caregiver help her and keeps saying "you need to leave"....
Anyhow, today went at 1:30 to dr. appointment. Deliberately withheld behavior meds to see how she'd act. holy cow. she performed (out performed) herself. She got to the point where she stated to the doctor, "I'll just get a gun and kill myself~" OH GREAT! Now the doctor says take her to the emergency room for a psych eval NOW.... and if you don't, I will have the police at her home at 5 to escort her. Now, 5 min later, mom doesn't even remember saying that. 20 min later in the waiting room at the hospital, she doesn't remember the doctor's visit at all. I'm thinking we are screwed they will Baker Act her - somehow by the Grace of God they didn't though. We were there SIX hours and finally she is on SEROQUEL 25 mg for 2 weeks until we can get to a geriatric psychiatrist for her, which I am actually excited about. We will see how she does on the Seroquel. She calmed down but was slurring her words a little 30 min after taking it... uh oh? I helped her to the bathroom to change her depends. She tried to put on a new pair OVER her pants... that's a first... but all I know is we have 2 weeks on Seroquel and in the meantime we see a person that will specialize in GERIATRIC PSYCHIATRY which obviously means Dementia. Just thank God. I'm fried and my period even started again today. I haven't had it for 2 years and am 49 years old...
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Seeing a person specializing in geriatric psychiatry does not automatically mean "dementia." Such people treat the entire range of symptoms and diagnoses as other psychiatrists, but for elderly patients.

You are right to be excited to have this option. It should be very helpful. But don't anticipate the conclusion before you hear it from the doctor.
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