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I care for a 76yr old retired nurse, she has had 5 hip surgeries and is on Prestiq. She is very 'edgy', to put it nicely, when I have to rouse her in the mornings. Her son requests that she be showered at least every other day. There is NO railing in the bathroom. The last time I took her in for a shower, she slapped me on the head when I tried to get her from the toilet to the shower. I know she is frustrated w/herself for no longer being 100% mobile. I also know that the morning emotional issues are from the Prestiq. However, her son is more of a 'Get it done and move on' kinda person. He's bigger than I am, and can just DO IT. I cannot. I also have a back issue. The woman stumbled 2 days ago, and I DID catch her, no problem. I do have my own confidence issues w/her in the shower situation. I also HATE having to take her in to the shower. She wears 2 Depends each night, and does need to shower usually almost daily, she can't go weekly. Short of having her son do this one task, anyone have any advise on how to manage this chore?
She can be rather cantankerous throughout the day, never conversational.
At best, my telling her I am only here to HELP and to make her more comfortable has been my own best approach. Appealing to her nurse's past is NOT a good idea. I think that makes her madder.
Thanks!

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Why are there no grab bars or rails in the bathroom? I think that is totally unacceptable and needs to be corrected. Is this a rental unit that does not allow such modifications?

Are you using a shower chair?
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Do you have a shower stool? If not have Mr. Get it done get you the one that allows her to slide in position, It is just a rally big seat with rails. Also a removable shower head so you can get her clean no other way to say her privates so sores do not develope. Also with a han wond she might feel free to hold some herself. He also needs to put handrails for her.Are you family oe hired assistance. Do not really like the way he approaches you. I would say if he is family to get a grip. Good Luck
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The only thing wrong with this woman is her hip and diabetes? I understand she's worried about falling yet again, but come on it's not the end of the world for heavens sake. If she doesn't have mental problems like dementia, then ask her what SHE suggests how to make it easier for you to get her into the shower. What the heck is she laying in bed all the time for? Is she depressed or something else? She should have a walk in shower with a shower chair sitting there too. No way should she be stepping up and over a bathtub. I don't understand why she can't just walk herself with her walker into the shower and sit on the chair.
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NancyH, where did you get the idea that she is laying in bed all the time? This event is first thing in the morning, when she just gets out of bed. Also, if she is taking Prestiq she has major depression.
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ok, I had to re-read the post, and you're right she doesn't lay in bed all day. To be honest tho, I read so many things on here that sometimes the facts get mushed together between posts. And after mentioning how many hip surgeries she's had, she said Prestiq which I assumed was a hip related drug.
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Once an elderly person falls, they develop a fear of falling again and her fears should not be ignored or taken for granted. she might still have pain, loss of balance, etc due ot the hip problems or other problems like blood pressure and fear is made worse in a slippery environment. You should insist that a shower grab bar be installed. and a shower spray hose if there in not one already. I don't know if the bathroom has a tub or a walk in shower but if walk in and large enough, I suggest having her walk in with the walker, have her sit on a shower chair (one with arms preferably so she can push up on the arms to get up, i actually use a commode without the bucket but it does tend to rust) and then most of the washing should be done while she is sitting. Then for places you can't clean while sitting, first rise the soap off the other parts just washed, and dry her hands and then bring a walker into the shower (you can put plastic bags over the legs with tape to keep water out of the holes). there should be a rubber drain mat with holes on the floor placed for no slipping but also should be large enough for no tripping. Then she can stand and hold on to the walker to complete the bath, rinse and let her sit back in the shower chair and dry her before walking her out. hen, The shower hose (with a lever to turn on and off at the sprayer) helps control the situation.

