My mom just entered an assisted living facility almost 3 weeks ago after a fall/hospital stay and then short term rehab. This was not her first fall and all family members agree she cannot be living alone. She is 84 years old and has been very independent her whole life (never a stay at home mom - always working). I received a phone call from the facility that she is not complying with the assistance for toileting, showering, dressing and personal hygiene. She thinks she can still do these things but she is very incontinent, has accidents and since she has no sense of smell - thinks everything is ok. We have all put up with the odor of urine over the last year or so, but that is not acceptable at the assisted living facility.
If she does not agree to let them help her, I'll be forced to send her to a nursing home and she really doesn't belong in that type of care situation.
I've tried talking to her and she continually says "it's so embarrassing, I can do it on my own", but she really can't. How can I convince her to let them help her?
Any thoughts or suggestions would be so very helpful. Thank you.

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I not sure you can convince her, I'm sorry to say - at least not as things stand now.

My mom had been living in IL for a number of years with a 3-day a week paid caregiver. The other days she got by but barely. Then she had The Fall - and spent three weeks in rehab. Mom hated it there so much she would have moved into a garden shed in order to get out of there so getting her to move to AL was the easy part. Getting her to accept her new limitations was a different story. So mom fell twice in the first ten days. Even though there was only one ER trip that only lasted about four hours - the AL administration asked me to move her out saying her needs level was more than they could handle.

Truth of the matter is - if mom had followed protocol and been the least bit willing to be pleasant and fit in I'm sure I would have been able to persuade them to let her stay - at least long enough to give it a fair shot. After all, she was just a week out of rehab when the first fall occurred.

But from day one mom was refusing showers, demanding to eat all her meals in her room and couldn't/wouldn't use her call button for help. I saw the "writing on the wall" after the first couple of days and talked myself blue in the face trying to get my mom to be reasonable - explaining what another move would mean.

But for being a fairly bright gal - there was one lesson regarding aging and dementia that took forever to sink into my brain - THERE IS NO REASONING WITH DEMENTIA!!!

Getting my mom into a nursing home has to rank up there - right at the top - of the worst times of my life. I'm sure it was no picnic for her either. And mom continued to fall at the NH - sometimes legitimately and sometimes on purpose (long story) but the NH was use to residents falling - no big deal.

But here's my point and advice - finally, right?

Hating the NH, my mom became more belligerent and unreasonable- didn't think that was possible- but she did. I was advised both here at AC and by my own doctor- whom I had seen for MY stress level - to get my mom into see a geriatric psychiatrist. He overhauled my mothers medication, started her on a couple of new ones and in about a month my mother was transformed - and not into a zombie either. It was nothing short of a miracle.

At times, I now wonder how things might have gone at AL if I had know to have her seen by the geriatric psychiatrist earlier. Based on my experience with the difference it made - I think things would have been much better at AL and likely would have worked out - at least for a while. Honestly- I can't recommend strongly enough that you give it a try. Really, what do you have to loose?
Helpful Answer (20)

Rainmom, this was perfect "But for being a fairly bright gal - there was one lesson regarding aging and dementia that took forever to sink into my brain - THERE IS NO REASONING WITH DEMENTIA!!!"

That one took me a long time too!!
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There are good points above by Rainmom. With dementia, it's not likely that you can convince a person to cooperate with staff at an AL. Even if she agrees to do it, she may likely forget and still resist care. Resisting care is quite common and it's often nothing to do with being embarrassed. It's just due to the brain damage. I do feel for you. Something similar happened with my LO in AL too.

At first my LO did well in regular AL, but, soon, things became problematic and some of it was due to her resisting baths, getting up, getting dressed, meals, medication, etc. I'll share what helped with her.

One thing is to rule out other things like UTI, other illnesses, infections, medication issues, etc. Sometimes PAIN can add to the problem. Make sure any pain is properly treated.

I'd discuss with her doctor to see if she has depression and/or anxiety. My LO did and going on a daily medication for that helped tremendously. She became more content and less anxious. She also wanted to get out of bed in the morning and not just sleep.

Still, my LO needed more hands on care, by staff who are specifically trained to work with dementia patients, so her doctor prescribed Memory Care for her. This is also AL ,but, focuses on those with significant dementia. It made a great change with her and though, I didn't think it would have been right for her in the beginning.....I think it would have been. 

The staff at the MC unit, just seem know how to work with people who are very confused, resistant and even worse.  They just take their time and deal with it.  They also offer social activities, crafts, games, etc., and it's based on each person's abilities.  

