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Hey guys, I'm a live in caregiver for an elderly woman who suffers from anxiety and who now cannot to walk after a fall about 4 months back.


The thing is she refuses to use diapers. She insists I put the bedpan everytime she needs to go. In the day I don't really care but in the night, her incessantly calling me every 30-45 mins because she needs to pee (she often doesn't even "go") is getting pretty old really fast.


I know what you guys are thinking, "well just leave her in the diapers." I tried that a few times and she screamed and yelled so much that either neighbors came over concerned, or have called the police.


She doesn't sympathize with the fact that I get no sleep. As far as she's concerned, she's paying me and so I should drop whatever I'm doing and come (these are her actual words).


From what I understand she's always been an extremely difficult person, I could go on for forever but let's just say that she's one of those people who's truly alone. No one comes to see her. If we see one of her siblings or grandchildren etc while we're walking about, they will pointedly walk to the other side of the street and pass her straight.


When she's calm and not being annoying with the diaper situation she's quite lovely and I enjoy spending time with her. But 3 months of literally no sleep is no bueno, and if I can't find a solution I will just have to resign because I know I can't make it through the summer with this.


Thanks for any tips and feedback!

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One answer would be a catheter. Of course, this has its own issues, but it made life a lot easier for my SIL when my MIL couldn't get up to go.
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So a few things have happened in the last couple of days. Her son got her an over the counter sleeping pill that has worked wonders for the past three nights. She's been peeing once per night now that she sleeps. So let's cross our fingers for that. We've made an appointment to see her doctor.

I know the logical thing might seem to sleep when she does. But I never get solid rest because she still needs to pee in the day of course.

As for working days only. Th thing is that I'm working in Spain and salaries are small as it is. This job is in no way worth it if I have to pay rent from a salary that will be even smaller than it is now, when I work only in the day. Not that money is the only thing, but I have to be realistic. Also her son is hesitant to get anyone else because I think when I leave he will be putting her in a residence. She's gone through a string of caregivers. I've lasted the longest at 4 months which is no time. He kinda sees it as; she's been this difficult all her life, so there's no use fighting to make her stay in her house if she doesn't want to compromise.

I know you guys keep thinking that she has dementia but she was tested while we were in the hospital a couple weeks back. As well as before I started working with her. She doesn't have it. She's been this way her whole life.

Apparently in Spain you can't get rehab for walking unless it's a physical problem which it isn't in her case. But we will be seeing the geriatric psychiatrist.

Thanks so much for all the help.
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Bedside commode. Definitely.

She ought not to lie in bed either, she should get up and get those legs moving or she's going to be in a lot of pain.

The type of person who wants what they want when they want it is going to be difficult to work for. She's isolated. She refuses to get out of bed. She wants you at her beck and call. She's not going to change. You might be able to change the toileting situation but she won't be any easier to work for. And shame on her for threatening your job in order to get you to do what she wants. I'm getting angry just writing about it.
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Modern "diapers" are made so that the fluid is wicked away from the actual surface that touches the skin so it doesn't feel "wet". (Sometimes it's hard to potty train a toddler because the diaper isn't uncomfortable enough for them to pay attention.)
Feeling like she has to "go" but doesn't is common with some kinds of urinary infections or irritations, and the feeling can be very uncomfortable; see if they can check further for a problem.
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I see two options. One would be to have two shifts of caregivers, one for daytime, one for nights. The night shift would be like any other night shift, they sleep in the daytime. The other is for you to sleep when she does, just like a mother with a new infant has to do. You can also try other methods to keep her up during the daytime. Plan activities, keep her busy. Good luck
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I'd be careful of concluding what she doesn't have without a full evaluation both medically and mentally. It's just not normal for someone to demand to be put on the toilet every half hour throughout the night and not actually urinate. There's a broad range of what it could be, but, I'd reserve her being a narcissist for last. Odd toileting behavior is certainly a symptom of something, so I'd keep searching. Regardless, of who are her caregivers are, she'll eventually have to have proper undergarments and sleep at night. I might discuss with her doctor and and get a psych referral.
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If she's afraid to walk pretty soon she won't be able to, her son needs to get her some rehab to get her on her feet,
As for peeing at night, unfortunately it is an old people problem, but it does sound as though it is partially due to her backwards sleep schedule. Encourage the family to get a bedside commode and a stand assist rail that slides under her mattress to help her stand and transfer to the commode, almost NOBODY uses bedpans anymore.
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Thanks so much for all the responses, guys. She's 79. She didn't break anything when she fell, she's just scared to walk. But she is on medication to thin her blood (eliquis) because she gets bruises quite easily. She also had bronchitis recently so she does use an inhaler. No other health problems though.

She doesn't have dementia etc... We recently had to carry her to the hospital because there was a scare with blood in her urine and they tested her extensively. it turned out that it was just a side effect of the eliquis. She doesn't have any bladder problems that was ruled out that day. Honestly I think it's just boredom when she can't sleep. Because on the rare. Night that she does sleep she sleeps a good 6 hours without waking up to pee.