And the every other day bath requirement? unless she is soiling herself in a way you can't clean her properly in bed (it's done all the time in hospitals and nursing homes) , once a week might be enough supplemented with bed baths. I was told by a dermatologist that fewer baths are better for the elderly so the skin does not dry out.
And if you have a back issue, should you be giving a woman who is unsteady a bath alone? how about the son and you doing it together? Maybe she senses, and rightfully so, your hesitance due to your back concerns? Her safety is the utmost importance so her son should cooperate to "get it done" safely.
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YES, she basically stays in bed all day. Left to her own accord, she will rarely get up. She just now got up for a snack. Unless she is very hungry or wet or has a BM, she will NOT get out of bed on her own. She CAN, she can get out and up with the walker. The shower has a white plastic handled shower seat. It is not a tub, her son redid the bathroom. The shower has a removable shower head, and only a 4" step over to get into the shower, and NO door, etc. The bathroom is just damn small. I let her take the walker in when she needs the Depends changed, she stands with the walker between her and the wall, over the toilet. I pull the Depends down, she sits, then it comes off, new one on. Done. Her son HATES this, cos if she's going to fall, it will be BACKWARDS and I'm not back there. This is my first caregiving job. She was previously on SEROQUEL. She does have emotional issues- she will often say (to herself) I think I'm crazy...I believe depression is the least of the worries here.
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The woman does not ever use the toilet, she wears Depends 24/7 and wets them or has a BM in them. Her bed is a vinyl coated mattress, and she smells bad right now- of sweat/BO, because she is hot. She insists on 2 covers/blankets. But luckily, I've managed to her out of the sweatpants. I'm not lazy, but her verbal lashing out at me, and NOT helping me move ...herself (I think this what I'm trying to say...sorry)...its very difficult. I have been tempted to talk to her son and ask if he could bathe her every other day for less pay for me. I feel like I do a LOT for her, trying to make what she would like to eat, etc, more than the other caregivers did.
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Instead of pulling depends down, why not rip them off, they are designed to be ripped and to avoid having her to stand balancing you could walk her back to the bed w/o the depends and put them on while she is lying down. there is a thing called a gait belt that might help to you have something to hold on to her with. Is she on medicare, maybe son can arrange for some in home physical therapy with someone who can train you and him how to properly transfer,etc? Regarding step down into shower. I had a carpenter come and build an insert made out of recyclable plastic that can be taken out for cleaning that makes the shower level with the floor. don't use wood b/c it will rot. would a small roll in shower chair work?
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Blessingpoetry, since my mother is not steady, I gladly help the aide give her a bath so perhaps you can ask the son if he would help you out. together it only takes 1/2 hour at most to "get it done".Why does't she use the toilet? how about a bedside commode? what about a bed pan at least? Does not not know when she has to go?
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and maybe her medication needs to be evaluated . does she have a physician or psychiatric who specialized in geriatric medicine. Some of those depression meds are not suitable for the eldelry and can make things worse. you have to find the right one and the right amount.
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Hi BP, do u work for agency or direct for son? Whichever it is should WANT u to have the training u need. Lots of good advice given. Not sure if grab bars in or not? Not wanting to cut shower walls, I tried the suction cup grab bars ( drive brand) they r dirt cheap n work great. Come in various lengths n finishes, so son could add easily if not done. Yes, home PT AND/OR OT would make a world of difference. I had witnessed gait belts used incorrectly like "leashes" but asked PT what he thought-said some for, some against. He showed me how to use correctly- very helpful. The PCP dr can order these in home services- I'd think get it done would be all for it....if I had depressive d/o n multiple hip FX's, I'd be a basket case too, but her treatment sounds inadequate. Isolation is not good, does she get any exercise, activity, sunshine or socialization? Good luck to u both. Kimbee
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How about a potty chair in her bedroom and bathing her in bed?
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Betty- the 76yr old- does not like to get out of bed. I do not know what caused her to basically STOP (everything). It took me 15min of cajoling to get her to get out of bed today. She told me, You don't care if I can or not (about her getting up on her own) I told her (probly a pointless issue), that YES, I do care for her, and YES I do care that she can get up and down (etc) on her own.
I know she does not like when her son comes and pulls her covers off and sits her up and gets her up. He seems to see that she has no sense of self, no dignity. I have told Betty, when I was giving her the ONE shower I managed- I understand that you do not like being bathed by someone else, I wouldn't like it either. I try to talk to her. It usually just gets her to be ugly to me, or tell me 'What do YOU care?' I am personally in a position that I need this job, I am w/o a car, other funds, etc. So I'm kinda stuck. Other than being a bit detached from the situation, her son is not a bad guy. I think he is dealing w/her by being detached. He just lost his 36yr old daughter to alcoholism, and is about to go thru a divorce which will be very nasty. His mother has been been thru at least 3 other care givers in the past 3 yrs. She was at one time in a home called Sunrise, in the Denver area. And her stepdaughter had her, and once took her $$ and just left her unattended in a room. Too much information? lol
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Blessingpoetry, you need this job, and Retired Nurse (RN) needs your compassionate help. So hang in there! I admire you coming to this site and trying to figure out how to make things better.

