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When I placed my wife in the unit, I asked them should I stay away for a while. They said no and they encouraged to visit often. My wife wants to know why we have “other people in our home”. The two times in the last week that they have called I have been there an average of about 4 hours each time. The aggressive behavior is very recent but seems to be increasing. She is not aggressive with me. She is getting a very bad reputation with the aides.

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Is she being seen by a geriatric psychiatrist?

In my experience, that is the specialist you want to get on "team dementia"
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Phogan001 Sep 2018
Thanks. Good idea
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Has she been tested for a urinary tract infection? These are fairly common in Seniors, especially in women. A UTI can cause aggressive and combative behavior, hallucinations and delusions. Facilities don’t automatically test for them. I had to ask that my mom be tested monthly.

Hopefully, the Geri Psych can suggest meds for her if it’s not a UTI.
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anonymous806474 Sep 2018
I asked and watched every afternoon with my Dad in aNH..for diaper changes, Dad would scratch himself..
Was told by a summer student NURSE
That the rule of thumb was every hour.
They never hydrated dad,he was blind
And sat in a wheelchair when he wanted to lie down...they do not want to do transfers.also I bought orange juice that I used to make smoothies
W yogurt fresh fruit...why don't NH make smoothies...easist healthy way
To eat..food was cold and hard as delivery was slow also one aide feeding dementia patients, eight one morning..geez glad I was able to see this..my opinions they are better off in a backyard with a sarong no diapers,
Listening to birds tweet..like the Godfather ..its too stressful and Expensive..you can get a very nice apartment for 2000 per month. As opposed to the cheaper rate of 4000
Per mo.
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How long has she been there? Maybe you should stay away for awhile. Sometimes memory care facilities request it. With my mom they requested a private 24/7 caregiver when the agitation was becoming an issue. That may come and yes, mom had to pay for the private caregiver too.

Facilities are understaffed and overburdened. The jobs usually pay around $10.00 an hour. What a stressful job and paid so poorly, turnover is very high.

Ultimately you have to do what is best for you.
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Ahmijoy Sep 2018
Yes, you’re right. Someone here just posted a job for a CNA or an STNA. The job pays $10 and hour. Wow. No wonder there’s such a turnover.
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I went through this with my dad while he was still at home. He would chase the caregiver on the shift out to their car and out of the driveway. They would go down the road and call me. I sought the expertise of a neurologist; in the meantime, his PCP put him on lorazepam. The neurologist was an advocate of melatonin; he used it to combat anxiety and sundowning.
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I'd discuss it with her doctor and consult with a geriatric psychiatrist. I'd explore if she would benefit from medication.

I'm not sure how I would react if the MC staff were not able to manage matters on their own. I might also ask for a team meeting to see how things are being addressed by them. They should be able to see trends, triggers, issues, etc. and create ways to deal with it. They should be trained to recognize the problem and make adjustments to help her.
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Hey Phogan, we are actually moving my Mom out of memory care tomorrow, after 5 weeks, because the progression since she's been in there has been through the roof. She was never aggressive before we moved her, so we're bringing her back home, and going to try and get her behaviors under control while we figure out how to proceed.

She has smacked a couple of care givers since she's been there, that was never our experience at home. I know it's the right move for Mom to come back home, but I'm pretty sure it's a axe blow to the head for me. Good luck, sir!
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Phogan001 Sep 2018
Thanks
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I have to say I’m surprised that the facility would continually call you and expect you to calm her down. If you placed her there, that means she needed more help than you could render.

My mom was combative, she would wander and she was stubborn and uncooperative. She would even stick her foot out and try to trip the aides when they walked last. I never got a call to run to the facility to calm her down. They always handled it. I’d call a Care Conference and ask what they think should be done. I would not bring her home.
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Phogan001 Sep 2018
Thanks. Had a conversation with head nurse. I think we are making headway
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My mother was diagnosed with dementia and alzheimers in 2006. She passed 2017.
I had the same happen to me.
What I found to help was I did not have a routine on what time of day I would visit. I always had to be on alert . If mom was trying to tell me she was uncomfortable in her surrounding? Payed attention which aides where working? Who also was her roommate? Just dropping in different times of the day keep everyone on their toes.
In the meantime , I made a friends with other familys in the facility. We keep each other informed. Called if we noticed anything. In the meantime, I talked to facililty Dr. on giving mom some anxiety medicine. They should supply music therapy to help calm her down . Also I talked to her on phone first before I went. She just wanted to hear my voice.

