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Are you dealing with extreme shadowing? A spouse that has no interest in anything, can't follow directions? Have you dealt with them doing just the opposite of what you say? Would love your feed back as how you handle things.
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Your question was when to get outside help. I think that when shadowing is driving you mad, you should get someone to come in and give the caregiver an hour or three to be alone with no one looking at him/her. You can probably find a companion/aide whose personality is reassuring to the spouse.

I think it's good to add help before it it absolutely essential. My mom said she didn't really need a cane, and I told her to get used to using it now, so that she would be comfortable with it when she did need it.

As far as putting someone into the NH, I would consider that when the physical care of a full-grown adult becomes unsafe for either party, it's time. When sleep issues do not respond to every treatment, it's time. When incontinence is unending, it's time. We endure what we can. I think children with kids of their own should give up earlier, because they should preserve themselves for their own family. As a spouse, I don't intend to martyr myself to keep my husband home when his care starts to destroy my health. Who knows what will happen in 5 to 10 years, though?
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Here are signs that may indicate your parent needs help at home:
Spoiled food that doesn't get thrown away
Missing important appointments
Unexplained bruising
Trouble getting up from a seated position
Difficulty with walking, balance and mobility
Uncertainty and confusion when performing once-familiar tasks
Forgetfulness
Unpleasant body odor
Infrequent showering and bathing
Strong smell of urine in the house
Noticeable decline in grooming habits and personal care
Dirty house, extreme clutter and dirty laundry piling up
Stacks of unopened mail or an overflowing mailbox
Late payment notices, bounced checks and calls from bill collectors
Poor diet or weight loss
Loss of interest in hobbies and activities
Changes in mood or extreme mood swings
Forgetting to take medications – or taking more than the prescribed dosage
Diagnosis of dementia or early onset Alzheimer's
Unexplained dents and scratches on a car
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Another option is a 'board & care' facility, which is usually less expensive (in my case anyway). My father has lived in one for 18 months. It's small and quiet with a higher caregiver to patient ratio than any larger facility can offer. Certainly there will be an adjustment period for everyone, but I watched caregiving kill my father-in-law and I was determined not to let that happen to my mother. Best wishes and keep us all posted!
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Meatjeanne - Have you gotten expert advice about how to handle the money? Try an Elder Lawyer and your local council on aging. There are things you can do to make him eligible for Medicaid. Just consider all your options before killing your self taking care of him.
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I'm not the primary caregiver of a spouse, my Mom is the caregiver of my Dad, who fits the description you've given in your post to a T. My Dad, for about a year, shadowed my Mom wherever she went in the house. He had to know where she was every minute of the day. He still wants to know where she is, but the shadowing has just about stopped. Instead, he calls out for her. If he can't find her or doesn't see her during the day, he calls her name repeatedly. Some nights he is up half the night yelling for her, wanting to know if she's in the house with him. It is very hard for him to follow directions; most of the time he stands like a stone, unable to be moved. When asking or telling him to do something, he must be told one thing at a time in order for him to understand and to do it. If I take him for a walk around the driveway I have to tell him to pick up his shoes, then tell him to go outside, then tell him to set on a bench, then tell him to put his shoes on. If we're lucky he gets them on the right feet. He has had no interest in doing anything for about two years (he was diagnosed about 4 years ago). He used to have a few hobbies, but slowly lost all interest in them and got rid of everything that had anything to do with them. On good days he sits and watches a little TV, or sleeps in his chair, or lays on his bed. On bad days he wanders through the house, picking on his hands.

During the worst times my Mom says she's ready to look at nursing homes. The next day she changes her mind and wants to keep Dad at home as long as she can. She says she feels guilty for thinking of placing him somewhere. Her health is suffering along with his. I know that the point where her health becomes the top priority is the time when he'll have to go to a nursing home, and she knows this also.

I know several people who have placed spouses in assisted living or nursing homes even though they can still take care of themselves in some ways. I know others who've kept their spouses at home until death. I suppose it really just depends on the couple, on the health of both of them, and how they feel they can deal with everyday life. Either way, whatever the decision, it's not easy.
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Thank You both, Vituralhorizon and Jinx4740! Yes, it is very hard for family and spouse to deal with the AD/Dementia in a family member. The mental and physical health strain is so hard on the caregiver! We all want to do our very best for them, but at what cost to our health as well? I agree on not to intent to martyr ones self...it don't help anyone in the long term of things! I guess one has to determine at what point they drive you mad enough to make the BIG decision to seek help, NH or Assisted Living arrangement. Thank you again for your supporting words. Just one day at a time for each of us.
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Thank you CandyKane57! There are options I do agree. Just finding the right fit and being able to 'let go'. :-)
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We are on our second marriage, spouses both passed away, married 10 years and he was diagnosed Alz 5 years ago. My husband lost his ability to communicate a few years ago, just makes sounds I call noising. So I get no comments out of him, no yes or no answers, no shake of the head. He lays in bed all day, gets up to use the bathroom IF he can get there fast enough. He depends on me for everything....helping him shower, all food prep. He comes out to the kitchen a few times a day, to unwrap cough drops or get juice (he can still pour a glass of juice). I think he is still 'in there' but most times he is not. I think about a nursing home, but I then think he is still ok to be home, and don't want to do that if he is still aware. I am also afraid of losing all our money, trying to pay for help. I have no family. I am doing this alone. I am very scared, very sad, no interest in my home inside or outside, no interest in myself. I keep waiting for the day he just cannot get out of bed anymore, becomes a complete zombie, or dies. THEN I might know what to do, and get back what I thought was my life. And yet....I know we have it better than many others.
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