How do I get my mom to be more compliant at the assisted living facility?

Rainmom: I am totally with you on doctors missing important details that are critical! My late mother's cardiologist missed that one of her carotid arteries was 100% blocked. He pulled her off her Coumadin and gave her the antidote, which was 81 mg baby aspirin. BUT she suffered an ischemic stroke 4 months later and did die . So yes, WATCH DOCTORS LIKE HAWKS!

I wonder what happened with this situation. I'm curious when there is no follow up response from the original poster. She got a lot of good responses. I hope she was able to get them.

I sure wish there was a geriatric psychiatrist available where we live. Nearest is 300 miles away.

Heather I have thought the same thing about most of the health care community. I have tried to understand that they have limited time for search individual, but sometimes they make more work for themselves. My mother is in AL and has an colostomy. She can empty it herself, but needs assistance to change the whole shebang. She started having leaking so needed to have it changed 4_5 times a week. I told the nurse from the service about a simple solution called an Eakin seal. Nope. When a new nurse was assigned, I tried again. Nope. After several failures to get through to anyone (including her doctor), a new nurse was hired who apparently knew about this herself. Wow, no more leaks. I think of the hours of wasted staff time.

What about a verbal walk threw and a care sheet so she knows whats expected. Sounds like she needs a verbal reassurance and a Personal care attendant to walk her threw care for a few weeks. That way someone can keep track of when she is going so she can have self realization that she is not taking herself to the bathroom. Sometimes if you track the times when they are going they will go on their own. Maybe even you could try working with her to teach her how to use the bathroom its a new process and some people don't want to try without someone being there. You could do it on a weekend its easy.

It was the wellness nurse at my friend's assisted living/memory care facility that guided me on what to do in getting her to a geri/psych ward at a hospital to find the right drug and dosage. I have never done this kind of care before, so the guidance I got from the wellness nurse was really important to me. She came to their condo before admitting them to meet them and evaluate their needs and was able to guide me from then on. Now that my friend has passed, her husband continues to live there. He sees a doctor once a month and caregivers every day with his meds. Every encounter is recorded and available to me when I ask how he is doing. He has no short term memory but is physically healthy and happy. I can't imagine what else could be done to make it a better situation, so I feel very lucky that I found and chose this place for their move from their condo to their memory care apartment. Since this is my first experience doing this, I have no idea how the care is in other places, but it can be a good situation. They will provide the care he needs until his demise--no nursing homes necessary. Lucky us.

Reading this question and answers I realize it could have been written by me. I truly sympathize with you and am grateful for this post. I have identical struggles with my 84 year old mother. Due to her dementia, anxiety, and natural born independent stubbornness, she is uncooperative and often mean and combative with her caregivers. She refuses to push her button and ask for help most of the time. This has resulted in mutiple falls since moving into AL 2 months ago. Most recently she fractured her c2 spine requiring her to wear a neck collar 24hrs a day which has been a nightmare for her and me. I have resorted to spending money on a private caregiver on top of the AL, but this is not sustainable long term. All advice seems to point to getting her to a good neuropsychiatrist. I have been trying to find one in the Atlanta area. Does anyone live in this area and have any recommendations? Would this be covered by medicare or insurance, does it require a referral from primary care physician?

... rain-mom ... I understand what you are saying, but everything You've said leads to a poorly trained physician, or simply one who is not-invested (doesn't care) or one who has absolutely no idea about the elderly. Which in that case is a physician selection issue. And I did not say ASsited living will talk about psychiatric meds... I said they would suggest speaking to a physician about the prospects of them, but that a conversation would need to be started first "specifically about the issue of anxiety, etc, not how's the weather. ... because if an individual is even in an ASsited living regardless private pay or medicade waiver etc a physician has had to not only send medical records of history but also a med list to even enter the facility.  

Now perhaps I've assumed whom-ever is in need of seeking help for an elder in their family have already "selected the better physician to fit their elder. I had fired 3 of her physicians before I found one that actually gave a d*mn about the aging process. Quality vs quantity understanding is what I and still believe in and finding one that respected my mother simply because she's a human being regardless her age, yet was well educated medically with the aged.. was not easy.  ... and trust me finding him was not done over night. By the way, my mothers doctor did not "initiate a discussion about behavioral and/or anxiety meds, I had to but did so within flowing conversations of new behavioral signs she was exhibiting, and it was my stating that there was most definitely a need to intervene medically. 
The ASsited living did not offer information about meds, I had to ask not only some aids but also the on staff RN if others have similar issues regarding restlessness, anger, panic attacks etc, and i had to breech the questions of are there more effective medicines they have noticed to be beneficial, etc... then, they did suggest seeking her physicians advice but I already had, talking to them was simply a part of the investigative educative process. And I will say this, that if the facility or her physician gave her even an aspirin without me knowing much less any phych meds, heads would have rolled, and I am not joking about that because I have not studied, invested my time, and completely altered my entire life simply to have others screw around with a very delicate situation, a human being that happens to be my mother. 