I hope you find this helpful.
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jacobsonbob Sep 2018
"My mother was diagnosed with dementia and alzheimers in 2006. She passed 2017. I had the same happen to me." (Fortunately, this isn't QUITE true because you are still alive and posting!) ;-)
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if she does not calm down and gets aggressive, they could send her to the psychiatric unit for medications which will keep her doped up. She will just get weaker and eat less and decline. If the meds fail, they could kick her out.
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BarbBrooklyn Sep 2018
I have to disagree, Cetude. Management of psychiatric medication, done well, can give much better quality of life to many dementia patients. My mother was one of them.

She was never "doped up". She was calm, at peace, and in a reality we could share with her. Before meds, she was in a state of extreme anxiety, dread and fear.

It was unbearable to watch and impossible to comfort or calm her.
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I’m sorry your wife is experiencing a similar situation to my Mum when she first moved into full time care. Imagine how it must feel to be in a strange place, suddenly being told what to do by people you don’t know. For example being told to sit down when you don’t particularly want to sit down. Imagine being told that the bag you are trying to pick up is not yours and to put it back on another residents walking frame (when you are convinced it’s yours, because it looks just the same). Imagine being told you must leave a room because another resident doesn’t want you in there, but this person asked you to come in and say hello as you were passing and then changed their mind because they also have Alzheimer’s disease and forgot you are friends.
If I suddenly lost my right to liberty, to make decisions for myself and was being constantly told (not asked) what to do by everyone, I think I would become aggressive and strike out to defend myself.
I think this is what’s happening. Like my Mum was, your wife is just defending herself, defending her right to liberty.
We all need training (professional carers, family carers, friends too) in how to put ourselves into the shoes of a person with Alzheimer’s disease and imagine how we would react if we were being treated or spoken to, in the manner we (or other carers) are now speaking to and treating our loved ones in care. It helps one to understand how we can better approach a person with Alzheimer’s so that we mininmise stress and obtain a more positive response and outcome.
Most of the carers at my Mums care home are wonderful, very experienced and speak to the residents with care, love, empathy and consideration. They ask a resident if they would like to do.....rather than telling a person they must do........The most effective carers don’t order our loved ones around, they gently coax and encourage with great care and empathy.
There are a small number of carers in my Mums care home who lack this empathy and caring-they do not show respect to the residents in their care. These are the ones my mum has slapped-in response to the manner in which they approached her a number of times when she ended up in another residents room (by mistake or after being invited). Telling my Mum she must leave a room gets a negative response-she will become stubborn and refuse to move. Rather ask her if she could please come and help out in the kitchen or with another resident in the living room (this would get her moving immediately because she’s an ex nurse and just wants to help everyone).
I explained why I think my mother slapped the carer to her care manager the day after the first incident occurred. She was unwilling to hear me (understandably because a carer had been struck) and called a doctor in who prescribed a sedative (my Mum now takes 4 times a day). So my Mum is under sedation each day to keep her calm. It breaks my heart as I am unable to care for my Mum at home full time. I have to trust that the care home is doing what they need to do to care for my Mum in a way that is manageable for the whole team. She is not an agressive person, she just has Alzheimer’s Disease and needs to be treated with care & consideration of her condition. She is never aggressive with me, will do mostly anything when I ask. If she doesn’t want to do something (like brush her teeth or finish a cup of tea), I just change the subject, redirect her attention, and few minutes later I ask again and she usually cooperates. It’s an ongoing learning curve for both of us.
I think the aggression your wife is now showing is in response to the manner in which she is being approached. I hope this information about my Mums experience is of help to you and your LO.
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Ismeraldo Sep 2018
I would love to share your response on my Facebook page. I share the struggle.
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I'm a caregiver and we have some resident that are like that, but when you have several others residents to take care of trying to redirect or calm one person is time consuming and it takes away the time for other residents. There may be places that you have a concern about the staff, so why keep your family member there so that they can hurt others or possibly get injured, if she is calm with just you and you don't want her to be medicated (not doped up), then she needs to go to a violent behavior or combative unit. Some people have worked in unit where everyone is mildly okay, that why they are opinionated.
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Phogan,

I would request a Test for UTI. If that is negative then I would request a psych consult.

Mom’s Nursing Home had a contract with a Psychological and Psychiatric Service that visited with the residents as needed.

