Mother in ALF having anger issues and refusing care. Any advice?

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My mother has always had a difficult personality, and has been in ALF for 1.5 yrs. Either I am with her, or a companion almost all day and evening. She has become aggressive, hitting and kicking at CNA's when they try to care for her. She is refusing to get in her wheelchair for meals, and refusing to allow them to put her nightgown on at night. She gives me difficulty too...but I know her well enough that I can work around her. However, I have to work fulltime, and cannot be there all the time. We've increased her Lexapro a bit to see if it would help, but so far no. She does have moderate dementia, and so far talking to her hasn't been helpful. She mainly is angry that her life is out of her control, and feels that she is being pushed around. Has anyone else dealt with this issue? What was helpful to you? Would be grateful for any guidance.

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This may not help, but I can share what I do with my mom. I keep everything slow and easy. I don't make her follow my schedule, I follow hers. I talk slowly, quietly, and simply. I don't force anything. Changing clothes: I start by asking her if she is ready, if she immediately flares up I drop it until a little time passes. I ask her if she can do me favor. Usually she will say yes. If not, I wait. When she says yes I ask her to lean forward or I am behind her and gently lean her forward. She usually does like it when I begin to raise the back of her shirt, but I go slowly and explain what I am doing. Then I unhook her bra all the time letting her know what I am doing and that I won't hurt her and that I'm not doing anything "bad". Then I ask again if she will do me a favor. When she says ok I ask her to raise one arm. I am touching under her elbow and gently start to raise the arm. I am saying thank you the whole time and explaining what we are doing. I have the pj's there and let her see them and we talk about how soft and warm they are. After the first arm is out of the clothes I repeat the process with the other arm and eventually go through the whole routine to get the shirt over her head. Sure, it takes longer but so what? It is reassuring to her and easier than getting her all riled up and having to force her. My mom can't walk, can't express herself, can't do anything for herself. I imagine that everything is terrifying so I try to make her feel safe and secure. I can't imagine that my mom was anything but tender to me when I was an infant and I try to treat her the same way.
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We've had the same issues with my Dad this year, since his placement in January. He was in two other places and 3 hospitals before his current residence. What helped him was getting him admitted to a geri-psych unit where there were psychiatrists and staff experienced with the dementias and the medications that helped. He is now in a memory care facility called Pacifica that only deals with the dementias rather than also assisted living, and they have on staff, geri psych MDs and Nurse Practitioners who follow his care. He is totally calm and happy now, with the meds. Not sedated either. The first and consistent drug ordered that seemed to help was resperidol. You could start by just finding a geriatric specialist to take your Mom to for evaluation. If you want to keep her in this ALF as she is, there is nothing to say, you cannot find her the medical resources outside of there to help her. And, of course, it just may be the stage of dementia and once she moves past this, she may be more calm on her own. My Dad was this was for about 5 months though and was actually hurting people and getting sent to the hospital and then the facility refused to have him return once he was out, so we had to look for another one all the time. This facility is committed to keeping residents and working through the behaviors with the medical support.
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I went through same situation with my mom who had lived with us with moderate dementia and became violent to us and herself. We had to put in Assisted Living and had to be put on risperadol and then changed to seroquil. You just have to be careful not put on too much meds but sometimes they don't have choice when they become violent to caregivers there. Very hard to deal with but talking to people who have had same situation was a big help to me. Unfortunately my mom passed away a year later from complications of a fall. Take care and God bless
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My Mom used to be like that but eventually she calmed down. She still does have outbursts. She has always been difficult too. I think you're right that she's angry because her life is out of her control.