I think your approach of talking to her and reassuring her of your good intentions is very appropriate. Try not to take her responses too personally. In that sense, you may need to detach a bit, too. Ask her what you can do to make her more comfortable. "I know you'd rather not do this at all, but since we have to do it, is there any way that would be more comfortable for you?" Surely as a nurse she is very familiar with having to do things the patients don't like. Without actually mentioning her career, maybe you can remind her of that. "I'm sorry, but sometimes helpers have to do things the person they are helping doesn't like. Let's get this over with as quickly as possible."

The notion of bringing in a physical and/or occupational therapist appeals to me. Son would have to ask her doctor to order a visit or two. The goal would be to learn how best to get RN into and out of the shower. This professional could also recommend (and perhaps order) an appropriate shower stool, grab bars, etc. Of course, just because RN has instructions of how to cooperate doesn't assure that she will cooperate. But it is worth a try!

Maybe RN has had a lot of experience with neglect or disinterest and that is where her "you don't really care about me" attitude comes from. Consistently assuring her that you do care, and that you really want to do things the best possible way both for her sake and also for your professional pride, is all I can think of to overcome the attitude.
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I appreciate your help. Her insurance is awesome, and provides for in home DR visits. I do not think her son will be thrilled with me asking for someone ELSE to show me how to shower her, when he has shown me how. I can approach it and see. I have a friend w/a sister who works for Visiting Angels, I am thinking of contacting the sister, to see if she can offer any hands on help. I am just personally not confident with taking Betty into the shower. There IS a shower chair, and some kind of suction bar. She is just so unwilling to offer any assistance for her own care. She hates getting up in the mornings, etc. I have a great lunch for her right now, that I am just hating to go bring her and tell her its time to get UP to come have. She has been hateful to all of her in-home care givers. At Sunrise, the live in place, her son said she would never leave the bed, go for activities, etc. Then THEY got apathetic on him, and wouldn't rouse her, either. AWESOME! (Not really!) Thanks for all the help! :)
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I wonder if offering her some degree of control would help at all? "RN, dear, I hate waking you up before you are ready. Let's try to set up a timetable for the day that would suit you better? What if you slept until 10:30, got cleaned up and had breakfast, then went back to bed until 2:30 before you had lunch? Would that work better for you? You have to get up everyday and get cleaned up, but why don't you pick the time?" Might not help, but couldn't hurt, right?

Again, don't take her hateful-to-caregivers attitude personally. Maybe it comes from the history she's had, and maybe it comes from her life-long personality, and maybe she has something going wrong in her brain. What ever the cause is, it is not YOU! This is not your fault. Keep doing your best. Keep being consistently kind, sympathetic, and firm with her. Try to let her hateful comments roll off your back.
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She has a large digital clock by her bed, which she can clearly see. I do not believe that time is of the essence here. (Not trying to be difficult) The main reason her son and I have set up getting her up when we do, around 8am, is that she sleeps all day and all night. She is WET due to sleeping in 2 Depends. She won't get herself up to remedy this. A few times, during the day, if she is wet "enough", she may get up and asked to be changed. Otherwise, she lays in it. I do not mean to contradict every offering, I am only offering the information her son has given me. I have been here just since Labor Day weekend. This is my first job like this. I have usually worked in preschools, with children ages 3 to 12. I do really appreciate ALL of the great help here.
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Yes. There is a really good reason for setting the wake-up time Son did. Very logical. But it is not HER reason. I'm just wondering out loud if giving her a smidgen more control of her life might improve her attitude a smidgen. Not that 9:15 or 10:30 is "better" for getting up, or that Son has been "wrong" to set it at 8:00. Just that psychologically it MIGHT feel better to her to set her own schedule.

