My 90 yo MIL lives with us in our home. She's been with us 8 months and as these things go, it has been ok.
She is diagnosed mid/moderate mixed dementia. She doesn't cook, clean, drive, etc. But, is able to handle her own self-care.
She's been able to bathe herself but lately she has mentioned she gets dizzy when bending over.
I'd like to hire an aide to help with bathing and hair washing once a week but MIL is pretty resistant. I know she is financially able to pay and I know it's not about being shy with strangers.
She says she's afraid of theft. But, I doubt this is the real reason.
I also know I'm not willing to handle all her hygiene needs as she worsens.
When did you decide to get in home help?
Thank you
Start with having the aide come once a week to wash her hair. Do this for a few weeks with you there then have her start assisting with the bathing.
Tell your MIL that you must insist she accept this help because you can't help her with personal hygiene care but that you want her to be safe and comfortable.
Make her understand that no one is going to steal from her because you're going to be there keeping an eye on the homecare worker.
Once she gets used to whoever is hired you won't have to stay with her.
When do you decide she needs in home health? When you know you don't want the hygiene chore and she needs help with it. You're there, dear. Get someone to come in a few days a week to handle it for you.
She does need more social interaction so a Visiting Angel type who can help with a shower, shampoo and companionship would be perfect.
You're in charge here so take charge. If she's truly worried about theft then have someone around while the aide is there. You could also get cameras and an in-home safe. Her health is at risk if she's getting dizzy.
- Expect resistance. It is something new for her. Be patient.
* Do not leave 'too much' up to her. Although do give her 'lots of room' to vent. She needs / [everyone who is losing independence + dealing with decline] wants and needs to be heard / listened to which shows respect and interest.
- Offer reflective listening, i.e., I hear you saying XXX" (this doens't mean you agree with what she says, it means you acknowledge her feelings and thoughts).
- It is recommended (by many, and specifically Teepa Snow, one of the country's leading experts on dementia) to offer someone two choices.
In this case "Do you want a person to assist you with bathing ISN'T ONE OF THOSE QUESTIONS. As, of course, she'll say NO.
You want to set up questions to receive a "yes" or choosing one of the two options you pose. For instance, (you'll need to figure out the questions that'll work) -
* Do you want to use a pink towel or a white towel after your shower?
* Do you like the water soft or harder?
* Do you want to use a face cloth or a (?) spongy thing to wash your back?
* After your shower, do you want to put on xxx or xxx?
* Would you prefer to use (in the shower) XXX soap, shampoo (mention scents or brands) and see what she says.
* I acknowledge you for knowing your limits/boundaries in dealing / engaging in her hygiene needs. Hopefully you are not conflicted with your decision. It is certainly understandable (as) It is critically important that you 'trust your own gut' in getting the assistance (you need that) she needs - as it is for her safety.
- She may not agree and that is okay. Expecting that she won't agree and will resist is half the 'battle' of you preparing for these types of needs/changes in care.
- Start with introducing someone to her to assist - perhaps with getting dressed or having a cup of tea with her - so she can get to know someone new. You want to create an environment of trust and comfort - so it is well worth the investment to for you to pre-screen someone and invite them over for a 'visit.' Don't necessarily start with a new person and SHOWER on the same day.
* Be sure that the caregiver is used to working with elders who are resistent.
- Ask the caregiver (on the phone) "How do you handle XXX" and mention a few possible scenarios that might / likely will come up.
- Patience, compassion, understanding are key and most experienced care providers know this. Although many caregivers are doing this work because they need a job and unable to do other types of work; their heart isn't in it - along with lack of experience).
Important qualities of a care provider:
- Smiling and looking into an elder's eyes, i.e., making this contact
- tone of voice
- How a caregiver physically touches an elder is important (gently, slowly) = no sudden moves (having a cup of tea and gently touching an elder's hand could be very helpful - that personal 'touch' / making a connection.
An elder sensing/knowing / feeling another person CARES is more likely to accept their support than a person who is 'matter of fact' and lacking compassion.
