A friend who had a UTI (her 4th) ended up in the hospital and then rehab for several weeks. She returned home three weeks ago unable to stand, much less walk. She had a stroke two years ago and now has memory issues and aphasia, so communication is a continuing issue. Totally losing her independence is clearly causing more frustration, fear, and anger. She can't clean herself but doesn't want the aide cleaning her. At first, she complained loudly and pushed the aide away, now she is throwing punches as well. She shouldn't be in bed all the time, but she hates the Hoyer Lift and fights getting into the sling. At first, she was resisting by yelling and squirming. Now she has added kicking and punching.
She has worked with this aide for two years, and the rest of the day they get along well. The situation just becomes totally adversarial, as though she's dealing with a stranger. This can't continue.
Any advice would be appreciated.
Obviously, one aide cannot get her changed and washed safely and successfully.
Losing independence and communication is about as bad as it gets.
She should not be forced into the Hoyer and tied in a wheelchair though. That isn't going to help her at all.
There should be a pressure air mattress on her bed. It inflates and deflates continually to relieve pressure on different parts of the body when a person is bedridden. She should be repositioned every two hours. Someone should be exercizing her in the bed to help prevent her limbs from getting atrophy which is a very painful condition.
There can be no argument on the washing and changing though. Two will simply have to do it by force. One restrains her while the other wipes, washes, and changes the diaper. There can be no leaving a person in their own mess because they have dementia and are combative about it.
If she has to be drugged to calm her down so this can get done, then someone will have to talk to her doctor. No one can be left in their own mess because that is so dangerous.
What would happen if the employment is stopped by either the employer or the aide (which would probably be the safest approach for each of them)?
She has dementia, yes?
Often in dementia, there is no rhyme or reason to why the client is resistant to something; they are perceiving something that we are not privy to.
Would a bidet help with cleaning?
Would a bedside pole or a bar over her bed aid her in getting herself raised up?
Has she been checked for something that might be causing her pain? (My mom was "resistant " to PT; it turned out she'd broken her hip.)
Maybe a small dose of anti-anxiety meds before major moves?
If she needs a Hoyer to get out of the bed, she's not using a toilet anymore so a bidet isn't going to be possible.
Another point:
”She returned home three weeks ago unable to stand, much less walk.”
This is not normal after UTI. As Barb mentioned in her mom’s example, the woman might have a broken bone: hence it’s so extremely painful that she’s even kicking/punching. In other words, there might be a reason for her sudden, extreme resistance.
Maybe she fell during rehab, broke a bone. Maybe rehab didn’t want to say anything about it. Swept it under the rug.
Besides the topic about what to do about the poor aide being kicked :( …unsafe employment, etc…
…I think the woman needs to go to ER asap. I think there’s a big physical health problem.
She needs to go to ER to get checked out for possible broken bones, and whatever else.
Once she is there the OP should refuse to take her back. SHe needs to be in a care facility with a staff of people. Not with limited care resources in someone's house.
She is not acting out because she is losing her independence, rather her brain is deteriorating more and more and depending on which portion of the brain is affected her behavior can be combative, violent and abusive during certain tasks such as having the aide clean her up.
What kind of psychiatric medications is your friend on? She may need her medication adjusted or have a new medication introduced.
Accepting where she is and making appropriate decisions for her rather than deciding she shouldn't be doing this or that will be kinder and gentler for your friend in the long run.
Sometimes surviving a major medical event like a stroke is a curse not a blessing. If she has no end of life directives in place medical interventions and treatments are going to keep her around and suffering for potentially quite some time.
And please give the advice Burnt and others gave below consideration. Keeping her in her home may not be the best thing for her at this point and she definitely requires more than one aide at this point.