BTW, making my mother get up at 8:00 would be cruel and inhuman treatment! She has not done that for more than 20 years, why should she start just because she needs help? And I pity the poor caregiver or family member that would try to get me up at the ungodly hour of 8:00 am! I have delayed sleep phase disorder, but even among people who don't officially have a diagnosed "disorder" our internal clocks aren't all set to the same Circadian Rhythm.

Even nursing homes are increasingly recognizing the need to respect individual preferences, and offer breakfast at more than a single sitting.

Letting her have some say in when she is awakened is also evidence that you do care about her and want to respect her wishes, as long as you can do that and still do what is in her best interest.

Time is always of the essence ... time is how we measure our lives. Being able to control our schedules can be very empowering, especially when we have power over so little.

I understand all the logical reasons why 8:00 am is the "right" time to get her up. But I still urge you to consider the psychological reasons why giving RN control over when to get up might be the right thing to do.
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I am a paid caregiver and my recent charge sounds very much like your RN... it is easier said than done when someone says to let it roll off your back, when you are the one that is being targeted all day, no offense JG, but it is very hard to detach sometimes.... so I do understand Blessing, and I have been where you are... what I finally did with M, is set her down and talk to her woman to woman... telling her I have no idea how hard it must be to let someone come into your home and do all the things you have always done..... but this is more than a JOB to me, I can get a JOB anywhere..... I had to show her my human side, that she does hurt my feelings at times, that just because I am PAID does not mean I am paid to be treated ugly... but I also pushed with the family to have her evaluated for depression... BINGO... I see a marked difference in her, but also if RN is on the one med, I don't know how meds for depression would work....if there would be a drug interaction..
And M would reject any encourgement also. now I am able to say to her, 'don't be so negative, you know you are making progress', but that took time and patience and consistency on my part... there are times she still doesn't trust me.... but your RN sounds as if her trust has been horribly betrayed and now she just expects the worst so she won't learn to depend on anyone in case you turn out like the others... keep doing what you are doing... just be good to her.... she is afraid.... respect her fear, she has reason to not trust paid caregivers.... and I'm sure she is hurt that her son felt this was needed, even tho it is.... I try to put myself in her place... she is of sound mind, so she sets the schedule, she says what she wants to eat, ect.... I know this is her home.... her safe place, and I am always a guest there, no matter if I am working or not... you sound like you know what you are doing, and it is good that you are fearful about the shower..... you have been given great suggestions.... and sometimes we have to figure out a way to approach the familes without offending anyone.... I don't think good in home caregivers are given the credit they deserve for having such a balanceing act we have to do between our charges and the familes that expect so much out of us... it's a hard job no matter what, plus being the 'stranger' taking care of their loved one.... and we don't get paid near enough... so hang in there... your heart is in the right place.... you are doing an awesome job under the circumstances and asking for help only validates that...... if you didn't care, you wouldn't be trying to figure this out.... lots of hugs and respect sent to you...
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I am going to try a different tack. So much of what I have read here speaks to me of depression, and maybe additional mental issues. Would it not be a good idea for her meds, and mental/emotional state to be reevaluated? Wanting to lie in bed all day and not help yourself sounds very much like depression to me. I know there are the issues of past hip surgeries, and lack of confidence and so on, but it is not normal for someone to want to lie in their own wastes when they could get up and use the toilet.(if I have understood you, blessingpoetry, correctly).

