My mom is in a nursing home with dementia and paranoia. Last night she punched one of the workers.

Unfortunately it is normal behavior from someone whose brain is diseased. Some people with dementia become very violent. They will hit, punch, bite, strike, throw things at, kick, and spit on people caring for them. It was probably just coincidence with the hair washing. What medications is she on? Is your mom a big woman? Did she injure the worker?

Ask the director of nursing to get a prescription for anti-anxiety medication one hour before bathing. Sometimes all they need is a small dose of Ativan and they are not so upset.

I might punch someone out if I'd just had my hair styled and someone wanted to wash out the set!

Does mom have a regular bath night? Is there some was you can make sure that she doesnt have someone attempting to wash her hair after she's been to the hairdresser?

My mom gets really agitated when we try to do anything she doesn't want us to do, but she is now on meds and it helps. So if you think this was a one-time, one instance occurrence, then I'd just wait and see. But if this becomes an ongoing thing, then I'd ask the doctor for a little something.

Yes, happens frequently in dementia. My mom was hitting and kicking residents, staff, walls. This then required a psychiatric evaluation where they figured out what meds she needed and how much. She had been on ativan, and it had the completely opposite effect on her as intended. Med reactions are different depending on the person. So, an in patient psych evaluation is often the best way to go.

Why were they washing her hair if she had just had it set? Wasn't it washed with the set? Sounds like there may be a communication breakdown at the facility somewhere. Was it set at the facility or somewhere else?

This kind of thing is terribly difficult. Obviously it is not okay for a member of staff to get hit, for any reason. But then you hear what led up to it, and how can you not think "well that was an incredibly stupid thing to do"?

Physically lashing out is, however, very common in dementia - not least because verbal communication has become so much harder. A good facility will have trained its staff how to preempt the frustration that might cause it, how to spot the warning signs before a meaningless, unprovoked slap or punch and dodge it, and how to calm and appropriately restrain the cared-for person. All the same, sometimes it's going to happen. Express regret that it did happen, but don't apologise because it's not your fault and it's not your mother's fault either.

Nursing homes go by schedules due to multiple inmates to care for, so they have no choice about when to get bathed, fed, or other activities. Sometimes the CNA will leave the tray and the inmate will forget to eat so they pick up the tray untouched, so they can end up malnourished or dehydrated. I think many of them know they are not home and strangers are caring for them and do not have a choice, and striking out can be a moment of frustration. Nursing homes are horrible places, which is why lawyers say family has to visit extremely often and at different times so staff knows they are being monitored. The stress of impounding a loved one does not end there. Now the nursing home doctor or nurse practitioners is probably pumping your loved one up full of drugs so her behavior will be better managed, which puts them at higher risk of falling and being malnourished. If that fails they will put them in a psychiatric center, which case the home may or may not take them back.

...first of all "Cetude" you need to not call care residents "inmates"... now about the question; Id be very serious about finding out why her hair was washed. If she's not being listened-to and staff are doing what "they want" over listening to or not picking up on signs of her distress or unhappiness that your mother (or anyone) are expressing, then a punch or strike may have been the only way your mom determined she could stop them. Staff are notorious for abuse, and yes that includes ignoring, belittling, condensending, acting as if the residents are valueless regarding their own self decisions,demands, cares and thoughts... and as many have mentioned here, I personally would not be so quick to medicate. I'd look a bit closer to the event and the entire setting, and I do mean entire, In which your mother is forced to live day after day in before any medication is requested (remember, it's allot easier to get meds prescribed, then to get them unprecribed, so be smart and think of her, not you, not the staff.)

It is not uncommon for people with dementia to lose their inhibitions and exhibit behaviors such as hitting, swearing, and other things they NEVER would have done when well. Before assigning blame to any staff member, speak with the liaison at the home, or even the social worker. Do some research and find out if this was a one time thing or if the staff has seen her behavior escalating. It may be time for a Care Conference meeting with the staff. Most facilities have them scheduled for every few months. I'd also like to mention that sometimes, if a resident has an infection like a urinary tract infection, it changes their entire behavior. Nursing homes don't test regularly for UTIs but they are more common than you'd think.