I'd explore if you have access to a Memory Care facility and check it out. It might be an option, if she doesn't require skilled nursing care.
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For us the answer was the right meds. In the correct dosages. Her family doctor had prescribed meds in doses to tiny to have any effect. So, she went to a Senior Behavioral Center for ten days to get the meds correct.

Now she is happy to see me every day, compliant, and content. And not dopey! She still beats me at cards!
Helpful Answer (6)

.... I have to mention something to all who are saying "there is no reasoning with dementia" ... dementia comes in ebbs and flows .. in waves with varying degrees of severity and cognition. "Reasoning" with Your mom may not be what you need to do... youve said your mom has expressed her sense of privacy repeatedly, that does not sound like a Demetia sparked thought. And because she's repeated it to you then it means something to her.  Start by asking her if she likes where she's at... then ask her if she likes or feels safer with a specific aid. Take the time to let her answer... then ask her if she likes it here, ask her if she accepts living in this place, if it's honestly "ok" for her..  then suggest with respect that unless she allows them to help her more she will have to leave to yet another even more intrusive care facility, a place she will actually have to have more hands-on help ... repeat the questions to her if you need to, until you get an answer from her (you are trying to reach your mom by doing this rather than reacting to her dementia.  The fact your mother is able to process that she "feels so embarrassed" and does so over and over, tells me she's not locked into deep dementia at all times. Talk to her,try to reach her on a level of respect rather than directing her rather than getting irritated . ... dementia sufferers experience and process differently than other dementia sufferers and because each of our loved ones  were once independent, entering an assited or nursing home is not to be treated as "you have no choice and you are going to do as I say"... regardless their state of illness they deserve every chance to create an environment that """ they"""" can live in. And lastly, yes there are meds available to help anxiety in elder persons that are able to calm them without lethargic effects. Talk to her doctor about her options for such medications to allow her a chance of peace and calm rather than feeling anxious and on edge.) 
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What strikes me with many of the responses is that the right meds made all the difference. WHY wouldn't these IL/AL places have the insight/experience to recommend this? If we as a support group have figured this out, how could they NOT have anything to offer other than show residents the door?
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When my friend was resisting all care after she soiled herself in her memory care apartment, I was advised to take her to a geri-psych ward at a hospital to find an anti-psychotic drug that would calm her without doping her up. She was there 3 1/2 weeks and after that was happily compliant until she passed away a few months later from her frontal temporal dementia. The right drug at the right dosage level solved this problem perfectly.
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Just a FIL became willing to accept "help" with bathing, etc. once it was explained to him that these care-givers were professionals at this job. If your mom is just embarrassed about the personal contact, maybe she can be helped to understand that they are like doctors and nurses, and personal care is their professional specialty--they help folks that need assistance without even thinking about...whatever it is that embarrasses her.
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My guess, heather? Because it takes extra effort. It's more work. This resident is difficult- maybe the next one on the wait-list will be easier.

Not only did I see it with my mom but I experienced it over and over again in the public schools with my disabled child. But that's a separate rant...
Helpful Answer (1)

Tired, I'm going to have to respectfully disagree. 

I went with my mom to her doctor appointments. If there was an issue I couldn't discuss in front of my mom, I talked to him on the phone - a number of times. He never once suggested taking my mom to see a geriatric psychiatrist or offered information on dementia related medication. In fact, I had to ask him to prescribe Ativan when my mother began to have regular meltdowns. In addition, on the occasion he did change a medication he never once discussed it with me - or my mom for that matter - although I asked him to do just that every time I spoke to him and I was clearly my mothers medical proxy by way of DPOA. I always found out a change had been made by accident during a visit to my mom and the med cart came around. Needless to say the folks at AL never informed me about suggested medications or the changes my moms doctor was making.

The first time I ever heard of looking to a geriatric psychiatrist for help was here by way of BrooklynBarb who is a informed supporter of taking this route. The only other person who ever mentioned a geriatric psychiatrist was my own doctor- it had helped his father-in-law.

I've said it before and I'll say it again - in my opinion every person receiving Medicaid or Medicare benefits over a certain age should be required to see both a geriatric psychiatrist and a PCP or Geriatric Specialist once a year - or even every other year to continue to receive benefits. And just like with my own medical insurance company - a booklet listing doctors in these fields should should be routinely mailed out to recipients in the same time frame. JMO.
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