How do you handle the rage "in the moment?"

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It's my father-in-law and he needs help walking, and that is when it usually happens. I am the husband of the daughter of an Alzheimer's male. My wife is not able to mentally deal with aiding in her father’s care, so I am stepping up to the plate. He still lives at his home with his wife who cannot care for him alone and refuses to put him where he can get the proper care. All the siblings are taking turns with his nightly routine.
He is barely mobile. He can move from room to room with the aid of a walker, and two others to help steady him. His legs are losing strength, due to sitting on the couch all day. But up until a few years ago he was still chopping wood, so his upper body is strong as an ox. He is no longer continent, and needs to have personal hygiene of that type. He is no longer aware of who we are, but can at least recognize that we are familiar.
At this stage, here is the problem as I see it: At times, while moving him from the morning bathroom/shower routine, he will suddenly and without warning become violent as we try to steer him into the bedroom to get him dressed. He lashes out and pushes with his (as stated before) very strong arms.
So we are caught between the need to keep him safe from falling and getting injured, while at the same time, trying not to get injured ourselves in the process. It’s almost impossible to restrain him (whether or not that’s good idea, I don’t know).
So far, these bouts are very brief in duration, and are over in a matter of moments. We finally get him to sit on the side of the bed, sitting next to him and talking calmly, so he can get his breath and calm down. This seems to work—so far.
But as general guidance, what is the best way to handle the rage “in the moment?” Should we let him fall, or allow ourselves to take a blow? I’m not sure, but that may be the thing that is needed for his wife to think more clearly about priorities. At the same time, I don’t want to feel manipulative, using him to make the point. I think maybe the wife is in denial, and can’t see the situation for what it is. All the siblings and I are not professionals, and have not been trained in these skills.
I am now learning about this horrible disease, and don’t know a lot. But it seems that at some level in his mind or brain, he does know we are trying to help. In the night time routine, after getting his diaper changed and his pajamas on, I’ll sit next to him on the side of his bed listening to Vaughn Monroe, one of his favorite singers. During this time I talk to him, as if I were talking to a child, but not talking down to him. We don’t get complicated, just simple things. I frequently tell him that we are all praying for him to get better, that we know he doesn’t like being in this condition. He surprised me when I was leaving after getting him tucked in, he said “Pray for me.” Now realize his speech is mostly mumbling at this stage, and it is getting more and more difficult to understand him. But this statement was clear as a bell. Whether the prayer is working, or he had a lucid moment or what, I don’t know. But it was a real thrill to hear it.
Any advice anyone has will be greatly appreciated.

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Dear CaringInLaw,

First of all, bless you for stepping in and becoming part of the 'team' of family members caring for your father-in-law.

I cared for my father in my home for 5 years. He is now in a nursing home. I am also a private duty nurse and have had many patients in very similar circumstances as your father-in-law. Professionally speaking I can give you tips on how to let your father-in-law (FIL) fall to the ground without him actually falling. It's a 'controlled' fall. Get control of his upper body: link your arm through his armpit. This gives you more control of his body. Stick out one of your legs so that your feet are about a foot apart. Like you're in the middle of taking a step. Allow your FIL to slowly glide down your extended leg. If you have him under his arm you can control his sliding slowly down your leg gently to the floor. The goal is a soft landing. However, once he's on the floor you have to get him back up and that may pose a problem for you depending upon YOUR strength. You can find this maneuver on Youtube.

I think you're correct when you say that your MIL may be in denial. I think it would be odd if she weren't. I understand wanting to keep a loved one at home, whether it's a parent or a spouse. Because so many spouses insist on keeping their loved one at home allows me to have a job. But in my opinion there comes a point when it's not safe and that's when we have to have timely and honest family meetings.

Restraints: I've never used them and if asked, on the job, I would refuse. However, I do believe in appropriate medication. You said your FIL becomes combative in the mornings, in the midst of his morning routine. Can you talk to his Dr. and explain to him/her about these combative episodes and see if the Dr. would prescribe a anti-anxiety medication? I had a combative patient very recently and he was prescribed Ativan so any time I had to change him or try to rouse him I would give him a dose of Ativan prior to whatever I had to do for him. My first shift with this gentleman I was socked in the chin and learned that way to give him Ativan any time I had to get him up or rouse him for any reason. It was very effective.

All rules, routines, and schedules go out the window when dealing with a person with Alzheimers. A lucid breakthrough is not uncommon (your FIL asking you to pray with him) but won't last especially if the disease is advanced to the point where your FIL doesn't know you but is just familiar with your face.

You're right. Alzheimer's is an evil disease that strips it's victims of all of their humanity and dignity and tortures not only the person who is unfortunate enough to have it but their loved ones as well. It's a cruel, cruel, hideous disease.

From what you wrote it sounds like your FIL is blessed with supportive, loving family. It sounds like you have help in your caregiving and I think that's wonderful. I think he's very lucky to have you and I think your wife is very lucky to have such a thoughtful and considerate husband. I don't know if I have any other advice for you but maybe just a thought: You have to know that your FIL may not be able stay at home long-term. His disease is progressing and he will continue to decline. Is your family able to commit to his care 24/7, 365 days a year? Do you have the numbers to increase your FIL's care? He's going to need it. Maybe your MIL and FIL are financially situated so that they will be able to afford around the clock care and your FIL will be able to stay at home but in the coming days, weeks, or months he will need professional care. For his own safety if not the sanity of all of you--his caregivers.

I'm not a huge proponent of throwing our loved ones into nursing homes the second they misplace their watch. Or whatever. As I said, I cared for my dad in my home for 5 years. But all bets are off with ALZ. In 17 years of working in healthcare I've never seen anyone with ALZ live out their days at home. The level of care required increases, sometimes daily, and the person can become a danger to themselves. There's a reason why nursing homes have completely separate wings for residents with ALZ. They have to be segregated because of the level of care they require and to keep other residents safe.

Having said all of this, I think what you and your family are doing for your FIL and your MIL is admirable. Check Youtube for videos on safe transfers. Learn how to ease your FIL to the ground before he falls to the ground. Continue to educate yourself about Alzheimer's and start a dialogue with your wife's family regarding your FIL's ongoing care (can they afford private duty care if/when it comes to that?). You're just starting a dialogue at this point. Get some opinions. Talk about the near future. Ascertain that everyone can continue to pitch in and figure out what you're going to do if someone can't at some point. And discuss the topic of medication if your FIL's not on medication already. Not keeping him drugged and sedated but anticipating these combative episodes and being prepared. You can get a medication that's in liquid form. You put it in a syringe without a needle and shoot it under the tongue like a squirt gun. It's a lot easier than trying to get someone to swallow a pill.

My best to you :-)
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Hi caringinlaw, God bless you for your compassion. Your wife is blessed, indeed, to have such a caring husband. I have a good one myself! ( he helps with my Mom). This situation sounds scary. Elders are so fragile-skin tears, bruises, brittle bones and yet can be so strong ( that upper body strength ). I am not sure that you or anyone not trained should be in this position and you may need to get in home care for his bedtime/ bathroom needs by a strong professional. Preferably a male, I think, but I have a feeling tht may be tough to find.
There is an item called a transfer belt that you can google for more info that helps keep a grip on the person you are guiding. There are some videos on how to use it and it how's you how to put the elder down gently using the belt if needed( if he becomes combative ) . It goes on the elder. This may help in the mean time. But I really think you need to convince your wife it is time for more help. Good luck! And God bless! - I will pray for your FIL tonight as well.
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