Here's how you deal with a person who doesn't like people in her home and won't "allow" paid help in when it's needed.
The choice is comply with paid caregivers coming in to help you or you get placed in a "home".
When the choice is simple and it's one or the other, a person usually gets on board with homecare coming in pretty quick.
Never play games with people who need help and care. If help in the form of homecare is an option it's better to just be plain about it. Either they choose on their own to accept homecare coming into help them, or the state forces you into a facility.
I have said this many times and to many obstinate elders:
'Nothing gets a senior a one-way ticket to a nursing home faster than being stubborn'.
I agree with Burnt and JoAnn. Few of us enjoy having strangers in our home. This isn't a matter of choice now, but of need. I don't know the level of ability to understand for this senior, but it sounds as though placement will soon be required.
I would have her evaluated by the Office of Aging. She maybe 24/7 care now. Thats very expensive. She may need an AL if she has money. Longterm care with Medicaid paying if she doesn't. If she has no DPOA assigned and no family to help, the State may need to take over her care. As a friend, your not oblitgated to continue to care for her.
Try taking the person there with you introduce as your friend, allow friend to do dishes while you are there, clean, pick up. Do this several times and then one time leave as friend is cleaning and allow friend to stay and finish.
The givens: 1) 99.99% elders DO NOT want another / a stranger / a 'helper' in their home. - They do not want change. - They do want to maintain their (perception of) independence - no matter how much they need support and help to get through day-to-day needs/care. 2) Much depends on medical provider's assessment and needs. Has this person been diagnosed with dementia? what kind? 3) Never ever argue with an elder 'needing' help. It is a no win and only causes more turmoil and emotional upheaval. The 'best' you can (often) do is provide reflective listening, i.e, "I hear you say you do not want anyone to come into your home (for 2-4 hours a day or xxx / week) as you feel ... ) What does this do? - You give them room to get their feelings out - whatever they are. - You let them know you (respect them in that you) are listening to what they say. This is important - esp as their independence changes and their need to rely on another increases substantially - and they feel FEAR of the UNKNOWN.
It is important to acknowledge fears, esp with someone with dementia and/or a person with a strong personality. They will resist.
You haven't provided much information for us to make an educated response, ie: 1) how old is this person? 2) What has been diagnosed re the broken vertebra? What care is needed / what is this person doing about it? 3) With this physical challenge, is she on medication? what? how does it affect her? 4) copied from #2 above: Much depends on medical provider's assessment and needs. Has this person been diagnosed with dementia? what kind?
So much depends on your relationship with this person (as you do not specify) Is this your mother? or another family member? * If not, you are certainly more limited in helping.
* If this is your mother/relative, you need to get legal documents in order to make decision for her welfare / care needs. i.e., are you the POA? manage finances? soc sec payee rep, fiduciary? Does this person have a social worker - can she get one? - If you do not, it is up to her to decide how to proceed / what to do as her needs change.
In terms of the specifics of briefs / peeing, perhaps the best you can do is have protective mattress cover on her bed, and supplies available. That she has a broken vertebra sounds painful and very serious. Someone needs to intervene immediately.
At the very least, if you cannot be there and mange needs/care, call APS - Adult Protective Services and see what they say. They may (hopefully) make a visit and assess the situation.
Unfortunately, in too many situation, something more serious needs to happen before any different / needed care / can be implemented. They are - in their mind - fighting for their life and dignity. It is important to view this situation from their point of view. HOWEVER, if a person is peeing and doesn't change their disposable underwear, clearly more is going on that requires a caregiver.
She might need to be placed somewhere. And she won't want to go.
Dear Llama, you're accurate on so many points; I always appreciate your input : ) About the weird stubbornness of living alone: and 99.9% not wanting anyone in the home:
My 93 y/o mom, always fiercely independent, went through a few fine daily caregivers (4 hours during the week) for inarticulated reasons; her personality went from polite and kind to plain shitty and rude. The last caregiver was IDEAL, an experienced certified caregiver, perfect personality, take-charge, understood seniors, sensitive, patient, and had been a semi-pro basketball player. Capable--PLUS, she could fix ANYTHING around the house; electricity, plumbing, construction; and did so without charging for her time [a handyman in S.D., would have cost at least $60 an hour]. She was PERFECT! My mom hated her for some reason, other than saying she was 'a b***h'--a word I never in my 63 years heard her say.
