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Had a talk with the Memory Care manager last night. Apparently Mom is doing great, recovering from her fall. She's eating well and gained a lot of her mobility back, albeit now using a walker because of some balance issues. She is eating with the other residents, and even participating in some activities. So far so good, right...?


But, that's the good Dr. Jekyll,. Apparently she turns into Mr. Hyde whenever any caregiver needs to actually do anything for her, such as changing clothes or a bath, or if she needs cleaning due to a depends accident ( she does use the toilet still, mostly using depends due to some bladder leakage and not realizing the time needed to get to toilet now.) She verbally abuses staff and fights thenm and now is scratching them. They wanted me to consider having a prn med to calm her to help them, as they want to protect staff.


Some history there, they had a prn Xanax prescription for only the first month of MCare, and they continued to use it without my or the dr's permission. I knew something was off, as sometimes when I would video call in the evening, she would be slurring like she'd been having a few margaritas. I really think being drugged up contributed to her bad fall that night. They haven't had it since October and she has been much clearer and happier; we had a great Christmas visit with her with the immediate family.


So what to do, I'm afraid if she continues to fight them and I do nothing they might ask her to leave. But right now we have an extra private caregiver with her at night, with her improvements in mobility, we were going to stop that soon, as it is super expensive . But if she is using extra meds again, I'm afraid she will be right back in ER.


Any suggestions? I've asked them to call me on the video call device when they change clothes, if I could possibly distract her. Or actually let me be a designated caregiver like they are supposed to, and I could help do it some nights. I don't think I can commit to doing every night, but she does accept help from me better.


She just doesn't understand her limitations and has always been independent and stubborn.

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The medication quandary is a real toss up. My mother had terrible anxiety attacks that grew worse as she slowly lost verbal functioning.

I always get a bit of an awkward feeling when someone here talks about staff complaints of “verbal abuse”. My feeling is, when someone takes a job caring for people who are diagnosed and acknowledged as having dementia, part of that job is FULLY UNDERSTANDING that the filters in such clients ARE, or MAY BE, MISSING!!!!!!

My LO, in her prior life a genteel and well mannered bank executive, lives in an MC in which she’s loved and enjoyed. Since entering her residence she’s developed a vocabulary that could make a sailor blush, and her caregivers are so thrilled that she’s a two time survivor that when she launches forth with a stream of epithets they give each other thumbs up for being so successful in caring for her.

Obviously unwanted and aggressive physical contact is unacceptable, and human nail scratches can transmit COVID.

I’d give mitts (NOT GLOVES) a try, easy on, snug elastic, move fast and get done what needs to be done as fast as possible. The care goal needs to be achieving the goal, not the manners necessary to achieve the goal.

YOU’RE NOT ALONE!
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The problem is probably her nails . Facility staff is not allowed to cut figure or toenails. A podiatrist can be called in for toenails but will not do figure nails. I cut my Moms. Leaving a little of the white. I then filed them rounded.

Ask if her nails are part of the problem. If so, since u can't get in there, ask if with your permission one of the aides can do it. Or like suggested, they put gloves on Mom. Call her neurologist and ask if there is a med that will help with her fighting back without making her loopy.
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I like your suggestion of having them call you on video call, when it's time to change her clothes, but will they remember to do that every time? Probably not. They have too much else going on. First I would make sure that moms finger nails are cut short, so she can't harm anyone with them. Or perhaps have the staff put mittens or gloves on her hands, so they won't get harmed, And I am with you on not drugging your mom to try and solve this issue. You saw the effects it had on her before, and I'm sure it probably did have something to do with her her bad fall. There's a time and a place to use medications I'm sure, but I don't believe this is one of them. I would sit down at your next care meeting, and discuss your options with the staff. Best wishes.
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