The other thing which you tossed intoi the mix was that the son recently lost a daughter to alcoholism, and is gong through a divorce. I can't think of much more trauma than that. As well, he is looking after a very difficult mother, who, incidentally, has lost a granddaughter. Not that she did not have problems before, but that loss is likely adding to those problems. Frankly, I can't imagine how he is feeling, and it may make him a little less able, at present, to be flexible regarding his mother's care.
Blessing - I think if you could get some help with the bathing it would be good. You are wise to look after your back .I gather the son is not open to his mum having more bed baths which might be easier for you, though you might need help there with lifting too. I do agree that you have to detach, and let her coments roll off your back, or the nastiness will get you down. You may well find the same in other jobs caregiving seniors, so it is a skill you need to develop. She (RN) has a lifetime of problems and you are not one of the, though you are a target at present. Offering her more control over something may help. One way to respond to anger from someone else is to reflect it back to them - i.e. say that you can see she is very angry/upset at being forced to shower. That way you are validating her feelings. It tends to stop them in their tracks as they are not used to it, and it helps them to see that you are getting how they are feeling. Also asking her if she has some preferences may help. It certainly can't hurt.
God bless you for taking on such a job, and working to do your very best at it. You sound like a very caring individual. ((((((hugs))))))) Joan
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ladee and blessing, I'm sorry if I made it sound like it is easy to detach and not take comments personally. I have a husband with dementia who went through a period of paranoia and accusing me of all kinds of things. I KNOW it is not easy to let these comments roll off our backs. But I still think it is the best attitude to work toward.

I think hired caregivers are underpaid angels. You both have my heartfelt admiration.
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Thanks for all the answers! Always helpful. Betty is in Prestiq and I believe that is her only psyche med. The rest is all 'reg' medication. I keep on telling her, I am trying to help. I brought her a drink to her bed, and had to raise the head of the bed just now. When I went to lower it, I got screamed at. She has made me cry, and seen me crying. I have tried talking to her. I tell her, I cannot help you if you don't let me, I cannot help you if you don't help me. I am a 'natural' servant. I enjoy doing. I USED to like cooking, but not so much now. I go in sometimes, to get her up, and tell her, you lay there and wake up, I will be back in a few min to get you up. I do understand about sleep cycles, I sleep barely 3hrs a night myself. I was a forced morning person.Her son won't be offended, he just probly won't go for new ideas. He's been at this for years now.
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I do not think Betty knows the girl passed away, it was 2 mos ago. She mentioned her a week ago, asking if her son had mentioned the daughter. I just moved past it. She asks if he is going home- I do not think she knows the size of the house, etc. John- her son, lives upstairs. I live in the basement, below Betty. John's wife Rita, is back at their house, as he tries to sell it. She is also an alcoholic. I am worried in am in over my head with this job. I have never done this before, with adults. I have been a nanny, for children. I will not be making this a career, I'm sorry. I was in a car wreck in July, rear ended by a semi- John knows this and am working on a settlement via SNAIL ATTORNEYS, lol. Thus, this was the only job I could find, no car, no $, no resources. I do want Betty to be comfortable, and be happy. She IS severely depressed. John said she was on Seroquel, which is an anti-phsychotic. she will often just say, "I think I'm crazy" (kinda under her breath) ...I don't imagine we are going to be having a dr visit for medication maintence anytime soon.
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(((((((((((((Blessing))))))))))))) It may well be best that she does not know about her granddaughter. I commend you for wanting Betty to be happy, but I really wonder if that is possible. Comfortable. maybe, clean, hopefully, properly nourished, yes, but happy? It might be good for you to lower your sights to looking after the basics. I don't think anyone can make Betty happy. I do think it would be good to mention to John that his mum may need an evaluation, and meds adjustment, as it could make her easier to manage, and also make her life more pleasant. The meds (too much or not enugh) may be contributing to her not wanting to get out of bed. He may not want to do that, but at least you have tried. She is on Prestique and Seroquel - pretty heavy meds for depression and bipolar disease I believe. Traditionally bipolar disease is very difficult to manage. She is a senior, so side effects of these drugs may greater. A friend of mine (since deceased) was a professor of Pharmacoloogy. He visited his mum to find her lying in bed with her face to the wall. He reviewed her meds, and found she was grossly over medicated. Once her meds were corrected she came back to herself. There may be a parallel here. Whether or not a med adjustment would have any effect on her temperament, I don't know.
I am really sorry about your injury, and know it will take time before you get a settlement. You are in a very different situation compared to what you were before - looking after, presumably, normal kids. Yes, detaching and letting the nastiness roll of your back is difficult - no question of that. However, detaching will help you survive, if you want to keep this job. Again, I commend you for seeking to find answers to a very difficult situation. Good luck, and keep us updated.
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She is not on the seroquel now. I was once on it, myself. I know that John has her on the minimal meds, which I personally agree with. I was overmedicated to the point of weighing 300lbs. I can't imagine what is going on inside her. I look into her eyes, and can SEE that someone is in there, but does she want out, does she want to GO and BE again? I have no idea. I only have my own horrendous experience with being over medicated to go on. A Friend told me to watch Patch Adams, and 'connect' with Betty, well. I do not foresee that happening. I know that she was an ICU nurse in LA forever, then when it got to be mostly AIDS patients, she went to the VA to be a nurse the last 8 or so yrs of her career. All of this is hard friggin work. Whatever she wants to eat, I will make her. I know a few things she kinda likes, and I make that on a rotation. I guess her being happy is not going to happen. Comfortable, and less annoyed with her self imposed confinement, maybe. Her son keeps telling me, its all her choice- he would have her in another situation, if she would do other things- books, crosswords, crochetting, all this would be at her disposal, if she mentioned it. She has tv. She doesn't even want it on. :( Thanks for the help...
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I agree with the others, there's some serious depression going on here and I don't see the woman cooperating, let alone progressing, until the depression is addressed. There are many, many signs in your posts of a major depression. My oldest daughter suffers from bi-polar disorder and it's truly amazing what the right cocktail of psych medicines will do for a person! Poor lady needs a mental eval as soon as possible, IMO.