I agree with Tired1of14. Should residents be drugged in order to be more submissive? Medicating your mother after one incident is wrong! How hard did your mother punch the aide? Women in this age group, and I'm assuming she's in her 80's at the minimum, aren't very strong so it probably wasn't much of a punch. Ask your mother about the incident. Also meet with the administrator of the facility to see why her freshly styled hair was being washed again to begin with. It sounds like your mother's logical requests are being ignored, and that she's being forced to comply with unreasonable demands.

...cont. Thoughts; If your mother has option of setting hair appointments within the facility and she does that from time to time, then they must know, they must be aware, that regardless her bouts of dementia, they are aware that she has some cognitive clarity .. So the event of her hair being washed soon after a hair appointment, is an event that will most likely be the facilities fault. And as Ive said above, staff are notorious for ignoring residents needs, wants and demands. Some on this thread have responded that no staff ever should be hit struck or other, I am not one of those persons ..Not when and if you've kept close attention of the care facility's (the industry itself) track records across the nation. Never forget that these people (the staff) are paid to "care for" residents .. they are not paid to mistreat, ignore, hurt, insult, etc, etc any human being within their care. The hair deal, again as also said above, is serious enough to evaluate a bit more thorough, because if your mother was simply defending an action she was not happy with, and if this "hit or strike" is solely left up to the facility to report on (meaning if you dont check out what went down) that report could very easily set your mother up on a road to diagnosis and "treatment" and medical reports being filed that can be to her serious detriment as time goes on.

This is normal behavior.They cannot help it.I have dealt with personality changes that would shock anyone not in the medical field.Perhaps she is in pain as well. Might have a UTI as well.They just do not understand what someone (employee) is trying to do to them so they strike out.Talk to the doctor,staff and try to come up with a medical solutionI\(change in meds for example) test for a UTI another example..Why was her newly styled hair being washed to begin with anyway? Of course she was upset I would be too.Explore all avenues..good luck and God bless.

Yes, unfortunately that sometimes happens with Alzheimer's. My uncle, a very mild mannered soul all his life, became violent because of Alzheimer's and had to be sedated in the nursing home. Yet his two sisters, also with Alzheimer's did not become violent. So, not everyone but some do. It's my belief that getting alzheimer's patients into a care situation, earlier rather than later, so that they can adjust, and have a positive experience, rather than be forced when it's late in the disease, makes a big difference. Just my experience.

It is not unusual for a resident with dementia to hit a staff member. However, when a resident is getting agitated and they are not a danger to themselves or others, the staff person should just leave them alone and let them calm down. Many times when residents lash out it is because a staff person is trying to force their will on them. If your mom did not want her hair washed, they should have honored that wish (especially since it had just been done.) Bathes are the number 1 refused treatment in nursing homes. Residents refuse to take a bath more than medication, therapy, and diet. Bathing can be a very stressful experience for a resident with dementia. If this is the case then maybe a consult with his/her doctor so that an anti anxiety medication can be given before bathing.

The only people I really know about are the ones I have personally dealt with to a point. Now my foster dad who was put in to a nursing home in the dementia ward became combative but I know how long ago he became that way. I don't know if everyone with advanced dementia or Alzheimer's becomes combative but I've heard they do so maybe this is normal for them at a certain stage. I currently know someone who took care of her pop until he died and by time he died he didn't know anything, nada. Not sure what she dealt with, she didn't say

Oh yes, I should add that I strongly agree that unqualified workers to agitate these patients are only making matters worse by worsening the situation. I don't blame her if she struck out oh yes, I should add that I strongly agree that unqualified workers who agitate these patients are only making matters worse by worsening the situation. I don't blame her if she struck out at them for messing up her newly styled hair, I don't blame her because I would also be very upset if my hair was newly styled and someone came along and undid the hard work done by a beautician

