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I'm an in-home caregiver for the 90-yo father of a friend. He has Parkinson's and at least moderate dementia, but when his daughter takes him to the doctor she coaches him on what day it is & so forth, so he can fool the doctor.
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He doesn't want to admit he can't do what he used to do, and they don't want to accept it either, which leaves me (& the other caregiver, but I don't think she's actually a CNA) stuck in the middle.
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The family:
doesn't encourage him to use his walker,
allows him to take showers by himself (without a nonslip mat),
won't consider an assisted living facility,
won't consider 24-hour care,
explains away the dangerous things he does,
buys junk food (which is what he prefers to eat)...
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It's just a dangerous situation for him & for me. I desperately need the income (in fact, I really need about twice what they're paying, and am looking for a real job) so I don't want to lose this job (which would include him hurting himself & ending up in a nursing home or dead). So how do I get him help, find a professional to convince the family that he needs 24-hour supervision, he's not really mentally together, etc. without making them mad at me?
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Dangerous things he's done include trying to go downstairs carrying a basket of laundry, repeatedly refusing to use his walker, insisting on taking extra doses of medicine, leaving the house alone (and at night!), taking a shower, and one day I came in to find him putting all his pills for the day into a cereal bowl! Just barely stopped him from ODing, and his daughter accepted his explanation that he was "counting them". There's always someone there to give him his pill, so he shouldn't be messing with them at all.
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Last night he claimed to have eaten dinner, when what he claimed to have eaten wasn't even in the house. Also, there was no evidence of him having eaten (no dirty plates, no plates in the dish rack, no cob from the corn he claimed to have eaten) so I'm pretty sure he had cookies. He'd eat cookies all day if you let him, and there's no way to get him to eat anything healthy when his family buys him junk food. (The daytime aide does the shopping, takes him along, so of course they come home every week with 3 boxes of cookies.)

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Captain, how true that is... my Dad didn't like using his cane outside, did want the neighbors to see that he was old.... [sigh]... and it took a nasty fall on his driveway and a trip to the ER for him to realize he needed to start using his walker, which I found put away in a spare room.

Once I got Dad one of those fancy rolling walkers with hand brakes, a basket and a seat, he felt like he was in control again.
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This is a bit of an aside. My husband Coy had some very scary falls WITH his walker. No wonder he didn't want to use it. Walkers aren't the perfect panaceas to prevent falls. I researched this at one point for Coy and was shocked to see how many of the ER visits for falls involved canes or walkers. Also, falls involving walkers resulted in more serious injuries.

Not saying there isn't a place for walkers, but I think we fool ourselves that we can relax if our loved ones would just use their walkers.
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it takes a scary fall to get the elder to use the walker religiousy ..
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even my aunts nh allows her to take limited risks . her wheelchair is alarmed but they want her to sneak into the restroom alone . the alarm summons them so they can oversee her , make sure she locks brakes etc . they want her to use her legs occasionally but they want to be close when she does .. there will always be an ongoing fall risk that will get worse as time passes . youve gotten good advice here . fix what you can and maybe alert the rest of the team to hazards you are seeing . there is no 100 % safe situation .. i used my ears a lot staying with my mom . if her shuffling thru the house sounded calm and steady i left her alone to rummage , wash clothes etc . if i heard her struggling with something id go see if she needed help . shes still an adult , still alive and you cant smother her with " shouldnt " ..
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I think there comes a time when family just gets tired.

Tired of arguing, cajoling, manipulating, sounding short, feeling guilty after . . . just bone tired of it all. I certainly do. I try to shake it off, but it's hard. Eventually, at least in my case, I've accepted the FACT that I can't change some things mom does. And that my having to be her brain 24/7 means that I'll make mistakes.

I'll forget that she won't remember to put her arms in when I take her through a door in her wheelchair. Or, I'll tell her and she won't do it. Then get mad when I do it for her. Or won't take her pills even with applesauce. "I already took them!" Tired of explaining three times that she did not . . . tired of her saying, "I'll take them in a few minutes," then remembering to check again in 45 and they're still laying there. And her telling me she took them. Again.

Someone up top said it better, I can't find it now to credit her, but it was something about people forgetting that care givers can't force people to do things they are determined not to do. And when it happens day-in day-out, we just get . . . tired.

It's very easy to blame family. You're a care giver for him, too . . . if YOU can't get him to do these things, or stop him from doing some things, why are you surprised that his family may have given up?

Sounds to me as though his family is trying to keep him safe. They've hired care givers. That's more than many families do, believe me.

You got good advice here: keep a log; you're doing a good job by emailing and thus memorializing your concerns. Great work. Maybe just don't judge the family quite so harshly. They may be doing the best they can.
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Many of us here care for elderly family members with dementia. It can be difficult to get an old person to eat correctly. Often it is difficult to get them to eat much at all. My father used to wait until we weren't watching and stash his food under his chair or behind the curtain. I would discover the hidden meat or other morsel later. I remember his last meal here. I wondered what he had done with his fish. I knew he couldn't have eaten it so quickly. I found it a few days after his death, stashed in a little bag in a box under the dining room table. Often what we do to get enough nutrition into our loved ones is buy treats that are as healthy as possible. Ice cream, yogurt, and some fruits were favorites for my father. Cookies and snack cakes provided needed calories. He would eat these things with no problem. He also liked salads and eggs. We do what we can to keep them fed as their food preferences decline, their stomachs become more touchy, and their taste buds disappear. It may be why the family buys so many cookies.