On the other mention, my mother has never seen a geriatric phycholigist, I'm not sure what purpose they would have served my mother specifically other than prescribing phych meds, when I was already activly seeking education and Dementia/ Alzheimer's information for her thru many avenues. Her physician, after I spoke directly of the options of today's medicine, began going down the calming meds path with me, for her. (And that was not as simple as her popping a pill, weeks were involved in dosage perfection that fits her.) ... 

... now, perhaps my first comment was too judging but at times the posters (after first deciding if each are a real poster and not a blogger) seem to behave as if they are clueless yet their profiles state caring for so-an-so for years... years... or, their profiles say nothing and they never respond to the very post they "posted (such as this 'poster for this question .. which then leads to the probability that is a blogger for the site, or for an Assisted living or similar facilty/s. 

Tired, I'm going to have to respectfully disagree. 

I went with my mom to her doctor appointments. If there was an issue I couldn't discuss in front of my mom, I talked to him on the phone - a number of times. He never once suggested taking my mom to see a geriatric psychiatrist or offered information on dementia related medication. In fact, I had to ask him to prescribe Ativan when my mother began to have regular meltdowns. In addition, on the occasion he did change a medication he never once discussed it with me - or my mom for that matter - although I asked him to do just that every time I spoke to him and I was clearly my mothers medical proxy by way of DPOA. I always found out a change had been made by accident during a visit to my mom and the med cart came around. Needless to say the folks at AL never informed me about suggested medications or the changes my moms doctor was making.

The first time I ever heard of looking to a geriatric psychiatrist for help was here by way of BrooklynBarb who is a informed supporter of taking this route. The only other person who ever mentioned a geriatric psychiatrist was my own doctor- it had helped his father-in-law.

I've said it before and I'll say it again - in my opinion every person receiving Medicaid or Medicare benefits over a certain age should be required to see both a geriatric psychiatrist and a PCP or Geriatric Specialist once a year - or even every other year to continue to receive benefits. And just like with my own medical insurance company - a booklet listing doctors in these fields should should be routinely mailed out to recipients in the same time frame. JMO.

.. Heather... all I can say to your question about why it seems all these posters have yet to hear of meds as help (which is how I took your mentioning all the responses are about using meds as help) .... it could be that the "posters who mention ASsited living issues are just voicing their thoughts on here rather than actually taking action, or perhaps are at the beginning stage of taking interest in the individual ... meaning, they notice somthing and instead of doing something, they simply "talk about it. Genuine action and care involves having already spoken to a physician (which is first step and most care givers and/or family who are actually having an issue with a loved one, they do talk to a doc first, that's the very expected base and beginning step .. they usually don't get on a post to talk about it) .. and about ASsited living facilities etc not mentioning meds ... they actually do, but they do so by suggesting that the individual sees a doctor to discuss options ... but remember, it takes an actual conversation with the very prime players in a love ones life in order to ever hear 'suggestions. (And that's all I'm going to say on the ASsited living mention otherwise I will gain arthritis by the sheer amount of concerns and conclusions I would be typing of the industry ...;)

And you are right as well, Heather. But they'd need a staff doctor- which I never came across at IL or AL, just nurses - and the doc would actually have to spend a meaningful amount of time with a combative resident to actually assess and prescribe mood medication. Too much work. Too much expense. Too much trouble. Easier for them to boot and cross their fingers that the next one in line will be easier. And yes, the facility has the power - especially the "good ones".

I was able to negotiate a couple of months to keep my mom in the AL so we didn't have to place my mom in the first NH we found - we had time to find the right one. But it took hiring a private caregiver to be with my mom every waking hour. The only duty I asked for that came with the enormous rent was that they still showered my mom once a week. And that became a battle with them lying and stalling. One aid even got in my face, all snarky and said "why doesn't your private aid do it?" They just didn't want to be bothered with having to make the extra effort it took to get my mom willing to take the frickin' shower that we were paying for.

The whole system frustrates me. But like I've said - the geriatric psychiatrist was a miracle worker. And frankly, one of the few professionals I came across who seemed to really know what he was talking about and honestly wanted to help.

Finally - yes! This site is amazing. Seems we all can piece it together and figure it out when the "professionals" can't buy a clue. I just wish I had found AC earlier in my joy ride through dementia.

