The caregiver did leave the house and since I was nearby I told her to leave and I was home in 10 minutes. Wife was confused and anxious, but did not recall the caregiver being there. She walked next door to ask a neighbor if they knew where I was. She took 0.5 mg of Ativan at 1:00pm and the incident with the caregiver occurred at 5pm. The caregiver arrived at 2pm. Any suggestions? Thanks.
That's pretty much what ends up happening. After all the redirecting and hand-holding and trying to calm them down in the end the caregiver has to just ignore what the client's direction and continue.
The wife sounds out of it enough to me that she should not have the responsibility of letting the caregiver into the house. The husband should wait until she arrives. That way no one is left sitting on the porch.
https://www.webmd.com/drugs/2/drug-6685/ativan-oral/details
talk her doctor and her about the side effects and maybe try to find a different drug for whatever she’s taking it for.
Personally I don’t thing anyone over the age of 70 should take benzodiazepines. But that may be the problem. Talk to her doc. And if he insists that’s the best drug for her get another opinion.
The dementia is. Often times what happens in situations involving a spouse with dementia, is the other spouse doesn't realize how out of it they actually are. This happens all the time. The OP's wife is too far gone with dementia to have the responsibility of being left alone in the house for even a few minutes. Once the refusing to let the help in and the ordering them out because they don't remember why they've come or who they are, it's time for placement or 24 hour care and supervision.
Be careful with that medication; it is only for short term usage and very addictive::
https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Lorazepam-(Ativan)
Leave the room then come back. (if it is safe to leave the room.) If possible come back in through a different doorway.
The caregiver can tell your wife..I will leave but I was going to make a cup of tea and have a little cookie would you like to join me?
or
I will leave as soon as I finish making your bed, or doing the laundry (or whatever task needs to be done)
Find an activity that your wife likes, get the caregiver to get your wife involved.
How long has this caregiver worked for your wife? If she just started then having her alone with your wife for three hours is way too long in the beginning.
I always told the client something like their spouse/adult child/grandchild hired me to clean the house. Or that their doctor sent me to help them do their exercizes. The caregiver can tell them anything they want, but never leave.
There have been times where a dementia client would order me out. Or threaten. Or even attempt to get physical. I always told ones like this that I was hired by their family to help out and that they will not speak to me that way. You have to be a little hard sometimes.
You should have a cellphone and the caregiver should call you to talk to your wife about why she's there. That caregiver shouldn't have to go asking the neighbors if they know how to reach you.
Get a cellphone so the caregiver can reach you.
Okay (to acknowledge your wife's request), I'll leave soon. First, I need to finish XXX or give you XXX (meds, juice, a magazine... whatever). The key is realizing that your wife will forget soon enough and that she doesn't mean what she says. Your wife is saying "leave me alone" (out of confusion, frustration, feeling uncomfortable with who she perceives is a stranger).
When 'putting off leaving,' your wife will forget about her request, telling the care provider to leave.
Another way to handle it,
1) have the caregiver ask: Is there anything I can do for you before I leave? I enjoy (a) helping you or (b) talking / being with you. This MAY help your wife feel cared about - and it may not, depending on the relationship they have or how your wife feels about a particular caregiver in the moment.
ANOTHER IMPORTANT REASON NOT TO HAVE CAREGIVER LEAVE...
You need (a) the break(s) you get, be it work or out doing other things, including socializing, which is extremely important to your well-being. You need to give yourself some time away. If your wife continues to be insistent, have the caregiver go into another room for 2, 5, 10, 20 minutes "Out of sight"-and then return... she could say, "It is nice to see you again ... (address by first name or Mrs...) - and continue on as usual.
So, the key is to have these options ready to go. If needed, write them down for caregivers. You DO NOT want them to leave. You DO NOT want to (set up a situation where you) run home, based on your wife telling someone to leave.
BE SURE to do what you can for the caregiver(s) to be familiar with your wife. Giving a hand massage or just holding her hand (if wife is okay with this) is helpful - this physical connector / connection.
Touch Matters
Do you need to investigate placement in a memory care facility?
From another room it should be possible to hear & discreetly supervise.
In 5 mins or so, knock on the door & re-enter with a smile.
If this fails & your wife chases them out the front/back door, the caregiver can wait just outside the door. Again, wait for her to cool down & attempt to re-enter.
If your wife is LOCKING the door behind the caregiver, the locks will need a re-think - that is a potential danger if the caregiver cannot get back in.
The caregiver may need to be creative - By 'leaving' but needing the bathroom first... By keeping calm & stating YOU had instructed them to stay, so they will be & that's that... By a sudden *re-set* eg like accidentally spilling some water on a table that needs cleaning up.
My mom would yell at the caregiver to get out of her house.
The caregiver would say ok - and hide in the next room where she could peek to see that my mom was ok. After 10 min she would cheerfully enter with a hot coffee and a smile and all was ok.
How long has the person been your wife's caregiver? Is this caregiver experienced with people with dementia?
Any caregiver should not leave the house until you arrive back home regardless of what your wife tells them. Caregivers experienced with dementia know the therapeutic fibs that can help the episode to pass.
5 pm is common for when sundowning begins. I doubt it had anything to do with the ativan, which was a small dose. What was going on at 1 pm when she took an ativan?
It's great that you have in-home help with your wife so that you can remain active. It's very important for you to have time and space for yourself.
From what u posted, ur wife should not be left alone at all. Dementia is very unpredictable.
The caregiver can back off and go in the kitchen to do some dishes or some other project until hopefully your wife calms down. Did your wife walk next door in the 10 minutes that you were on your way home after caregiver called? This is a little disturbing. Doesn't sound safe to me. It would have been nice if caregiver were still there to at least shadow her and make sure she wasn't in danger.
I have told my mom's caregivers not to ask mom many questions but to be assertive and lead her to the choice she "should" be making. Like, don't say "do you want to have a shower" but nicely say "OK, it's time for your shower now".
Did you give your wife the ativan? I just had to pull all medication from my mom's reach cuz she made a minor mistake but don't want it to be one that could actually hurt her.
You may have to have the caregiver with you there for a while until your wife gets accustomed to her. She may not ever get accustomed to her, unfortunately, but she should never be left alone. It might be time for a memory care facility.