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My mother has moderate to severe dementia. She has occasional incontinence with her usual caregivers. When the fill in caregiver comes, my mom has all day incontinence. My mom verbalized she doesn’t like the fill in caregiver because she doesn’t talk to her and watches too much TV.


I think the fill in caregiver talks too fast and it’s hard for my mom to process the rapid speech. When the caregiver doesn’t get a response from my mom the caregiver takes it as if my mom wants quiet time. Sometimes my mom doesn’t answer my questions, but I don’t shut down and stop talking to her.


I have very few options for fill in caregivers, so I want to make the best of this situation and try and address the caregiver directly and sensitively. Any suggestions?

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Create a toileting schedule with all the caregivers. Mom should be placed on commode every 2-3 hours while she is awake. While at it, create a schedule with mom's caregivers for her daily care: time to wake up, times for meals, time for nap(s), time for activities, times for hygiene... Most people with dementia do better with consistent routines in a consistent environment.
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Lakegirl2: Pose this discourse to the fill in caregiver.
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Incontinence with a particular caregiver. I am still trying to figure that out. So either this person gives her more to drink, doesn't remind her to use the toilet, or makes her laugh so hard she pees. Or Mom could be allergic to her and have accidents when she sneezes. That last one actually makes sense if this person wears a strong scent.
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RedVanAnnie Nov 15, 2023
I expect there is not more "incontinence" per se, but less attention from the caregiver resulting in more frequent incontinence accidents.
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Ask the "fill in" caregiver to take mom to the bathroom every 2 hours.
Does not matter if she has to go or not, the caregivers should take her. (they should all do this not just the fill in caregiver)
Are you there when the caregiver is talking to mom If so if you hear that she is talking fast and not allowing mom enough time to respond you can say something.
Some of the things I made a point of doing with my Husband is:
Lowering my voice, not the volume but talking a bit deeper if that makes sense.
I think the higher pitched voices are more difficult to hear and understand.
Speak more slowly and enunciate.

I read a while ago that it can take someone with dementia 45 seconds to hear a question, process the question and formulate a response. I don't know about you but most of the time in 45 seconds I am onto a totally different subject. So to slow things down requires some thought.
Your replacement caregiver might not have the experience with people with dementia and if you help clue her in it might help.
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Here's what I did.... I got a pale for just her changes and a notebook. Everyone had to document document DOCUMENT. I told both caregivers it was important, (especially with senior women) to keep clean and dry in preventing infection. Didn't have any issues of that. Since I was there, I was able to oversee this. Since you have multiple caregivers, if I understand you correctly, you can address all of them in this suggested protocol under the guise of "infection control". I firmly believe that being proactive is a must.
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BurntCaregiver Nov 12, 2023
That's a good suggestion about documentation. I always recorded a note at the end of my shift with any dementia client I had for their family or especially if another caregiver followed my shift.

Anytime I brought additional caregivers onto a position with me, I required we all make a client note in the same book at the end of shifts of exactly what you're saying. How many times the diaper was changed. Hoe many times toileted. If the client ate or what they're general mood and condition was.

This is gold for any caregiver that works a position where the client has other caregivers.
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If your mom’s urinary incontinence was anything like my mom’s, a schedule won’t do much good.

My mother could use the bathroom and be walking out of the bathroom and have to turn around and go right back in to pee again.

She had to switch over to wearing Depends regularly. It’s a tough issue to deal with.
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If your mother has moderate to severe dementia, why are you taking her word about the fill-in caregiver not talking enough or watching too much tv?

Look, if you have regular caregivers who work a schedule and occasionally a fill-in has to be sent if one of the regulars is sick or on vacation, just deal with it.

I was an in-home caregiver for 25 years and I'm going to tell you truthfully. It's never in a client's best interest or their family's to get fussy and knit-pick.
If your mother has good aides who are doing right by her, don't carry on about her peeing herself too much when there's a fill-in.
The aides need to be taking her to the toilet regularly. Every two hours or even every hour if needs be.

The cause of her peeing herself all day could also be because there's a disruption in her daily routine because a new face is there. The slightest disruption in a daily routine when you're dealing with someone that has severe dementia can make huge setbacks.
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anonymous1732518 Nov 10, 2023
If she's in a facility there could be some truth.
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Tell that caregiver to speak slowly with Mom and take her to the toilet every 2 hours.
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Give everyone mandatory scheduled times to toilet Mom.
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Incontinence is one of the many symptoms of dementia, so you shouldn't be surprised that she's having issues.
It sounds like when this "fill in" caregiver comes that she is not taking her to the bathroom on a regular every 2 hour schedule. Have you verified with them that that in fact she is doing that? And if she's not then it's time to find another fill in caregiver.
And you don't ask someone with dementia if they have to go to the bathroom, you just take them and sit them on the toilet as often as needed.
You can have moms caregivers sign off on a chore chart as to when they take mom to the bathroom if you think that would be helpful, and you can also consider placing some inexpensive security cameras around moms house so you can see first hand exactly what is going on.
If someone has nothing to hide they shouldn't mind the cameras being there.
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MargaretMcKen Nov 10, 2023
Funky, does the 2 hour schedule apply during the night as well? or what? I'd really like to know. Margaret
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Your Mom should be taken to the toilet every two hours as long as she is continent. Depends are for accidents. Two hours is common practise. And if Mom still knows when she has to go, she should feel she can tell the aide. And yes, the aide also needs to be told she talks too fast for a mind that cannot process fast enough. She needs to slow down and make sure Mom understands her. You know when they don't, they have that look in their eyes.
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Clearly Mom is not getting good care from this caregiver. So it's simple. You sit with the caregiver. You tell her exactly what you just wrote above. She will either step up to the plate or she will not. In either case you will know what to do next.
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My mother was hard of hearing. She was able to lip read fairly well when people faced her and spoke slowly. I instructed her caregivers to do this. It worked out well.

Tell her caregivers to face her, talk slowly and don’t speak as they are walking away from her. I hope this will help her situation.

Best wishes to you and your mother.
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