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My mother and father who live with me have declined considerably in the past three weeks. First my mother, who was my father primary caregiver, has become ill and cannot attend to my father as before. My father has severe dementia and requires constant care because he cannot do anything for himself. I work full time but have nurses and aides come to the house. My father does not like getting out of bed in the morning. MY mother usually got him up eventually but now she can no longer do this, so I have tried to get him up. On two occasions he has yelled at me and told him he was going to punch me if I did not get out of the room. Today, he came at me and hit me with his pajama bottoms and told me to get out of his room. It was a shocking display that I have never encountered. I do not want to be in this situation again. The social worker said that he senses that his routine has changed and he does not know how to respond other than to lash out. I really don't know what to do. Taking care of one elderly parent is hard but dealing with two is impossible. Any help you can give me would certainly be appreciated. I know he has a disease but experiencing the anger and vitriol is unsettling.

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You have nurses and aides coming to the house. Ask them to get your father up and dressed, and don't worry that he isn't presentable when they arrive - that's part of their job. Also... if your father prefers to get up later, is there any special reason why he can't have his way?

Make sure your mother has everything she needs, then hand over and go to work. And good for you for keeping your full-time job!

Will the people you've got coming to the house be able to cope with your mother's ill health too?
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I think his eating and medication schedule should reflect his own daily cycle, and not the other way around. If he usually wants to sleep until 11:00, then his medication schedule shouldn't start at 8:00. And perhaps his in-home help could arrive later, depending on Mom's needs. Brunch is a perfectly good meal.

Would Mom take it better if the nurse explained the new schedule to her, and assured her they would handle the medications and make sure he got nutrition?
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These folks need 24/7 care either at home or in a facilty.
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Your mother is a real fighter! That's both admirable and touching, but you will need gently to help her come to terms with changing realities - one of which is that your father's care is best left to professionals, and that allowing them more input is the best way to keep everything under control for longer. Reassure her that they know what they're doing, and that she mustn't feel worried about staying out of the way while they get him sorted.

It might be a good idea to look for a memory care unit for your father. Your mother will likely say no if you ask her, so don't ask her - you're just finding out, you're not planning to abduct him and lock him away. And then, if you find one you're happy with and they're really any good, they will be able to help you gain your mother's agreement to placing your father for the benefit of *both* of them.
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People say "let the nurses handle it" -- well, the patient can refuse help and the nurses can't do anything about it. Nurses cannot force care without violating some code of ethics. In my opinion you probably have to get medical help such as psych medications to get his behavior under control..and if you go the nursing home route and he acts out (starts hitting staff), they WILL put him in the hospital and may even refuse to take him back because he could be a danger to both staff and other patients. IF he is refusing care and medications you could end up calling EMS or the police to get him in the Emergency Room and have him Baker Acted which would force a medical evaluation. It's probably all you have left if he's refusing this and that and striking out. You can try reasoning with him which sometimes works..but in the case of severe Alzheimer's that's very difficult.  I know people will disagree with me but believe me home health nurses just won't "handle it" -- they simply will chart refused care and leave, and offer to come back at a later time. They would have no choice but to do that.  PS: You may have to give up your job. In my opinion they may need 24-hour supervision.   Just wait until he starts wandering around at night or going to the bathroom in his pants. Oh yes the "fun" has not even begun yet.
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Thank you for your response. I am inclined to let my father stay in bed if he wants to. My mother wants my father to get up so he can take his medications and eat so he does not get weak. She insisted that I go up and get him to come downstairs. I told her I am not going to do that again. I don't want to be yelled at and hit. The people who come to the house handle both of their needs. My father is not very cooperative with anyone who wants to bathe him or have him put on clean clothes.
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I tend to agree with cetude. Has your Dad been tested for a urinary tract infection? Those reek havoc on the elderly. My usually mild-mannered albeit mouthy mother became combative and delusional when she had one. They actually had to tie her to the bed at the hospital. My hubby has a visiting nurse once a week. She does heart and blood pressure checks, asks him the same questions every week and then leaves. She has been of some help, agreed, but in the long run, not much. Since she is our " Case Manager", I plan to be very frank with her when she visits this week, on the advice of the good people here, and see what "real" help she might be able to provide. You seem to be spinning a whole lot of plates on sticks and that's darn near impossible. I worry for you that Dad is becoming combative. I worry that if he gets his hands on a knife or scissors, things could turn serious.
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Check out a book called Elder Rage. ANd remember you are doing the best you can. But being "hit" with pajamas would be a concern in the event it could escalate. Maybe it won't ever happen again.
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To satisfy mom and help out dad, perhaps you could provide his meds and breakfast in bed, then let the hired hands see to getting him up and about later?

Definitely a change in routine can precipitate emotional response in someone who does not understand it all... If the suggestion I made doesn't work, then you may have to try getting intervention and/or medication to alleviate his problems. You cannot reason and/or argue with dementia, so there is no point in trying. You either find ways around the issue or get additional help.
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It may be that you are dealing hostility brought on by dementia, but you do need to rule out a urinary tract infection.

My mom would never hit me, then one day I was tying her shoe lace and she began hitting me on my back with all her might. Clearly her intent was to hurt me. Then the next day when I was removing her soiled pull-ups as she sat on the commode, she began hitting me in the side of my head with her fists. We had her tested and she came up positive for a UTI. We got that cleared up and she never raised a hand to me again.
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