My Mom would become combative, was anxious, etc. When Mom was in this state she was miserable.

It took some time to get the meds right and they needed to be tweaked occasionally. Mom was never over medicated or in a Zombie state.
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Because she believes she is in her home ( which she is but not the home she thinks ) , would it not be normal to react when people do things in her home she does not want ( or she thinks they do ) ?

On the other hand , there are schedules to keep and aides sometimes have to be a bit ( or even a lot ) pushy to get things done before the next shift comes on .
This is not a comfortable thing for one to feel in their own home but it is the way it has to be most often .

When your wife feels she must protect herself with aggression , is it after dinner , before lunch or at bed time ? This can be key on how to help but it is really important to know .

Remembering that a care center must always sound positive and leave no doubt they can " handle " things and they want you to believe they do " nothing " , which can be true , whatever behavior they do have may be a misconception in your wife's mind that is not correctly working .

Again , this is a hard call .

Having worked in Memory Care I am sure of where I speak .

Alprazolam is a medication that if you insist she is able to try then it most likely will be for the best since it brings complacency for most within 20 min. Then your loved one and the facility are at peace . I really believe in helping with this medication ( never Lorazepam since it has serious side effects like panic attacks which make a situation worse .

Think about it like this - Let's say you have a headache , a really terrible headache but someone wants you to do something like shower and get to breakfast . If you take an aspirin or whatever you may be able to do so within a few minutes . But they want you to function right away ! What kind of stress would you be feeling ? ( and in the meantime you cannot communicate to let them know what is wrong ) Your wife is in a situation where her mind cannot work correctly and she cannot tell anyone even if she feels sick . She cannot control her mind .

Getting her help you are sure will work is best for your peace and all concerned .

There is an answer and it can only be the right medication . The care center knows this already but apparently nobody is suggesting this type of help which can depend on the care center budget , I don't know .
A dr YOU can speak with in person to express how uncomfortable this is for your wife , you and the facility is crucial .
Yes they may try to convince you to have her try whatever is normal for their facility but please take down the 2 medication names I have given you and take them with you . Otherwise we get confused in a world we do not normally function with . God bless you friend & know I am really praying for your situation .
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Judysai422 Sep 2018
My mother takes Lorazapam PRN when she has a panic attack. In 20 minutes she is calm and asleep with a minimal dosagae. However the doctor is worried she is too old to take at this point (92). She takes a half-dozen times a year and for us it is a miracle drug. Going to neurologist next week... will see what she says.
Point is, drugs work differently for different people.
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If it’s not UTI, I’m wondering if she’s taking Arocept or Namenda. Both together or seperatly can cause stomach irritation and other nasty side effects. Patients can’t always communicate what’s hurting so they become aggressive. That was our experience with MIL, anyway.
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I am a caregiver and I have experienced some of the behaviors you touched on. With proper training, those caring for your wife at the facility she is in, can better assist your wife. Understanding that empathy, loving and being calm goes a long way when these situation arises, and that it is not the resident fault (it is the disease that is acting our and speaking).
A set routine for residents with Alzheimer's can be very helpful, distraction and redirecting sometimes will do the trick. Knowing what their favorite music is and playing or singing to them had worked for me in the past.
However, there is another alternative, have you thought of In-Home care for your wife? There are some good home care companies out there with programs that are beneficial to those suffering from memory loss. The key is that you have a one to one approach, not one caregiver caring for 10-20 residence.
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So appreciate your sharing
Vuongphi
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I feel your pain. The same is going on with my brother. What I am finding out is when one of the aids approaches him in the slightest aggressive manner - he gets nasty and in a rage. I have been called down a few times also. Talk to the director and director of nursing. You have valid concerns and need to ask why she is getting anxious. It is part of the disease, but appears to come on faster they get nervous, feeling backed into a corner or yelled at. Does she get sun down syndrome? Is there a specific time she gets agitated? If you see a pattern maybe they can play soothing music for her or engage her in an activity to get her mind refocused. Good luck and God Bless.
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Have you watched any of the Youtube videos by Teepa Snow? I strongly encourage you to do so. There are quite a few, but one in particular shows how she, a stranger, would approach someone who was being very aggressive. These are two that are excellent... Helping a Distressed Person with Dementia" with Teepa Snow - 10 ways to de-escalate a crisis with Teepa Snow. These are short and there is no reason the staff could not find time to watch them as well. I would insist on it! I'm watching everything I can find by this lady. She role plays the situations and makes it very clear how to approach and deal with those with dementia.
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Please review her meds. My mom's doctor upped her Aricept and within a week she was throwing things at me, hitting me, punching. We immediately went back down and after about a month the violence stopped.
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I am sorry this is happening. I know it must be horrible for your wife and upsetting to you.
You might want start showing up at different times. It might help you pinpoint what is going on.