Ah, but Rainmom - they have no way of knowing what behaviors they'll "get" next...At least by referring for medication adjustment - they can "reap the rewards" of resident that's better managed...And I'm assuming the "cost" of turnover isn't cheap. But, yes, I suspect you are correct. They think the path of least resistance is to boot out residents & HOPE for a better outcome. And of course the impending surge of aging - they are going to have all the power to pick & choose. Yikes! Note to self - get any behavioral issues managed before the time comes to place someone! Now, finding someone who can adequately do that...another crapshoot. Feels like one thing after another, doesn't it? arrgghhh On another note - thankfully sharing these things on this forum at least prepares some of us!

My guess, heather? Because it takes extra effort. It's more work. This resident is difficult- maybe the next one on the wait-list will be easier.

Not only did I see it with my mom but I experienced it over and over again in the public schools with my disabled child. But that's a separate rant...

Speak gently to her, and if she is arguing that she can manage (she will), get her clothes organised and then turn back to her and say 'lets go' or something like that. She will argue about getting there, but 9 times out of 10 is very happy to be in a lovely warm shower. Try it, see if it works, I has over the years for me. Also, a little bit of sneakiness, with the forgetfulness of dementia, use it to your advantage. She will forget what she was talking about. It is horrible, everyone deserves to be clean and have clean clothes. Hope this helps, Arlene Hutcheon

You cannot argue with a dementia patient.

What strikes me with many of the responses is that the right meds made all the difference. WHY wouldn't these IL/AL places have the insight/experience to recommend this? If we as a support group have figured this out, how could they NOT have anything to offer other than show residents the door?

My Mom had the same problem in Assisted Living.  We then looked for a "Memory Care" facility and it worked out much better.  Look around and see what you can find in your area.

I'm not sure there's really going to be any easy way to try to accomplish this. People are independent and learn early on in life how to care for themselves, and this is a learned behavior you never forget unless some underlying health issue interferes with that lifelong ingrained ability. People take advantage of our elders, and very personal care can be not only embarrassing but even the suggestion of it and even doing it can leave some people very offended. Therefore, they can become combative because it's their personal space you're invading. What you can try though is putting the patient on a sedative and bathing them when they are completely asleep. Groomers often do this for animals who are combative, and you can do this with people who will otherwise fight against you. Of course my very favorite is just to pick them up and put them in the shower and physically wash them when all else has failed and this is the only remaining option. I know this will probably get some backlash but there are certain cases out there were pushing the issue this way is the only other option left. What do you think they do in the squadron when a military trainee won't shower? It's called a GI bath and as long as it's done carefully, there's no harm done because the person will just come out clean. Of course, in public settings where everyone is out in one big shower stall,  I can clearly see why some people are so self conscious they won't get in the shower with everyone else, and I don't blame them. However, that's when you can pick a time when no one else was in there and take a quick shower to avoid a G.I. bath. This is exactly what happens at some point when someone just won't shower no matter their age, just pick them up and put them in the shower and physically wash them like they would in the military. I know this kind of thing goes on because I've heard these kinds of stories even from my elderly friend who was talking about one when he was living. He was talking about a guy who wouldn't shower either and they did the same thing to him and gave him a G.I. bath. To those brave enough to successfully do that, good for them! This is a strong encouragement to civilians to do likewise when necessary. 

When my friend was resisting all care after she soiled herself in her memory care apartment, I was advised to take her to a geri-psych ward at a hospital to find an anti-psychotic drug that would calm her without doping her up. She was there 3 1/2 weeks and after that was happily compliant until she passed away a few months later from her frontal temporal dementia. The right drug at the right dosage level solved this problem perfectly.

.... I have to mention something to all who are saying "there is no reasoning with dementia" ... dementia comes in ebbs and flows .. in waves with varying degrees of severity and cognition. "Reasoning" with Your mom may not be what you need to do... youve said your mom has expressed her sense of privacy repeatedly, that does not sound like a Demetia sparked thought. And because she's repeated it to you then it means something to her.  Start by asking her if she likes where she's at... then ask her if she likes or feels safer with a specific aid. Take the time to let her answer... then ask her if she likes it here, ask her if she accepts living in this place, if it's honestly "ok" for her..  then suggest with respect that unless she allows them to help her more she will have to leave to yet another even more intrusive care facility, a place she will actually have to have more hands-on help ... repeat the questions to her if you need to, until you get an answer from her (you are trying to reach your mom by doing this rather than reacting to her dementia.  The fact your mother is able to process that she "feels so embarrassed" and does so over and over, tells me she's not locked into deep dementia at all times. Talk to her,try to reach her on a level of respect rather than directing her rather than getting irritated . ... dementia sufferers experience and process differently than other dementia sufferers and because each of our loved ones  were once independent, entering an assited or nursing home is not to be treated as "you have no choice and you are going to do as I say"... regardless their state of illness they deserve every chance to create an environment that """ they"""" can live in. And lastly, yes there are meds available to help anxiety in elder persons that are able to calm them without lethargic effects. Talk to her doctor about her options for such medications to allow her a chance of peace and calm rather than feeling anxious and on edge.) 

