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My Mother has dementia and we were just recently told she has Alzheimer's. There are 7 children that care for her at home for the last year and a half. She has to have 24 hour care and each of us spend at least one night with her. She is incontinent so we all have to change her and either wash her or give her a shower which both are a chore no matter who is doing it. The problem is with the younger two (a female and a male) just recently she started hitting them when they were trying to clean her up. My sister bent over to clean her legs and such and she started smacking her on the back of her head. My brother started cleaning her up and bending over to do the same and she started hitting him on his back with her fist. She has never been a violent person. Was told by Occupational Therapist they shouldn't be cleaning her. That would be great if we had someone to come over every time she made a mess in her pants or she needed to be cleaned up. Recommendations?

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I have lots to say but I’ll try to make it brief. I’ve been caring for my mom with dementia for 10 yrs. She has gone through hitting phases. Phases because it happens to people who add to the confusion & are forceful making her do things that scare or humiliate her. The way to stop the hitting is to back off before it starts. If they don’t want something try later or just don’t do it. Don’t raise your voice & don’t over talk. Too many words add to confusion. Keep words brief, to the point, matter of fact & with a happy tone. Elderly can also be extremely modest. Don’t wipe them down unless you absolutely have to. You can add a bidet attachment that washes them if they have diarrhea. Watch their food intake & fiber so that rarely happens. The bidet helps a lot & is just for a minute, leaving their privacy intact. My mother has been fine for 2 yrs of incontinence this way. I put a little powder in the pull ups to prevent a rash. When they start to hit, tell them “no, that’s not nice” but learn from it. They need to be treated with dignity otherwise the control placed over them leaves them defensive in fear. If they’re not put in that position everything is much more peaceful. They also don’t have to stand partially or entirely unclothed ever. You can dress them with them having complete privacy on the toilet. Taking the socks, pants, pull ups off while they’re sitting & dressing the bottom half. Then pull up the shirt to replace it with a fresh one. I let my mom wear her bras longterm. After all, their peace is what matters most. They don’t sweat much creating bacteria, you can use body wipes on their arms & legs instead of showers/tubs. You can use a no rinse shampoo. It’s enough for them. I’ve never had to see her naked & our system is working. Hospice comes out once every 2 wks to check & sit with her while I run errands. Her physical hygeine is in great shape without any wipe downs or showers/baths. People with Alzheimer’s/dementia are in a terminal state so just be gentle, never pushy & do the least evasive things to just make sure they stay clean enough to not have skin issues. Follow their lead & only do what they’re ok with at that moment & they won’t have a reason to hit anyone. They’ll smile more & so will you!
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Emmdee Jan 9, 2021
Fantastic answer!

Thankyou so much for your brilliant insight - I am going to print it out and give a copy to our local Alzheimers Society office!

Emmdee from Bristol, UK
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Please know it’s never okay to accept abuse no matter what the cause is, and while it’s true that your mother can’t control her behavior, it doesn’t mean anyone needs to put themselves in the path of it. Your first step is her doctor to see if there are meds to calm her behavior. And then to get professional help, either in home or in memory care, to help care for her. In an entirely different set of circumstances, we had professional care for both my parents and I was amazed by the tricks of the trade the caregivers had, things they knew to do that we’d never have known. Their skills and knowledge was invaluable. I’m sorry you’re in this place with your mom and hope you’ll find a new plan soon
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Mom needs placement, ASAP. At the very least she needs calming meds.
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TrishM Jan 9, 2021
Sometime placement will give her less care then what they are provided at home...
Fact is this is not a site to tell people what to do but share your experiences. They can decide what works from there.. Choose your words carefully.
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Will add to previous advice that if this is a sudden change in mental status, she should be checked for a UTI.
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disgustedtoo Jan 6, 2021
Yup - if this is a sudden change in behavior, do check for UTI or other infection (if UTI test, preferably a culture, is negative, have bloodwork done. High WBC can indicate another infection. Recent discussion with someone experiencing odd behavior/regression wasn't a UTI, but it was an infection in the mother's mouth. Once treated, she resumed her old "self".)

If no signs of infection, she may need some kind of medication to calm her down. During a serious sun-downing episode due to UTI, mom was also given the lowest dose of anti-anxiety meds. It was just enough to take the edge off, and worked first time, every time, within 15-20 minutes. No need to wean off the medication when it wasn't needed anymore.
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Truthfully, if she actually inflicts physical pain on others, the only two alternatives available for her care are a trial of calming medication or residential placement.