Is the facility calling you at around the same time? It might be some activity or a particular person that is causing your wife to get agitated. Especially if it happens out of the blue.

My dad was never a problem at the home. Then he started to get clearly upset when I would visit.
Found out one CNA was doing things she shouldn't. She shouldnt have been a CNA. She was very young and had no empathy for her residents.

She came in the room right in front of me. I had never seen her before. Went straight over to my dad's bed. Grabbed his hamburger off his plate, and shoved it in his face, yelling EAT! Then turned to me and said he doesn't eat enough, with an annoyed look on her face. Then threw the hamburger back on his plate. He got very mad and upset. I was so shocked, I couldn't even talk! She didn't wash her hands, was very abrupt, and shoved just food in my dad's face! Then she walked out of the room!

My dad was also getting big scrape marks on his face from pushing the razor blade into his skin as he was getting shaved. I got a few ph calls warning me he had big bloody scrape marks on his face. That had never happened before. The CNA was being very rough with him. I think she was abrupt and he was reacting. He had been in the home a couple yrs before he started having problems. He hated her. So the problems were real. He tried to tell me things were happening. I thought it's not that bad. Yes it was!
Another time the CNA pulled his blankets/bedding off the bed and threw them on the floor. The air from that went in my face along with the dirt from the floor. I was sitting in a,chair visiting.

Nothing is allowed on the floor. Not even trash bags with soiled briefs. It goes from bed to special trash can. The nursing home can get cited big $$$ for that. So she was doing things she wasn't allowed to.

So my dad had a legitimate problem. He never complained before that. I went to management over that.

Your wife might be objecting around an activity, like bathing. She might feel bullied to bathe. The staff insist residents get clean. Residents can say no, but at a certain point they need a shower. It also helps check for sores/skin etc. Is it happening around bed time? Changing clothes to get ready for bed. It can be very traumatizing having someone remove your clothes when you don't want to. Cna's can be abrupt to get them into bed. They have 12 residents to look after. They are on a tight schedule.

I would definatly see if there is a legitimate reason she is getting agitated before requesting anxiety drugs. It could be 1 CNA or an activity/s she is objecting to. Or it could be another resident coming into her room, taking things.

That was another problem with my dad. Residents were walking in, taking things out of his closet and drawers. Luckily his room mate was able to yell for the nurses and they would redirect the wandering resident. They were both very upset by that.

So it could be a legitimate problem. Let us know if you find out what it is. Good luck~
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Cmthatcher Sep 2018
Surprisingly moms new assisted living/memory ward said I can bring my nanny cameras.
I have had to increase and add drugs due to moms aggitation but change in aides has helped too. Once settled in new unit they will try decreasing some meds.
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Check for a UTI - anger is often an indicator.
If not, consider a calmative. There are natural alternatives at a health food store that may work or talk to her Wellness doctor to prescribe a low dose of something to take the edge off, for her.
I use both on my dad.
Allowing ppl with dementia or alzheimer's to suffer makes me really sad.
Some families refuse to allow anything to be given.
It's the person that suffers because the aides start to try to avoid taking care of them. I've watched it oh-so many times and breaks my heart.
All the best to you!!
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It could be a progression of her dementia.

It could also be that she is being mistreated in some way.

Can you install a nanny cam, without sound, to record how she is treated, when you are not there.

My grandfather was becoming aggressive with several aides.

On a nanny cam I learned that one was rifling through his draw and taking items.

The other was refusing to give him water, when he asked because they said it would cause him to urinate.

It is not healthy to withhold water from someone, particularly the elderly who are already prone to dehydration for various reasons.