- It is always important to see the situation from the elder's point-of-view. This is how we develop / are aware of / and extend compassion. It is always helpful to say "I understand ..." "you are not alone."
* Logic often doesn't work in these situations due to:
- Based on the elder's perspective/feelings. So saying that it isn't safe for her to shower alone as she might fall likely won't get the result(s) you want and need. Mom is likely thinking of losing independence, fearful, feeling uncertain about how she's declining (these are the issues / concerns to address).
- Although, you know her. Is she concerned about falls? breaking bones? being hospitalized? These are the reality of what could / might happen if she doesn't get the support/assistance she needs.
Gena / Touch Matters
I personally can understand the hesitance she might have. Who wouldn't? You certainly have a lot of great answers to your questions. May God grant you and your family strength for the coming days ahead. God certainly helped me tremendously. Bless you.
You could introduce a Visiting Angel as a highly recommended friend from one of mom's old friends. You could ask Mom to help if she ever gets inspired to do so.
Anything of value can be hidden or removed to someone else's home. I already sent my youngest daughter all my "real jewelry" so that there's no issue with little valuable things missing.
If all else fails, seek medications from a Geriatric Psychiatrist...................and placement may be in the near future without cooperation.
Hire someone who makes her feel like she is getting a spa treatment so it is fun and a happy, relaxing and comfortable time for her.
Obviously this is a difficult point of dignity/privacy and anyone in her position might feel vulnerable and strange.
Her concerns about stealing are slightly paranoid, but also in line with reality and current events. Don’t discount these concerns. Find some way to make her feel protected, such as buying her a small safe that she can keep wherever she chooses.
Let her be part of the interviewing and hiring process so she feels less of a loss of control.
“I did not know Medicare Part B coveted any kind of home care except after a hospital stay. Is there really some provision for "intermittent skilled nursing?". That would be helpful.”
Yes. There is a sweet spot in medicare part B which is very helpful for the insured like Lia, OP’s MIL. Part A covers the after the hospital/rehab stay.
https://www.medicare.gov/coverage/home-health-services
Perhaps you could go ahead and decide which home health services you will use and see if they will begin for example 2 x week....that won't overwhelm anyone and, yet will give some adjustment time before more care is needed.
She will always be resistant to agree up front; this is normally the case. The caregiver, you, must not let this deter making the changes needed for both her safety and well being and, your own well being.
She may try to guilt trip you, get angry, try other things to avoid this but remember this is her denial and avoidance of the reality, her grief associated with aging and changing needs. At some point you may want to speak with a hospice of your choice , especially if you are thinking that in home care is the path you will continue; the clinical director of the hospice can probably give you some good guidance; they are always glad to educate family and caregivers ( and patients is pt. is cognitively able to engage).
Practice good self care.....you are worthy and,will need it for the long haul.
Or perhaps when a scratch on one’s hand infects after a disposable brief goes the wrong way.
Or when the patient slips in the caregiver’s grasp and is bruised because the caregiver was unable to make a safe but less restrictive “catch”.
”Guilt” isn’t useful in decision making about this, but facts and being honest with yourself and your own limitations can be VERY helpful.
These CNAs who bath the elderly are professionals. They know how to help a senior If given half a chance. The two LOs I’ve helped with HH came to love their helpers. They are quickly not strangers.
But I agree dehydration is important to watch for.
And, in many hospitals, there are now a huge number of male nurses and aides. Mom would not accept help with toileting and bathing from a man. This made the male nurses and aides very angry. It heavily affected their treatment of her across the board.
There are modesty garments for showering you can buy. They might help. I have one, haven’t tried it yet.
http://www.dignityrc.org/
The organization is the Dignity Resource Council. I am really quite surprised there are not many options like this out there.
Here is the page where they offer what they call the “Honor Guard”. It is a cover to wear while showering, for men or women.
I have been very unhappy with the lack of discretion and sensitivity shown my parents by health professionals in their old age. When they protest, they are marked as “difficult patients” and I have seen vindictive responses from the male nurses especially. Again, I have been surprised that there are not more companies making products that address this need for modesty.