My mother has always had a difficult personality, and as time goes on, her personality has become even more difficult. We have been through many aides, but I now have a team in place that she can tolerate and that can tolerate her.
Recently, she has begun to have screaming tantrums when she needs to have her diaper changed. One aide handles the situation like a pro: She advises my mother it is time to change her diaper and proceeds to change the diaper -- even if my mother is screaming at her. My other aides are frightened of my mother's tantrums and have left her sitting in the dirty diaper until my mother is receptive to being changed (and this can be hours later).
My mother has suffered multiple UTI's which can be caused by a dirty diaper, so this situation is of great concern. Has anyone had any experience with this issue? I would hate to have to let some of the more emotionally fragile aides go because they have been with us a long time and my mother is comfortable with them. On the other hand, I feel I cannot allow this situation to continue. I have tried to reason with my mother to allow her diaper to be changed when needed, to no avail: "I'll change it when I'm good and ready!" I've explained the UTI danger, to no avail: "I don't care!"
Any suggestions or advice would be very much appreciated!
Oh, and save your energy on explaining UTI to her. You're wasting your breath. My Alz. mother sometimes refuses to do things, and I tell her when she's done changing into a new clean diaper, or taking a shower, I'll take her out to go shopping. That usually gets her to cooperate.
What does you mother like? What incentive will work with her?
If it is anxiety again medication might help.
OR
this is just her having a tantrum like you say. If this is the case then the caregivers that back off need to be TOLD, INSTRUCTED that they are to carry on with the change no matter the screaming that is done.
If they are from an agency you could request other caregivers that will do what needs to be done.
BUT if you mom is doing more than screaming, if she is hitting, biting, scratching then she needs to be either medicated or since this is in your home you can put mitts on her to somewhat restrain her hands. Sometimes giving someone a towel or a soft toy will keep the hands occupied.
I probably would not give her anything to eat during one of these tantrums as she could easily aspirate whatever is in her mouth. But a child's teething toy might work.
You need to hire people who can do just that: push past your mother's tantrums and change her soiled briefs. Otherwise, you're going to have a lot bigger problems to deal with than screaming fits!
Good luck!
Any chance you can "foster" a cat or two, for a little while? If not, then so long as no pets in the house, they sell rodent traps with tasty poison... I can't use them, as I don't want the cats to eat a poisoned mouse! Hard to leave traps around too, as the cats could get a nasty nip! Often they do have cats who won't ever be "pets", but if kept in basement with litter, water and food, they might "manage" the rodent problem, then you can send them back. Basements are usually good for cats finding the mice...
Unfortunately she needs to be changed when soiled and her care providers need to change her in a timely manner.
I cannot imagine how hard this is for everyone involved.
At first when this started with the PSW's I was alarmed and thought they were hurting her but then it started with me and I realized they, like me, weren't doing anything and the screaming/crying/difficult behaviour was just her way of expressing her displeasure. No abuse was happening but to anyone listening on, they would think she was being murdered (smile).
One PSW works through the tears and difficult behaviours - pushes through and gets the job done. The other PSW doesn't - she gives up at the slightest resistance. I think she is afraid of hurting her and also, she doesn't want anyone whose hearing the commotion to think she's hurting her. Remember their job is on the line and the last thing they want is to be accused of being abusive.
For my mom, I try to put myself in her shoes. She doesn't think anything is wrong with her, she things she can walk when she is bedridden and hasn't walked in over a year. She also doesn't always remember or recognize the PSW's, even though they are there everyday, or me for that matter.
Imagine you're sleeping/resting comfortably and some strange person comes into your room and immediately tries to take off your clothes/your diaper..... or tells you that you've had a bowel movement or pee'd and they have to clean you up......wouldn't you know if you did (and in your mind you haven't), further more why would you do that in bed when you can just get up and use the toilet like a normal person..........I'd be thinking what the hell, I'd be screaming and crying too (smile).
What works for me most times is the appoach..... I start with a little converstation, see where she's at mentally, begin with something not too intrusive like massaging her scalp or brushing her hair.... then I move in for the kill..... why don't I wash your hair with this soothing shampoo..... or instead of saying it's time to reposition you so you don't get pressure sores (what the hell is a pressure soar and why would I get them) I say why don't you turn over so you can see me and we can talk......in the midst of repositioning mention I notice the diaper needs changing and will do that for her quickly. I work my way up to diaper changes, maybe give her the diaper or wipes to hold and ask her to help me.....
I find the direct approach doesn't work sometime because she genuinely doesn't think there is a problem and what needs to be done, has to be done.
With medication, I stopped telling her I'm giving it to her because then she asks what it's for and I have to explain all the aliments she has that she doen't know she has. That confuses her because in her mind she is not sick. I just crush them up and put them in her juice or tell her they are vitamins.
It's hit or miss... some days this all works other days it's a no go. For me, what works best is never rush. Sometimes the PSW's just want to get in and get the job done, since they have other clients and are working with time. Work your way up to the tasks they find unpleasant or too intrusive, timing is everything. Make note of their mood and that will give you an idea of where to go. Be chirppy and pleasant always even when you're stressed - pretend. Talk....let them know what you're going to do, doing as you do it.
Hope this helps. Good luck and best always.
While it may be "okay" to struggle through it, screaming and all, it would be better if there was a way to calm her down. I don't know how staff handles this issue, as clearly sitting in soiled briefs isn't good - generally, so they tell me, they can't force someone to do what they refuse to do. They usually have to coax them, promise something good, get them to think it's their idea, etc. Hospice nurse said mom seems to be "shy" now about being changed. It may be that her dementia has progressed further, esp with the stroke. But, much as I dislike medications, I would try that before trying to change a whirling dervish! The nice thing about the one she took, worked first time, every time, usually in about 15 m or so, and no need to wean her off of it if it doesn't work out. If you can find one that she can take a little before the usual changing time and it goes smoothly, go for it!
Otherwise, they'll just have to suck it up and continue bulling through the process. If those aides can't do it, find others. You can't reason with dementia, so trying to explain why the change is needed really won't help.
UTHIS can happen from many causes and one just not drinking enough water.
UTHIS can be cured easily enough.
Tell the Caregiver to try just letting your mom know ahead of time when she needs to have her diapers changed but tell the Caregiver to tell the mom to let her know when she's ready.
Just use a good night time brand of diapers to keep the urine away from the skin.
UTI's can also happen from too much moisture and diapers leave no breathing or airing out.
You should have your mom lay on pads and not have a diaper on for a few to several hours a day so her private area can air out.
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