No matter how much you offer to pay, it would be VERY DIFFICULT to find someone who would do toileting and monitoring while having to deal with being assaulted physically.

Are her present targets afraid of her outbursts?

Keep in mind that her personality prior to her illness has NOTHING to do with what she is doing now. At this point, she is operating with a brain that is becoming progressively more and more dysfunctional.

As painful as it is, you cannot expect her to control herself or her reactions.

You have clearly tried everything possible to honor your mother, but perhaps it’s time to consider whether she’d prefer you to continue your present care plan or to consider another level of care.
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Anyone else think it is amazing that all 7 children are caring for their mother? I’m assuming everyone is an adult by now. That’s incredible! It attests to the closeness of your family (and the organizational skills to keep everyone updated on your Mom’s status)! Kudos to you! (But also don’t be afraid to seek out a good care facility if that’s what’s needed.)

Im not sure about the hitting issue. Alzheimer’s is very difficult. I like the idea of trying to distract her. But, definitely talk with her doctor about it. Maybe it’s caused by anxiety, but maybe not.

Good luck 💕
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disgustedtoo Jan 10, 2021
I was thinking the same! Not just 2 or 3 but SEVEN! If it had come down to no choice but to take my mother in, I KNOW I would not have had help from my brothers. One refused to even go visit her after the last 20-30 minute (if that) visit over 2.5 years ago. The other, can't even get a simple response to text or email and I'm fairly certain he hasn't visited either. It's been hard enough to do everything else that needs to be done by myself, caring for her as well would have been the end of me.

But, kudos to the Band of Seven!! May you always be together and get along so well!

Like JuliaRose, I don't have suggestions for the hitting issue - there are many good ideas posted, so try those or a variation of them and see if any might work.
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Your Mom is showing violent tendencies. You need to contact her neurologist and see if she can be given something. If it doesn't help, it maybe time to place her.

Why does she need an OT therapist. They help with ADLs. You Mom probably doesn't remember from day to day what the therapist has told her. You dress her? You bathe her? You cook for her? Laundry? So where does she need someone to show her how to do her ADLs? You probably do it all. I let Moms go. The Physical Therapist showed her how to use her walker. I did everything else for her. It wasn't like she had a stroke and had to be taught how do do things all over again. PT I can see but even then with Dementia they forget the exercises or are hard to teach.
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Karabiller Jan 9, 2021
I have found OT intervention very helpful with my Mom. They provide strategies and solutions to thoroughly clean that I never thought of.
I do agree your loved one will not retain the skills to be independent but handling the hitting and preparing your Mom with calming strategies may be helpful and prevent the hitting. Every situation is different but very helpful for us
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Seven people who will remember their mother at her absolute worst..... Time for placement, I think.
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Reply to CharlieSue
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I don't know if this would be possible for a family working on a relay basis as you all are - and such credit to you! - but what we'd do is make your mother a 2:1 call, which means have two people at a time supporting her. One person distracts her, engages her in talking, perhaps washes her hands (which would also keep them busy!), while the other person tackles the other end.

This assumes that you've already explored what might be upsetting her? Plus, it is important to give her a running commentary on what's happening so that she isn't startled or frightened by any part of the washing routine. "I'm going to take this pad away, is that all right?" "Let's get this soiling off your skin, okay?" "I just need to make sure your skin is dry and comfy." etc etc etc.

I also have to assume that what the OT meant is to come back to the task if she's upset, and meanwhile just do what can be done. So, for example, take any wet/soiled pad away and put a clean one under her, then come back to proper cleaning and drying after a bit of a break; that kind of thing. The principle that if the client says stop, you stop is correct; but of course it doesn't mean that you give up altogether!
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Reply to Countrymouse
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Unless she’s truly filthy, don’t bathe her when she objects. Clean up her behind on the toilet as necessary with a bidet wand (they sell them as attachments for a regular toilet).

It’s not worth the fight to give her a shower when she’s not in the mood for it.

I know elderly people with dementia who have gone years without bathing.

If she has the resources, consider a memory care community. They’ll take care of the ‘maintenance’ stuff and you can go back to having a more pleasant, non-confrontational relationship with your mom.

If she doesn’t have the resources, talk with an elder law attorney about spending her assets down so she can qualify for a Medicaid nursing home when her care becomes too much to handle at home.
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