Over less than a 2-year period, mom had physically deteriorated to where she needed 7/24. The perfect caregiver was in a situation where she and her roommate needed to part ways; she could smoothly move in to the private upstairs bedroom and bath; she wouldn't have to pay rent (in San Diego, $2k) and we didn't have to pay for more than the 4-hour day care.
Well, a week before she was to move in, and had nowhere to go, mom suddenly, willingly, agreed to leave her house of 55 years to go into AL--at 3-4 times what it would have cost for mom to stay in her own home. Leaving the perfect caregiver in an awful, terrible position, which my sister had to inform her about.
The whole thing makes me sad, angry, and sick, to this day.
Curlybob1959: Perhaps your friend is past the point of in home care. Reach out to their town's Council on Aging, who should have on staff an elder care staffer and also a social worker. Many elders will resist change.
A trusted Doctor with time to discuss, a home care nurse or best of all, a specialist continence helpline (if can be found in your area) can give good advice on how to manage.
Are PAIN or MOBILITY factors that stop more frequent changes?
Is it lack of knowing WHEN to change? Lack of sensation, memory or cognitive issues?
Waiting too long & then needing to strip right down to change pullup style briefs + clothing can be a huge chore - sometimes just too hard.
What about adding insert pads inside briefs that can be changed frequently with much less hassle?
There are specific booster pads (that don't have the plastic backing like liners do). These allow any overflow to leak into the padded brief/pullup. Can be bulky but make briefs last the day. Also more hygienic that getting wet, adding rash & risk of UTI.
Suitable clothing eg skirt or pants with easy elastic waistbands may help too. Longer tops can hide the bulky nappy-pants look. (My look post babies 😀)
Having 'someone in your home' would propably just be a pop in visit in the morning or evening some days anyway - not going to be there for every toilet visit (or mishap).
MAYBE with the right products, your person can regain some independance in that area?
Of course I don't know if that is just one issue on a long long list of issues.. ?
Good response, thanks--you covered a lot of possibilities.
With my mom, it was 'knowing when to change'--loss of sensation, or loss of smell? Both? She was o.k. enough about wearing 'adult underwear', but she rarely would change on her own during the day.
When I'd try to tactfully suggest it was 'time to change', she actually responded with 'why?'; it was uncomfortable for me, her daughter who was trying to help her keep her sense of independence, or dignity, to tell her 'because you smell'. And boy, as many of us know, it's pretty unpleasant.
This could work, as could Touch Matters' suggestion. As an old-old person myself, I would hope to be treated with some regard for my human dignity even if/when I find myself in a situation where I may need help. I acknowledge and respect Burnt's 25 years of experience in dealing with elders, and she's generally spot on, but approach matters, IMO. (I'm assuming that the elder in this situation has competency. It's a whole different situation if she doesn't, and not dealing with the pee situation may be indicative.)
Honest, dependable in-home assistance is hard to find in our area and in many others. COVID exacerbated the already existing shortage of home healthcare staff. One other thought: untreated PAIN from a broken vertebra may be a major reason why the elder resists changing.
The choice is comply with paid caregivers coming in to help you or you get placed in a "home".
When the choice is simple and it's one or the other, a person usually gets on board with homecare coming in pretty quick.
Never play games with people who need help and care.
If help in the form of homecare is an option it's better to just be plain about it.
Either they choose on their own to accept homecare coming into help them, or the state forces you into a facility.
I have said this many times and to many obstinate elders:
'Nothing gets a senior a one-way ticket to a nursing home faster than being stubborn'.
We would need a whole lot more details to be able to suggest anything other than in facility care for the person you speak of.
1) 99.99% elders DO NOT want another / a stranger / a 'helper' in their home.
- They do not want change.
- They do want to maintain their (perception of) independence - no matter how much they need support and help to get through day-to-day needs/care.
2) Much depends on medical provider's assessment and needs. Has this person been diagnosed with dementia? what kind?
3) Never ever argue with an elder 'needing' help. It is a no win and only causes more turmoil and emotional upheaval. The 'best' you can (often) do is provide reflective listening, i.e, "I hear you say you do not want anyone to come into your home (for 2-4 hours a day or xxx / week) as you feel ... )
What does this do?
- You give them room to get their feelings out - whatever they are.
- You let them know you (respect them in that you) are listening to what they say. This is important - esp as their independence changes and their need to rely on another increases substantially - and they feel FEAR of the UNKNOWN.
It is important to acknowledge fears, esp with someone with dementia and/or a person with a strong personality. They will resist.
