Client, who is 83, is very difficult and daily she states that she wants to commit suicide. Any advice for me?
In our state we have, like most of you, the APS and our local obundsman.
My 83 year old client unfortunately has Lewy body dementia and Parkinson’s.
18 months ago she became non ambulatory and feels very helpless, afraid, full of fear and panic.
I have taken quite a verbal beating from her because I know it is the disease talking yet, when do I draw the line? She said very plainly she wanted to commit suicide the other day and purposely fell out of bed. I was not there at that time but she ended up at the ER with a broken wrist. They wrapped it and discharged her that night, even when telling the social worker she was trying to harm herself.
The next day, I was there and she threatened the same thing so I called 911 for an aid car, as she was on my watch and anyone who is of harm to themselves needs to be mentally evaluated. Her daughter went with her. They casted her arm, and discharged her, not addressing the self harm.
It is very taxing caring for her because Lewy body is really playing a huge roll and the daughter will not Medicate her for the hallucinations.
Any advice for me?
I watch her 20 hours per week!
thank you all for your love and support.
She is with Dementia but at times very lucid?
19 Answers
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This is reportable and you are a mandated reporter as is your supervisor. I would also CLEARLY document each time your client says she wants to kill herself and CLEARLY document what you did in response. (talked to supervisor, called 911..)
2. If you do not think your supervisor is taking this seriously a call to APS would be one I would make as well as to Suicide Hotline 1-800-273-8255.
3. Is her daughter, family aware of her talking of suicide? If not they should be made aware of how serious she is about this.
4. Is she on Hospice? If so this might be something that should be discussed with the Nurse, Chaplain, Social Worker that comes and visits. If you do not feel comfortable discussing this with them make sure that the notes that you make clearly articulate the times she has talked of suicide. The Hospice staff should have access to notes you make as it relates to her care and.
After all that....I do have to say I completely understand her and I would be having the same thought pattern and I would be doing everything I could to end my life before it got to the point where I no longer could carry it out.
My heart goes out to her. And to you.
Please be certain of your obligations now legally and morally and under the law in your own state. I hope you will be able to use your search engine for your own area. These rules are easy to find for my own state.
There are periods of clarity in Lewy body, in the early stages.
She does need to be under the care of a neurologist, but I imagine that getting her to a doctor's office is a nearly impossible task.
I think this elder would actually benefit from placement in a 24 hour care setting - probably a nursing home - or assisted living with private paid support. If she has the funds.
She won't necessarily be any happier, but she will be safer and there will be people to check on her very often and help her with her needs.
And it is not fair to you to be trying to meet her needs all by yourself 20 hours/week.
Good luck, and take care of yourself.
And you can't understand why she may want to kill herself??? I think we all would in that situation. Suicide is the ONLY thing she can control herself, e.g. purposely falling out of bed. Talking her out of her situation is, of course, is impossible. Her health issues are SO invasive!
Does your client listen to music, can she talk about her past, or.....? Otherwise, call 911 every time you are with her, until someone takes you--and her--seriously.
In the meantime, continue to give great care. Document the instances of self-harm and threats to kill self. Always call 911 for any threat to kill self or harm self and make sure it is treated as a psychiatric emergency - since that is what is is.
Washington is a 'Death With Dignity' state so your client may be able to request and then self-administer a lethal overdose of medicine to end her life. There is a link to the article above. She has to be mentally competent, however, and administer the meds herself, which could be an obstacle.
I would resign my position with this woman, if it were me, because it's too stressful to be in such a role. Her daughter needs to pull her head out of her butt and HELP her mother here, for crying out loud. What sort of a person refuses to medicate her own mother who's suffering like this??
My mother did, for years and years. Drove me batty---nobody else took her seriously and I shouldn't have, but what 10 yo has the ability to hear "I will kill myself and then you'll all be sorry" and not internalize it??
On my 30th birthday, she asked me to come by. I did, and she gave me a card (a 20 mile drive for a birthday card!) I was pregnant with baby #5 and had my 4 small kids with me. What does she say? How unhappy she was and how no one cared..on and on and something snapped inside me. I said "Mother, feel free to kill yourself. Just don't leave a mess for me to contend with. I can't even see my feet for my huge belly".
If she were doing that manipulation NOW, I would call 911 or APS or someone and have her Baker Acted.
If mom is making statements to that degree, she needs to be hospitilized and helped or called out on the manipulation that it often is. (BTW, mother never did one single act of self harm. But, wow, her constant talk of killing herself did a number on me).
My mother does the same thing, and I tell her the same thing as you. 'Go ahead. Just don't leave a mess'.
Even though the mom has dementia, she might just be putting on performances to get attention too. That's always a possibility.
Someone that will not do what is best for the patient is likely to blame others when a tragedy occurs. You need to protect yourself.
I would send letters to all of her doctors stating that her daughter is practicing medicine without a license on her mom and her mom is suffering as a result.
I totally believe in doing it naturally when able, heck maybe some CBD would help, but, it gets to a point when nothing being done is dangerous and malicious, IMO.
Maybe some medication to keep her calm and to treat her anxiety would at least help her feel a little better.
At the very least, the daughter should be pressed to medicate her mother to help with the hallucinations. Imagine having the worst nightmares of your life all the time because your brain can't turn them off. The daughter needs to understand that the medications won't prolong her life (which I suspect is her motivation for denying her the meds), but they could provide her comfort and some degree of peace.
While a neurologist might undertake a lot of trial and error with various medications and regimes to find something that helps, the attempts often increase the hallucinations and anxiety, and speed physical decline. In some cases the side effects are severe and long-lasting. Generally, any improvement is fleeting.
This is is by no means as simple as slipping a Benadryl to an anxious dog before a car trip. And BTW, Benadryl is another drug often exacerbates Lewy Body Dementia.
Best of luck!