I've been trying to learn to "detach with love" and realize that I can't control her behavior. It's difficult.
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Can only send hugs.. going through that now, but Ma has been quickly going thro the levels of care and just now gone to a secure dementia unit. She is angry because all she remembers is so muddled, and cannot realise that maybe we did not just grab her and take her with out discussing things.. discussion of course is now really a waste of time, but is still done. It is the dementia, whether you can get her to realise that her brain is not longer as sharp, that its like a paper doily, and so yes she is losing control as more and more memory is falling through the holes. I guess she is in a panic. Maybe work out what is remembered and concentrate on that. Even going back to her childhood, and then writing up what you remember being told as a child and now, so that the staff can hold a conversation with her on that topic..e.g her first job, where she lived, brothers and sisters, going to school.
And hope the transistion to no memory at all is fast and not too painful
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Geedeeoo, you are a caregiving pro. The elderly need to feel safe and secured/loved. I always asked my dad to help me with his care. Ex. "Dad I need you to sit up so I can wash your back" etc. He was always will to try to help God love him. I never made any of his care something I was doing for or to him. Rather we were working together to help him get bathed, fed etc. Getting their
acceptance is so crucial. If he didn't want to do something, I would ask him if we could do something a bit differently or delay the meal if he wanted to read or rest. Everything takes tons of time as they move towards 90 yrs old. Rushing never works.
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Geedeeooo, I have read books that talk about managing elders without drugs by being responsive to their needs and their reality. It sounds like you have it down!

I'm sort of a fan of medication, because I know two difficult people who became lovely people when on antipsychotics. Taking the time to gentle the elder into cooperating lines up more with my philosophy, but I might not have the patience to carry it out.

The aides in facilities vary. Some are sweet and gentle and loving. Others react badly to resistance, or are rough, or sometimes even MEAN. Well, they don't get much money or respect. Old age ain't for sissies.

I have heard people recommend videos by Teepa Snow. They sound really helpful.
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My mom is in an ALF now and recently she began having anger issues and outbursts like you described. Evidently from what I have learned on this site, the elderly with dementia very often get "Sundowners Syndrome", where these behaviors just seem to come out of nowhere, usually the late afternoon and evening hours. She too, has gotten verbally abusive and has hit the aides with her cane. Her neurologist has put her on medication to help with this and so far it seems to be working for her. She is not a zombie, but the meds do help to calm her down and keep her mellow. It did not matter who was with her either, since they would call my niece and then my brother if they couldn't get her to calm down and go to bed-in her room! Sometimes that worked, sometimes she would just get as angry with them and accuse them of just abandoning her at the ALF. Never a rhyme or reason, just something that would happen. It really is sad, my mom is not my mom any more, but I still call her and see her whenever I am in town, about once a month at least! It's hard, very hard. Prayers for you and your mom.
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sorry no answer, but if its any help, my mom is doing the same...very mean to me and my brother....she calls me all times of the nite...I have to work 49 hr weeks as well and she is still in her house, alone, as she wants it..she still does all her work, takes her bath, does her hair, fixes her food...everything, I do she fights me...help, if you get it...let me know
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I think we need to make sure the elder is comfortable with the aide in the NH or home health aide if you employ help to be with your parent while you earn a living. My father's primary home health aide made my dad's days pleasant. When she was unavailable due to a sick child (she was a Mom), he was never as happy. I did get aides who were more interested in using their cell phone on our living room sofa than attending to my dad. I tried to make sure they did not come back. My dad was paying for the aides so we needed to get aides which met his needs and a were pleasant.

I do think elders lived in a different world then ours. They are reluctant to take baths , disrobe with all the aides. They want to maintain their privacy and I think we should allow for that. My father was only bathed by the primary aide and me. He told me he did not want to have just anyone off the street, bathing him. I would bath him later, after work on days when the primary aide was off. If it makes him feel better it really isn't asking too much. They like to keep their dignity.

I also found some of the younger aides did not have the ability to talk or have a conversation with an elder. The day is just too long to have them in the home if they are not able to talk to an elder--show them caring etc. Many of the younger aides aren't talkers because they text their BFFs all day long. I did have a young male aide who was able to talk sports to my dad and he so enjoyed those conversations. I tried to request him but of course he was in demand by the agency because he was a pro.

Hang in there, error on the side of compassion. Old age isn't the time to try to change or control an elder. Their time with us is short.
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