I commend you on being such a caring, compassionate caregiver - hang in there!
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You are in a situation which is very difficult b/c this family is undergoing a lot of turmoil and it seems like the son is overwhelmed but trying to do the right thing. And you, not being a family member, have to walk on eggshells with your attempts to help out. This lady needs a good doctor who will listen to her and talk to her and try to find the right combination of things (low dosage antidepressant) physical therapy, etc to get her condition improved. When the dr comes to the home, does he communicate with her or talk over her to the son? Are you allowed to talk to the dr to tell him what you are observing? Have you tried asking your patient, since she is a nurse, what she thinks she needs to feel better and improve her situation? Have you asked her what you can do or her son can do to make the shower experience better? Have you asked her if she wants to try to put a bedside commode next to her bed so she can start trying to get up when she has to go so she won't have to walk so far? What about a wheelchair, does she have one? can you suggest you both go outside for fresh air? If she has severe depression she probably needs the right medication and right dosage to give her that boost to get back on her feet. I know from experience with my elderly family member that some of those drugs can make them act crazy, some make them sleep all the time. some make them sleepless. The magic one turned out to be a low dose of wellbutrin, after many failed tries. Would her son be open to suggestions if you find articles on the internet that talk about depression and the elderly and the different drugs and treatments and give them to him? And re his not being open to shower training. Tell him that things change with the elderly and she may be getting weaker from laying in bed all the time and need more support. Thus, my original suggestion to look into getting a good home therapist to come and evaluate her and offer some sessions. Medicare ususally covers it. She is too young to waste away in bed.
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She just came out, and had...uh...a shit blowout, as her son puts it. She sat down at her table, I smelled IT and got her to the toilet. It was..horrific. Stupid me, thought BABY WIPES! Hell no. Thank Buddha her son walked in. I told him, I need you to get her into the shower. He did, and she kinda fought him. She won't help, that's the issue, but he's like 6ft2, and linebacker from HS, College- he gets it done. HE sez, its ok, this is a team effort, if I'm here, I'll help. Thankfully. But she didn't even clean herself under his instruction, he had to turn the shower back on her, and tell her to do it again. I will attempt to talk to him tomorrow about all of these things you all have given me. she IS too young to just lay here. My dad is 77 and totally active. My friend's sister, from Visiting Angels, may come talk to me, too. That would totally help.
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Oh dear, blessing. Indeed, thank goodness her son walked in, and that he is prepared to help you. I am shocked at her lack of quality of life. My mother is 100 and still in an ALF, though with lots of help. I am 75, and still driving 5 hrs to see her sometimes, and do my own house wotk, cooking etc., though I think I will look for once a month cleaning help. I went tenting a few years ago. She has no quality of life at all. I am glad that your friend's sister may come to talk to you. She could have some valuable ideas. I do hope that the son will take his mum to see her doc and he will make some changes to help her. Keep up the good work!
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