.... I want to explain something if I may, and yes in regards to this post. Lets look at the existence of care facilities and then what our parents must experience in them. ....When we have no other place that "fits our parents needs (or ours) be it full or part time, then care facilities are (most times) our only options. Care facilities (be them any name you wish to call them) must actually "care for the persons residing. They are paid to do that very act because either we, or each state, are willing to "pay the facilities staff members" to be nothing more than courteous, patient, intelligent, reliable, alert, helpful and kind. Is that not our hope? Those are our requests that we have for our parents, yes? Indeed it is. Now the reality is this; we are not there 24/7 to watch over them. Much can and does take place each and every hour of every passing day within these "facilities. Some good, some bad. We have learned that the industry within its workforce seems to attract either the very kind or the very unkind, and then you have the ones in-between, the "its my job for 8 hours a day until I clock out." its an industry of incredibly high turnover rates in quits, fires and rehires of employees, for a reason. ...Yet, our parents live every single day in this industry. The poster mentioned her mother has paranoia, well without knowing all details, I imagine we all would have "paranoia to some degree when in these places. I imagine paranoia is only one thing they feel. I mean look at the reality; They go from independence, to dependence, and it most likely wasn't their choice. They are forced to live with having many different people come to their "space" every day. They have strangers approaching them, directing them to do this or that. They are forced to trust actual medication being handed to them and being told to "take this" They are now forced to having complete strangers bathing them (let that one sink in.)... They are now forced to be "social. They are forced to "put up with and learn staffs personalities & temperaments. They are told what they will be eating, even if its written with a smiley face on a chalk board in the "dining room" as if a "special of the day" is to be glorified. They are actually unprotected, unless they feel safe because someone has taken them under their wing or someone, a staff member, has taken a 'liking to them. They are now expected to live by rules and schedules. So the "paranoia, that many are "diagnosed with" in these facilities, may be factual, or just may be a true and (should be) a reaction to the actual environment they are now expected to "enjoy." and not complain. Facilities that are "pretty, or a smiling face that greats us as we visit, all of that may make us "feel like we made a good choice" for our parent/s .. and perhaps we have, but we dont live there, do we... they do. So if a parent is at risk, or vulnerable to being subjected to less than expected care (even an unexpected hair washing, I mean think of what actually had to take place to wash her hair when she didnt want to have it washed) and if they cannot or will not (for fear of raising problems) protect themselves when things occur (I'm talking anywhere from abuse to even a snooty or attitudinal Aid, or a grumpy nurse, etc) then someone being their voice, their advocate, their "eyes and ears and their power to do something when things go wrong, or if/when things look fishy, or strange, is very important. So take a little time and check things out for her. Thanks.

It's possible that your mom's hair was not "freshly done" -- to her, it was just done, but it could have been a week earlier. My mom hates bathing and refuses to let staff bathe her. I am able to gently get her cooperation so I am the one who bathes her once a week. We have a little routine now that seems comfortable for her, but would be too time-consuming for staff. Yet every time, mom tells me she "just showered this morning" so she doesn't "need another shower." I am fortunate that I can be there for her, because she is quick to be verbally combative with staff over anything she perceives as "telling her what to do." And I have full confidence in the caregivers at her AL - they are wonderful.

It isn't uncommon for dementia sufferers to become violent and agitated. I've been punched, kicked, bitten and had a chunk of hair pulled out.

What worries me about violent behavior is that Mom is in Personal Care and a sweet looking woman is violent and has come into Mother's apartment saying she used to live there and has refused to leave asking where is her furniture. It took a nurse and two nurses aids to get her out. She was kicking and hitting the staff. I started locking the door. She came back the next week and was hitting and kicking the door. No staff was on the floor. I got her away from the door myself. On a Sunday morning after breakfast after I was leaving Mother she was sitting in the hallway telling me that Mother is evil. She said at nighttime the evil one comes into my Mom and consumes her. She says she knows Mother is mean. I told her that Mother is sweet and loving. It worries me that apartment doors are not locked. I have seen pictures of residents of nursing homes in dementia centers where they have awful bruises that look like they were beat up but passed off as "a fall." Mother does not have dementia but if beat up she could become disoriented. After a fall she deteriorated and it took her 2 months until she got back to where she was. Mom is a prisoner in her facility.

Believe it! My husband tried to hit me last night because he was angry I took his shaver away (I needed to charge it), and I think a person with dementia just gets so frustrated they will lash out at anyone nearby. I've been hit as a nurse working in nursing homes with seniors, so it is just part of the job. Get used to it. You knew your mother when she would not do things like that, but now she is someone else. Accept that she is going to have behaviors that are not nice.

