Lexxie Asked April 2020
I work with a stroke pt that needs consistent prompting to remember to put his brief on first thing in AM without me around. Any suggestions?
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How with an adult? This is a cantankerous gentleman who gets mean if you even ask if he changed his brief or even to wash his hands. He is incontinent.
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After a stroke, my mother needed prompts to dress in the correct order (to put on underwear first; unprompted, she would put on slacks and THEN underwear).
We found (after much aggravation) that the key thing was to not "remind" or ask but to say cheerfully "now it's time to..." and just make it an expectation.
If this isn't what you're looking for, my apologies and let us know what you need!.
There are other folks with more expertise in the hands-on care part, but what jumps out at me is the irritability and agitation of the elder gentleman.
Has anyone considered that depression and anxiety might be an issue here and that meds might help? Depression is very common in vascular dementia which appears after a stroke. Has he been evaluated by a geriatric psychiatrist?
How to get the tensions down & get the job done (without any 'smoothing' medicinals)?
In a facility I'd image this would be a two person job. Separate the elders to start. Settle Mrs at the breakfast table or wherever then tend to Mr. First carer where he can see them, to sweet talk & distract him, the second carer ripping the old pull-ups off at the sides. Then sweet talk here are you clean pants, time to put them on. If too unruly. Leave room. Wait 5 mins try again - carers swap around.
But only Lexxie! Going to have to be crafty I think. Or daughter lays down the law & tells her Mother, Father needs help to dress. Lexxie will help him. He cannot come to breakfast in dirty pants. Lexxie is helping you too so you don't have to force him. Her job can be to tell him how nice he looks when he arrives clean to the table.
I wish I could think of more... this is a tricky one!
In reply....
This is a bit complicated because Mr. and Mrs. Elder live with 3 other family members. Daughter is #1. Caregiver but wants to give him too much independence because if his anger. 1. Mr. Elder has got “ slight dementia” and yes, he needs supervision while he dresses himself but is angry if you do so people set out the clothes and brief, remind him but as is expected, when you leave the room he may or may not. Mrs. Elder tries to help remind and you can hear him yell when she does.
Of everything I have experience in.... THIS ONE I am not because I always assisted at least stood in room. I think it is time to have a family meeting on supervision if they don’t want feces all over their room to clean or taken downstairs. Food is a HUGE motivator so, I think I need to insist I stay present with my back turned and then go start breakfast.
Thank you for your reply....let me explain if I can better.
I work privately with a family. There are three generations in this very large house and it is still a new set up. This middle aged couple moved her parents in after her dads stroke and mother could not care well for him. College daughter living in as well.
Daughter hired me. Dad has slight dementia and needs small amount of supervision. Mother had recent stroke. Can’t help much. The family showed me what they were doing for me to take over so daughter could go back to work.
Here’s the deal. He does need someone to make sure he changes his brief that’s laid out for him. He is cued but that doesn’t always work. Mother could but he snarls at her so she let’s it go but they share a home.. IE... spreading contamination.
Neither parents want me to supervise him before coming down to breakfast yet it is what daughter needs me to make sure he does.
Mother is VERY angry someone has taken over caring of him yet she cannot and when given some things she can help with she bosses him around and he yells at her so she caves. It’s a never ending cycle.
I shared with daughter that I would post here for helpful communication and suggestions to help set up a better routine for handling the aggression issues and helping to make sure he changes his brief since I cannot he in the room to cue him.
Hope this explains better.
Think of a strong willed child and how you would motivate him. The problem is this sounds like this man has an angry disposition - Have his wife and daughter look outside the box - so to speak - to find a way to get this done. I wouldn't be surprised if the stroke has also altered his understanding.
A small dose of an anti-anxiety med would help. A large dose of HUMOR could be prescribed but it sounds like the tension is huge.
I call my husband's pull ups - briefs. I told him to wear them because it helps me in with the laundry and I could spend more time with him. Hopefully, others here will have some motivational ideas. It is challenging to motivate, manipulate and yet leave the person with their self respect. I look forward to hearing ideas.
Thank you for your reply,
You are so correct. This is a very difficult spot for all of family. Everyone’s loosing something yet what a wonderful set up they have vs. being in a facility. It hasn’t been that long since the move and then Covid changed things a bit.
So, I was hired so that daughter can go back to work, Granddaughter has College. Wife needs to get healthy herself. I think I have found the issue and need to communicate with the daughter to see if we can try a few new things and a strong routine for him so, wife can be wife, daughter takes over after work.
Yes, on the other areas, I think I have found the carrot which is good but he’s also diabetic and that’s another thing that someone needs to control. Poor guy!
So, this is all so normal and I have heard many stories like this but not experienced this until now. I believe with everybody on the same page, we’ll get there.
Thank you so much for your input!
Thank you so much for your reply. And THANK YOU for your kind words. You’ve got some GREAT questions and what sounds like some insight already.
First question is yes, dad has been taking cues from too many women we feel, Mrs. was taking care of him prior, they lived in Assisted living, then she had a stroke I believe she said five years after his. She is doing better but still in therapy but, we all understand he doesn’t want anymore women bossing him around. Since moving in with daughters family, they all have really had it rough as is normal and it is amazing. Daughter is VERY organized and very selfless. I don’t think mom and dad have had enough time to grieve the loss of their prior self and home yet.
Having said that, I had training years as CNA but went into another field but do Home Managing for the last 6 years, but not in this complex situation so trying to establish a routine for him with only one of us cueing him when I’m there. It has taken about 3 months but with some more insight I am getting it figured out better.
Yes, there is another male in the house and a Granddaughter. It is actually a pretty cool set up with plenty of places to be alone should they want to be.
My position was to make breakfast and lunch, possibly prep for dinner menu...some laundry, light clean, help with meds if needed, change bedding and to help him when he needs. There’s been a lot of resistance. I say good morning and lay out his things but he doesn’t always get out of bed easy. He usually changes and gets in clean clothes but too many times he has not changed brief and then gets dressed and down for breakfast.
I have not been trained in how to deal with elders about changing their brief and they resist. Once he’s dressed then it’s really impossible from there.
I feel if I can establish a routine and consistent cues with him, he will do well with me. He does pretty well with everything else.
Thank you for any insight you have.