You haven't provided much information for us to make an educated response, ie:
1) how old is this person?
2) What has been diagnosed re the broken vertebra? What care is needed / what is this person doing about it?
3) With this physical challenge, is she on medication? what? how does it affect her?
4) copied from #2 above: Much depends on medical provider's assessment and needs. Has this person been diagnosed with dementia? what kind?
So much depends on your relationship with this person (as you do not specify)
Is this your mother? or another family member?
* If not, you are certainly more limited in helping.
* If this is your mother/relative, you need to get legal documents in order to make decision for her welfare / care needs.
i.e., are you the POA? manage finances? soc sec payee rep, fiduciary?
Does this person have a social worker - can she get one?
- If you do not, it is up to her to decide how to proceed / what to do as her needs change.
In terms of the specifics of briefs / peeing, perhaps the best you can do is have protective mattress cover on her bed, and supplies available. That she has a broken vertebra sounds painful and very serious. Someone needs to intervene immediately.
At the very least, if you cannot be there and mange needs/care, call APS - Adult Protective Services and see what they say. They may (hopefully) make a visit and assess the situation.
Unfortunately, in too many situation, something more serious needs to happen before any different / needed care / can be implemented. They are - in their mind - fighting for their life and dignity. It is important to view this situation from their point of view. HOWEVER, if a person is peeing and doesn't change their disposable underwear, clearly more is going on that requires a caregiver.
She might need to be placed somewhere.
And she won't want to go.
One step at a time.
Gena / Touch Matters
My 93 y/o mom, always fiercely independent, went through a few fine daily caregivers (4 hours during the week) for inarticulated reasons; her personality went from polite and kind to plain shitty and rude. The last caregiver was IDEAL, an experienced certified caregiver, perfect personality, take-charge, understood seniors, sensitive, patient, and had been a semi-pro basketball player. Capable--PLUS, she could fix ANYTHING around the house; electricity, plumbing, construction; and did so without charging for her time [a handyman in S.D., would have cost at least $60 an hour]. She was PERFECT! My mom hated her for some reason, other than saying she was 'a b***h'--a word I never in my 63 years heard her say.
Over less than a 2-year period, mom had physically deteriorated to where she needed 7/24. The perfect caregiver was in a situation where she and her roommate needed to part ways; she could smoothly move in to the private upstairs bedroom and bath; she wouldn't have to pay rent (in San Diego, $2k) and we didn't have to pay for more than the 4-hour day care.
Well, a week before she was to move in, and had nowhere to go,
mom suddenly, willingly, agreed to leave her house of 55 years to go into AL--at 3-4 times what it would have cost for mom to stay in her own home. Leaving the perfect caregiver in an awful, terrible position, which my sister had to inform her about.
The whole thing makes me sad, angry, and sick, to this day.
It's not easy.
Are PAIN or MOBILITY factors that stop more frequent changes?
Is it lack of knowing WHEN to change? Lack of sensation, memory or cognitive issues?
Waiting too long & then needing to strip right down to change pullup style briefs + clothing can be a huge chore - sometimes just too hard.
What about adding insert pads inside briefs that can be changed frequently with much less hassle?
There are specific booster pads (that don't have the plastic backing like liners do). These allow any overflow to leak into the padded brief/pullup. Can be bulky but make briefs last the day. Also more hygienic that getting wet, adding rash & risk of UTI.
Suitable clothing eg skirt or pants with easy elastic waistbands may help too. Longer tops can hide the bulky nappy-pants look. (My look post babies 😀)
Having 'someone in your home' would propably just be a pop in visit in the morning or evening some days anyway - not going to be there for every toilet visit (or mishap).
MAYBE with the right products, your person can regain some independance in that area?
Of course I don't know if that is just one issue on a long long list of issues.. ?
With my mom, it was 'knowing when to change'--loss of sensation, or loss of smell? Both? She was o.k. enough about wearing 'adult underwear', but she rarely would change on her own during the day.
When I'd try to tactfully suggest it was 'time to change', she actually responded with 'why?'; it was uncomfortable for me, her daughter who was trying to help her keep her sense of independence, or dignity, to tell her 'because you smell'. And boy, as many of us know, it's pretty unpleasant.
Honest, dependable in-home assistance is hard to find in our area and in many others. COVID exacerbated the already existing shortage of home healthcare staff. One other thought: untreated PAIN from a broken vertebra may be a major reason why the elder resists changing.