Just a thought...my FIL became willing to accept "help" with bathing, etc. once it was explained to him that these care-givers were professionals at this job. If your mom is just embarrassed about the personal contact, maybe she can be helped to understand that they are like doctors and nurses, and personal care is their professional specialty--they help folks that need assistance without even thinking about...whatever it is that embarrasses her.

For us the answer was the right meds. In the correct dosages. Her family doctor had prescribed meds in doses to tiny to have any effect. So, she went to a Senior Behavioral Center for ten days to get the meds correct.

Now she is happy to see me every day, compliant, and content. And not dopey! She still beats me at cards!

Rainmom, this was perfect "But for being a fairly bright gal - there was one lesson regarding aging and dementia that took forever to sink into my brain - THERE IS NO REASONING WITH DEMENTIA!!!"

That one took me a long time too!!

There are good points above by Rainmom. With dementia, it's not likely that you can convince a person to cooperate with staff at an AL. Even if she agrees to do it, she may likely forget and still resist care. Resisting care is quite common and it's often nothing to do with being embarrassed. It's just due to the brain damage. I do feel for you. Something similar happened with my LO in AL too.

At first my LO did well in regular AL, but, soon, things became problematic and some of it was due to her resisting baths, getting up, getting dressed, meals, medication, etc. I'll share what helped with her.

One thing is to rule out other things like UTI, other illnesses, infections, medication issues, etc. Sometimes PAIN can add to the problem. Make sure any pain is properly treated.

I'd discuss with her doctor to see if she has depression and/or anxiety. My LO did and going on a daily medication for that helped tremendously. She became more content and less anxious. She also wanted to get out of bed in the morning and not just sleep.

Still, my LO needed more hands on care, by staff who are specifically trained to work with dementia patients, so her doctor prescribed Memory Care for her. This is also AL ,but, focuses on those with significant dementia. It made a great change with her and though, I didn't think it would have been right for her in the beginning.....I think it would have been. 

The staff at the MC unit, just seem know how to work with people who are very confused, resistant and even worse.  They just take their time and deal with it.  They also offer social activities, crafts, games, etc., and it's based on each person's abilities.  

I'd explore if you have access to a Memory Care facility and check it out. It might be an option, if she doesn't require skilled nursing care.

I not sure you can convince her, I'm sorry to say - at least not as things stand now.

My mom had been living in IL for a number of years with a 3-day a week paid caregiver. The other days she got by but barely. Then she had The Fall - and spent three weeks in rehab. Mom hated it there so much she would have moved into a garden shed in order to get out of there so getting her to move to AL was the easy part. Getting her to accept her new limitations was a different story. So mom fell twice in the first ten days. Even though there was only one ER trip that only lasted about four hours - the AL administration asked me to move her out saying her needs level was more than they could handle.

Truth of the matter is - if mom had followed protocol and been the least bit willing to be pleasant and fit in I'm sure I would have been able to persuade them to let her stay - at least long enough to give it a fair shot. After all, she was just a week out of rehab when the first fall occurred.

But from day one mom was refusing showers, demanding to eat all her meals in her room and couldn't/wouldn't use her call button for help. I saw the "writing on the wall" after the first couple of days and talked myself blue in the face trying to get my mom to be reasonable - explaining what another move would mean.

But for being a fairly bright gal - there was one lesson regarding aging and dementia that took forever to sink into my brain - THERE IS NO REASONING WITH DEMENTIA!!!

Getting my mom into a nursing home has to rank up there - right at the top - of the worst times of my life. I'm sure it was no picnic for her either. And mom continued to fall at the NH - sometimes legitimately and sometimes on purpose (long story) but the NH was use to residents falling - no big deal.

But here's my point and advice - finally, right?

Hating the NH, my mom became more belligerent and unreasonable- didn't think that was possible- but she did. I was advised both here at AC and by my own doctor- whom I had seen for MY stress level - to get my mom into see a geriatric psychiatrist. He overhauled my mothers medication, started her on a couple of new ones and in about a month my mother was transformed - and not into a zombie either. It was nothing short of a miracle.

At times, I now wonder how things might have gone at AL if I had know to have her seen by the geriatric psychiatrist earlier. Based on my experience with the difference it made - I think things would have been much better at AL and likely would have worked out - at least for a while. Honestly- I can't recommend strongly enough that you give it a try. Really, what do you have to loose?