Dad's nursing home staff, hold down his wrists, seated on toilet.

My mom has advanced Alzheimer's. She is at home with us. She started being somewhat combative at the end of stage 6. Now in stage 7 and needing to be changed in bed, she still is combative at times. I follow all the recommendations from Teepa Snow and Naomi Feil and still some days are just tough. My husband will ask mom... Do you want to hold my hands? And takes her hands. We did this both when we used the bedside commode for changing/cleaning and now that she is in the bed for changing. It keeps her from hitting me, or grabbing and holding her pants (which I think is a reflex), or putting her hands into the mess. When he is not available to help, we have a "toy" which is actually a soft braided dog toy, that I put in her hands. She holds it and it keeps her hands busy. Maybe you could try something like that. I would guess that your dad would have marks if they would using heavy restraint. It is challenging to change a person at this point in the disease. My mom is 5'2" and weights about 105 lbs but she can wallup me pretty good ;-) and she usually does it when I least expect it. Maybe you could take you father to the restroom and see if you strategies/suggestions work for him with you...then show the staff.

Another suggestion to put to the personal care aides: give your father something to hold, like a towel or a pack of wipes or his belt, so that his hands are constructively occupied and he feels as if he is actively participating in the toileting process.

Staff in a hurry do tend to forget how a person will react to having things done to him, as opposed to being helped to do something. I'm sure if someone tried to take my clothes away when I was seated on the loo I'd resist vigorously too.

MissBBWlady, as I said before, snap a picture with your cell phone. Then call your state hotline number and formalize the complaint.

Last Friday, I spoke with the Director of Nursing and suggested that the nursing home CNA's which assist Dad with toileting, immediately place a clean pair of pants on Dad's lap, while he is on the toilet, in hopes he will then let go of his wet pants and the staff will not need to restrain his wrists (which the Director of Nursing again denies). I also suggested that the CNA's also bring a second pair of clean pants into the bathroom, just in case my Father will not let go of the clean pants. I have no idea if the Director of Nursing will pass along my suggestion or not, as they continue to deny that Dad's wrists have ever been restrained and held down, during toileting. FYI....my Father's nails are always groomed and kept short. In addition, Dad has never had a modesty issues, on the toilet or other places.

I am not allowed to witness my Dad when staff assists him with toileting any more, as the nursing home is trying to prevent me from documenting the truth.
Dad does not always get angry, only when they immediately restrain his wrists on the toilet rails, as Dad does not understand to Let Go of his Wet Pants, because he has only sat on the toilet for for a few seconds.
His medication has been reviewed by many, several times. Dad is given an anti-anxiety med, only after one of his toileting anger outbursts, which is the lowest dose of the best prescribed medicine for him, with all of his dx's, which lasts in his system for up to 36 hours.
I am hoping to find a written article to take to the nursing home, discussing improper toileting techniques can provoke and trigger anger in advanced dementia persons. Use of proper toileting techniques will normally not provoke anger, as the advanced dementia elderly person, does not feel threatened, when his/her wrists are not restrained, thus does not respond back in anger. Same with staff's use of yelling at Dad and rushing him. These improper skills also can provoke and trigger anger in advanced dementia elderly persons too.
It would be great if I could find a Professional who would be willing to an In-Service at the Southeastern Michigan Nursing Home.

You gotta do what you gotta do to get the job done, as long as you are not deliberately abusive.
Would you rather he was sitting there flailing all four limbs and risking hurting himself and others.
By all means take pictures and have a meeting as Pam suggests. If this is the only time he is aggressive I personally would prefer a little restraint rather than have my loved one turn into a zombie with drugs.
I also agree that protecting the patient's modesty is very important but sometimes this just is not possible.

My mom hates it when I wipe her bottom but as her daughter I'm not afraid of her bark or bite so I try to get her to do as much as she can herself - lately after a wet wipe I've been handing her a warm wash cloth and she wipes as best as she can front to back - it goes easier if we keep it lighthearted and sing or make silly jokes - even at 93 with dementia she has a sense of humor (albeit only at times)

Interesting to know about.

Thanks, Pam. I have watched those videos, and while I don't always remember to do as she suggests, I do try to protect Mom's modesty. Sometimes I get in a hurry. I was hoping there was something that the professionals do or know, that I could learn from. I am a big fan of Teepa Snow although I had never heard of her until I joined this forum. I am trying to make Mom's journey through this disease as easy for her as possible, but lately, every day is different. Thanks again.

Teepa Snow always stresses to protect the patient's modesty. It can be as simple as a towel over the lap before removing the pants.

My mom does the same thing sometimes. And she's at home and it's me changing her wet pants. Sometimes she just doesn't want me to do that and she gets very angry, even to the point of pinching and biting. We have just stopped a medication that helped with that combativeness, but we thought there were some side effects that weren't worth it. So we'll try something else, I guess. In the meantime, I keep her nails cut very short, have someone hold her hands when I can (which actually makes her more frustrated) and carry on with my task. With her advanced (also vascular) dementia, she just doesn't remember that she has to have help with her needs. Sorry about your dad, I know how frustrating it is for children to see their parents in this way. I do wish you could elaborate a little on what the proper training is for this task, as I am always looking for ways to do something better. I always think there's gotta be a better way to do what I'm doing, I've just had on the job training, so to speak.

Use your cell phone to take pictures when this happens. Pictures don't lie.

Is your father being treated with any medications to help with his mental distress? I'd explore how that might need to be revisited. Has he been admitted to a hospital to get his medication adjusted? Can you inquire into that?

It sounds like your father is not understanding what they are trying to do for him with regard to changing his clothes. The staff cannot allow him to stay in wet clothing and I would suspect that they are allowed to protect themselves from being hit. What is it that you are upset about and how would you have them handle things differently?