I was just talking to her son and he says we'll def have to take her to a psychiatrist. But still, she's been this way all her life... it's her way or the highway so before her kids just avoided her because she was self sufficient. But now that she doesn't have her mobility, it's unavoidable.

I don't want to diagnose but I truly think she's a narcissist. She's very cold and rude when she doesn't get her way she'll call you names etc. But when she wants you to do something for her initially she tries to persuade you by buttering you up.

She's not resistant to care persay. She just wants me to do everything that she says when she says it. And she's very bossy, like a drill sergeant when she's telling you to do things. Never says please or thank you, never apologizes. And anytime I resist immediately starts telling me, "if you don't want to work, I'll tell my son to get someone else". Luckily for me her son knows how she is.
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You say that she suffers from anxiety. I'd explore a geriatric psychiatrist or other doctor who can treat her anxiety with more than just the current med, that seems to be inadequate, based on your reports. My LO was also very anxious, but, a daily med for anxiety really helped her a lot and she is much more content. She isn't drowsy either. 

Is she resistant to care in any other ways?

While with the doctor, you or the family can present the doctor/psychiatrist with a list of your observations. Maybe, that will help. It's always concerning with the person's ability to reason seems off. Her nighttime demands to get onto the bedpan every half hour seems odd. I'd check for UTI, bladder prolapse, dementia, etc. Figuring out what the core problem is would be a start.

I'd be happy that she thinks a long term care facility will be a nice situation. I wouldn't discourage that and I would avoid calling it a home around her, since that can have negative connotations that should be avoided, for someone who may eventually need AL or Nursing home care.
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Annacce, could you tell us the age of the person, and what are her health issues besides not being able to walk after a fall. After the fall, was she in rehab? Did she had diaper issues while there?

If your patient is in their 80's or 90's, it is very common for an inactive person to doze off a lot. I remember my parents, in their 90's, use to brag that they needed only 6 hours sleep and would get up at 6 a.m. every day and go to bed at 11pm. Of course they never took into account that they would doze off after breakfast, doze off after lunch, then again before dinner, and another cat nap right after dinner.

My Mom hated the actual diapers that were use when she had to go to long-term-care due to head injury in a major fall. But since she was bed ridden, this was the easiest for the Aides to use.

Instead of resigning, why not work just 12 hours, and have the family hire something for the overnight shift. That way you can go back home to your own bed and get a good night sleep instead of being a live-in.
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Oh I have to add, her problem with the diaper is the idea of having her pee and poop being on her for a while. Apparently she used to be a bit OCD about her higiene and often used to spend like up to an hour washing herself everytime she would go to the bathroom, when she could still walk. It doesn't matter how pretty it is, she won't accept.
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Thanks so much for getting back to me.

Cwillie: Her sons hired me. One of them stays with her on my night off. He's said thay he's going to talk to her doctor again to get her something to sleep but so far all her doctor had done is increase the amount of Valium that she takes. On normal people this would work, but she's been on this medication for years and abusing it for the same sleeping problem. Her doctor seems to think that we're exaggerating her behavior, she's pretty good at playing the victim and getting people to sympathize with her. She's starts to cry and make it seem as though we really just want to neglect her at the night.

Her son knows that eventually she'll have to go to a home, but he'd like to prolong it as much as possible. She's convinced that a home is a 5 start hotel and that the caregivers there will be at her beck and call, like she wants me to be. Of course she's sorely mistaken.

I should probably mention that she sleeps during the day. I take her out for around 2hrs in the morning. Then she sleeps until lunch. Even if I sit there poking her the entire time she's usually dead tired at this point and nothing can keep her awake. In the evening she's a bit in between being asleep and awake so I've tried taking her for walks and such, but she refuses. She's quite tall and overweight, so if she's not willing to cooperate I can't move her into the wheelchair or anything.

I'm guessing basically the only hope for her is the home. But still if anyone has any ideas let me know.

Sorry this is so long. And thanks a lot!!
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Are there any pretty delicate looking pamper (pull-ups) that she's willing to wear because it's not 'obviously ' pamper? They usually associate pamper with baby. And they're not babies. Therefore, they're not going to wear pampers.... It's messy using pull-ups on a bed rest person. I accidentally bought one and... well, I always silently prayed Dad didn't poop.
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Who is in charge of her healthcare, who hired you? You need this person to speak to her doctor about finding some medication that will allow her to sleep through the night, not just for your sake but for her own. When my mom was waking up and calling incessantly we started her on a very low dose of mirtazapine at bedtime and it not only helped her sleep through the night but it made her more like her old self during the days as well. (That may not be the right medication for her, but there are other choices.) Once she sleeps through the night you can diaper her "just in case", and if she does sleep through she will likely need it. Continuing on without sleep is a recipe for less than spectacular performance during the day, and eventually burnout.
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