As a caregiver, maybe the best thing to do when you see him walking down the steps with laundry is say, "Here. Let me help you with that." If he wants to do it himself, stay near him in case he starts to fall. I know that falling is a big risk with Parkinson's, so I understand your concern. It is always a tough one, deciding how much to let them continue to do and when to take over. Usually it is more work to let them do what they can, but it is better for them physically and mentally.

You can talk to the family about your concerns with his falling and get on the same page about what to do. You spoke about your client needing 24 hour care. I imagine that you and the other caregiver cover about 16 hours between you. Are there family members there the rest of the time? What stage of Parkinson's is he in? Dementia is progressive, so he may still be able to do much until the later stages.

Still trying to figure out the one about medicine making him ugly. I know some people with Parkinson's. Their medicines make them feel ill sometimes, but I don't think it made anyone ugly. :)
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"Competent to make his own decisions" is a legal concept. Unless he has been determined by a court to be incompetent there is limited control a family member or caregiver can exercise. For example, JessieBelle has been participating in these forums for a long time and I am familiar with her struggles to help her mother control her diabetes and not make dangerous decisions. But it is very difficult to control another adult unless you have guardianship over that adult, and you can't get that while they are legally "competent." Just having dementia does not make one automatically incompetent.

If his doctor has told the family that Father needs 24 hour supervision and they prefer to ignore that, there isn't much you can do about it. If the doctor has not said that, they are not likely to be convinced by you.

I think you would be more effective tackling the "unsafe" things one at a time. Ask if a non-skid mat could be put in the shower. Mention the possibility of keeping medicine locked up. Just one thing at a time, and only as a suggestion or question, not as a demand or instruction to them.

It bothers me that you don't consider what you are doing as a "real" job. I can understand that you want to find a better-paying job. But there is nothing "fake" or "imposter" in doing caregiving. It is as real as it comes.
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I work directly for the family. If there were an agency involved, I'd report to them.
Yes, if he only had Parkinson's he'd be competent to make his own decisions. But his mind is definitely going.
And if he didn't have Parkinson's & didn't have dementia, he probably wouldn't need caregivers.

But he's a fall risk, has fallen already (that's why they got caregivers for part of the day), yet refuses to use his walker or take other measures to prevent future falls (nonslip shower mat & floor rug, not trying to go downstairs, having an aide when he goes out of the house).

I have been leaving activity notes for the family when I'm there all day Fridays. Last night I wrote the notes about the most dangerous actions on a separate piece of paper for my own records, and will continue keeping my own notes. I also have some emails to the daughter about dangerous situations, which of course will be saved.
For now, I think I'll just keep my head down & keep looking for real work, hope he doesn't do something fatal.

BTW, if he were nauseated he probably would want to eat crackers to settle his stomach.
(I don't think the medicine makes him ugly. How could that be?)
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I read the things that you wrote and realized I am guilty of neglect myself. My mother doesn't like nutritious type foods. She doesn't like to use her walker. She does her own laundry, takes a shower alone, and frequently wants to take extra pills. You could have written this about me, because I am not able to control my mother and she makes some decisions that many would think bad ones. Perhaps you need to see your client as a person with a personality and will of his own. People with Parkinson's are still competent to think and talk for themselves. Try to talk to him about why he needs better foods, etc. It may be he doesn't like heavy foods because the medicines he takes make him nauseous. I'm glad the family buys cookies for him to enjoy.
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Don't stick your nose into family business even if you have the best of intentions. It will come back on you and you will lose your job.
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Regarding the junk food, he's 90 years old, he should be able to eat what he wants [unless it is a medical issue should as being diabetic].... maybe he won't eat anything else as once you reach 90 your sense of taste diminishes, so that's the reason many elders love sugary food.

My parents eat a lot of pie, ice cream, cookies, cakes, but I figured they got to their mid-90's, I am not going to ask them to change their eating habits now :)
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Part of providing care is keeping a daily log of what transpired during your shift. Make sure you do so. If you are not keeping one, start doing so for your own protection and his. Do you work for a service or are you self employed?

If you work for a service then you should talk to your supervisor of your concerns. Keep records of the days activities! Even if they do not require you to. If your self-employed then do so to protect yourself. When you write this record do not give your own personal opinion, keep it factual and just tell what happened. Example " Found Mr. XXXX putting all his pills for the day into a cereal bowl. He said he was 'counting' them, but it appeared he was going to eat them with his cereal as the milk and cereal box was close by. Reported findings to his daughter later that same day."

Your in a 'grey' area trying to mess with his right to decide his own diet if the family is not supportive, even with good intentions. So, unless the doctor, family, a judge, and or social services is willing to step in and say he is incompetent to make these decisions, you cannot change things just because you think you should. Be careful where your stepping in this regard.
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Oh, I think they have accepted it if they have hired two caregivers. Do what you can on your shift and let the other caregiver know what has been done, too. As long as he is maintaining weight, you are coping well. Ask the family to get a seven day pill box. That will help. Help little bits at a time.
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