As for the lady coming to the apartment, is it possible that she really did used to live in that particular apartment before she moved or maybe she was moved? Depending on how long she's stayed there versus how long the current resident has lived in that particular apartment, it can point to a strong possibility that maybe this other lady really did live in that particular apartment. Now my foster dad who is now in a nursing home would most likely come right back to his old house from where he was taken because he lived there for so long and to him it was home. Anytime you're single and living alone with no family, you can actually dread ever having to move from that place for fear of having nowhere to go, especially if you're on fixed income and normally broke by the end of the month

...to "Daughterlu"... Call an immediate meeting with the curator of the facility, and include all involved in your mothers financial and move abilities, her power of attorney, etc etc. Look into either having the other resident transferred or ultimately moving your mother if they drag their feet about the other resident. Your mother does not nor should not "feel afraid in a place she will be for the remainder of her life.

I agree with Tiredof14 as well as susanesmith. Even though people with dementia have trouble expressing their feelings, you should investigate why by asking the head nurse. She probably didn't feel right about specific CNA. I would believe in my mother than the CNA. Can your mother speak ? If so, ask her if anyone is treated her good or not. She'd be bluntly honest with you even if some are not accurate.

I heard of another situation where there was another lady I currently know of who took care of her husband at home. I don't know if he stayed home to the very end or not, but rumor had it that he used to beat the crap out of her. I personally as an abuse survivor would've been out the door and gone the first time someone raised a hand to me! I don't know how the pros handle this kind of behavior but I've noticed they have some clever way of keeping violence under control but again, I just don't know how they do it but they do get things done

I love that id "goodgravy123" - I have found that with my mom since she has lost her communication skills, the only thing she can do is lash out. An infant cries, screams, thrashes about because that's all they know how to do to get attention. Same is true in adults who have lost their communication skills, they will hit, swear, yell and scream, etc when they are upset with what is going on to them or around them. I do not have any first hand experience with nursing homes, just what I hear. I agree with Hugemom above in that you should do some investigating before passing blame. Although, I'm not a big believer in blame, I believe in getting to the root of the problem and fixing it. With this disease, that can be near impossible, but still worth the effort because you always come up with an idea or two or three. I find I have to "think outside the box" a lot which has come with practice. You know your mom, she is still in there, do what you feel she would want you to do. Stay in there with her, visit as often and at different times of the day if you suspect she is not getting the care she needs. Follow your gut instincts, you can't go wrong when you do. My daily goal is to get my mom to smile at least once a day, some days that is a pretty tall order! But I do what I have to do and I usually succeed. A smile is priceless, the feel mom gets from that smile is also priceless. Stay in there, your mom's need you.

Human beings, whether they have dementia or not, often lash out when they are frightened, cornered, or threatened in some way, or perceive that they are. I am friends with nurses who worked in emergency rooms who told me that people coming in from car accidents would hit the attending nurses, not even realizing what they were doing, or pull out their IV's without having any clue they had done so. There was nothing "wrong" with their brains, nothing demented about them. .But their bodies were in state of medical shock, some had lost blood or they were otherwise medically compromised.

Elderly people are often medically compromised due to their advanced age, loss of physical mobility, and inability to communicate their basic needs to those that care for them (such as hunger, thirst, physical discomfort, whether they are wet, bedsores, etc).

When I worked in a nursing home I recall that when patients were groomed this was done while the patient sat in a wheelchair. Wheelchairs present a problem that non-wheelchair users rarely consider. I know this since a person very close to me used a wheelchair and I was aware of the problems and implications of being in a wheelchair and not being physically able to get out. What happens?

Well, if you are seated in a wheelchair, unless the arms are removed, you cannot get out. Basically you are left vulnerable and must trust the person caring for you. What if the person is not so trustworthy? Even one bad experience can leave a person terrified.

Imagine being cornered on three sides, unable to get out, and a threatening person approaches you. From the point of view of a person with bad intentions, say, a sexual predator, this is an ideal setup as the victim cannot escape and most likely will not be believed should he or she squeal later on. Other types of threats or assaults might be a person coming to take blood and doing so forcefully, getting bathed without regard to body privacy, or various degrees of shoving and verbal abuse such as scolding or even demeaning judgments with religious overtones.