Some of the people that work in these facilities have good hearts, but too many do not and really only work in these facilities because it's the only job they can get.
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I have been my mother's caregiver for ten years and barring any ill treatment from NH staff, can tell you that she went through a very aggressive stage here at home. She has Vascular Dementia. She is so strong and violent that she twice sprained my wrist while I was changing her brief. This behavior, like many others, comes and goes in waves. In her case, I believe it's brought on by stress, anger and frustration at being 'forced' to do things or have things done to her. She sees it as a violation of her person and responds in kind. Her mind no longer understands that being fed, kept clean and safe are behaviors we perform for her benefit. She simply thinks we are trying to bully or harm her. It's the dementia exacerbating these thoughts and behaviors. But since your wife is being cared for in SN, you might seriously want to consider a low dose med when she is on an upswing toward anxious and aggressive behavior. Normally most behavior can be charted and dealt with before it gets to the point of violence. Her carers at SN should alert you when they see anxiety rising and offer you the option of a preventative mood med to nip it in the bud. It's bad for her to be aggressive with staff, but imagine what it's like inside her mind. Confusion, fear, anger and frustration running rampant in a way her mind can no longer control or make proper sense of. Talk to her doc about a low dose med, make certain she is not being baited or abused by staff and most importantly, offer constant reassurance that she is safe and you will protect her no matter what. Good luck to you.
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To any of the residents smacking the aides - if I was an aide, I'd smack you right back and twice as hard. I don't care about being fired, the GD joint will hear from my lawyer
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ML4444 Sep 2018
You probably should not apply for a position as an aide.
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If the aggressive behavior is sudden, I would suspect a UTI. She needs a visit with the doctor to determine if that is the case. If not, Seroquel might help her.
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pooneil1 Sep 2018
the UTI issue is real. Most of the time my 97 yr old mother has outbursts it boils down to a uti. My mother has had “Alzheimers” for 15 years now and does experience forgetfulness often but she knows she is forgetful... when she is at her worst cognitive state it usually involves recent meds. It is hard to tease out real disease from issues anyone would have when lucid of mind and confined to a wheelchair... who among us would not balk at being told instead of asked not to do something or sit down as if they were a child. My worst nightmare and the reason I visit often is that I love her and I fear there is a fully cognitive individual inside who wonders what she did to deserve being in a place like this
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I agree with BarbBrooklyn. If I were to have that terrible disease, I would want to be "doped up" as much as possible. Why would I want to experience the fear and anxiety of knowing what is happening to me? If it meant I would live a few years less with this awful disease, so be it. Sad to say, but there is no cure, and Alzheimer's patients do not get better. It's horrible for their loved ones to watch, but I would think seeing them calm (even if doped up) would be a little easier than seeing them agitated and afraid.

Consider the people who work at these facilities. Would you work at a place where you might be assaulted at any time? Some of these patients could be bigger and stronger than the workers. It's difficult enough to get people to work in nursing homes, etc.
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CaregiverL Sep 2018
Okie, you are absolutely right 1000 percent
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Has she had a new medicine recently added or changed? There are meds that effect one's cognition, and or behavior. Most , but not all are psychotrophics meds. But Not all. This would be my first thought and or action. Some meds when added with a current medication can cause side effects that a person was not experiencing or displaying prior to new meds combined with an old med or more than one of older meds.
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As others have mentioned, have her doctor take a look at her meds.Take her off of EVERYTHING that isn't about helping with her anxiety and physical comfort. Drug interactions aren't always extreme. Often they just cause a generally less-than-well feeling. So, eliminating unnecessary ones can just make people feel better and behave better.
Also, I second the Teepa Snow video suggestion. If the Memory Care Community where your wife lives doesn't use her Positive Approach to Care, you can still learn it (for free online) and introduce key tactics to the aides simply as "ways that I know work with my wife." I've seen it work wonders with residents who were rejected from other communities for violent behavior and were totally agreeable when the Positive Approach was used.
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I always ask if there has been a med change try to elimate the cause. Sadly to say anti depressants do not always work with people with dementia. I am going thru almost the same thing a member of the family with dementia. I told them to cut down on some of this medication it is only making matters worse.
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CaregiverL Sep 2018
Curious, Piper, which med was causing the problem? My mother has dementia & gets combative at times...she takes Seroquel to calm down
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Tell those homes who do not encourage their residents to drink their water
to go out of business, even drop dead
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Kalliekaykat Sep 2018
I’m having a hard time understanding why you are being so confrontational and aggressive in your responses. Caregiving is a tough (and often thankless) job, but the people who do it are expected to have kindness and compassion towards their patients. Nobody wants to be hit, but a good caregiver will never attack her patient in retaliation
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