Even if those doing her hair were very kind and had totally good intentions and communicated well, anything in her past may have scared her so much that she might have felt threatened being approached at that very moment.

This is one of those things that health care workers should be aware of. It's a hazard of the job. They are dealing with vulnerable people who are medically compromised. No way should these folks nor their families be blamed.

The nurse at the facility I worked at got a black eye from a resident, the day before her daughter's wedding. Another CNA had her collar bone broken from a resident. I have scars on my arm from a female resident swinging her wheelchair alarm at me and the metal clip hitting me. Yes it hurt. Six months of classroom training along with six months Clinical, I forget the total hours. Miss one class or one clinical, we were out of the program. NJ state law. Everyone thinks the job is easy. I'm lucky the clip didn't get me in the eye. We take the abuse and go on with the shift, after doing an Incident Report.

My mom has dementia and she hasn't had major personality changes as of yet, other than an increased level of pre-existing OCD but I think that's probably more about trying to control something in a world where she no longer controls anything. She has had personality changes only when she's having a UTI- so I think that for sure should be explored. She has her full wits about her but has physical impairments that led to first being in the rehabilitation wing and now a permanent resident by her choice, she knew I couldn't care for her at home. I say all this to confirm that my presence in and out all the time makes a huge difference. We are lucky to live just 4 miles away and work only 1 mile away. I've been a compliance officer for the agency that accredits hospitals and nursing homes for 10 years and I thank God for that as I know it helps the type of care she gets. But, I've had several nurses there say that unfortunately the ones who have the "over involved" daughter are rare, some have no visitors at all. I do ask for a copy of her MAR and notes regularly so I can see if anything is escalating, like a roommate situation and also because my mom doesn't remember everything accurately and it helps her to trust the staff more because she knows I check in all the time.

Is your Mom in a specified Memory Care or Dementia Care section of the nursing home? If so, the staff should be specially trained to deal with these types of issues. Residents should be listened to. It is common for those with dementia to refuse many things....because it comes down to them wanting some kind of control over themselves. Diversion should be well taught to caregivers. Let them say 'NO" right now. and reapproach with the request in 10-15 minutes again, and ASK....not order.... there are clear techniques that work generally. BUT, in the case of the fresh hairdo....this does seem like miscommunication or perhaps, staff who just do not wish to be flexible. If a woman has a fresh hairdo, what is wrong with doing the shower but not the hair for one time? We need people who can think past their noses in these positions but often they are not there!! Someone suggested that you find out the shower days, and then plan the hairdresser AFTER or in between the shower days, or somehow, make it clear to the director and staff supervisor what you want done in this kind of situation. Finally, I do agree with NOT going for medication for this situation. Medication should come when there is a pattern of agitation or aggressive behaviors....not an isolated or occasional episode. Staff should be trained in diversion, redirection and other techniques to get a memory impaired resident past this agitation. We had a big problem with this behavior with my Dad when he was first admitted to Memory Care, because he was a male who was used to being in control and making his own decisions and he detested, in his normal memory situation, other people TELLING him what to do without explantions and discussions with him. Even after he got settled, and became calmer, he always referred to his caregivers as 'the bosses' because some of them just didn't have the right approach. They didn't give acceptable choices so that Dad could be 'in charge' of simple things. He became more compliant and everyone loved him, but he still had problems with those who treated him like a 'thing', rather than like a 'person'....and he knew it enough to talk about it regardless of his memory problems. So listen to your relative's concerns; be there often and different times; make friends with the coworkers who are treated your loved one and others with respect; ask at mother's nursing home about the training staff get, REGULARLY, about working with those who are memory impaired....and make sure the executive director and whomever is in charge, ultimately, of all the caregivers, get to know you, and know that you going to be there....and you want the best for your mother. You can do all this with love and sweetness and innocently asking questions about this or that.....but it has been proven that the ones who do get the best care, are the ones where it's well known that they have family and friends who are going to be showing up regularly....so be sure you are on that list!!