Tuesday, December 1, 2015

Caregiving Routines

 Each time Mom takes a downward turn, my first impulse is to say, "Ok, this is enough, I can't handle it any longer." But I've found if I'll give any new difficulty just a bit of time and prayer, things tend to reconcile.

The most recent caregiving challenge for me has been the necessity of administering a daily sponge bath to my mom. Both Mom and I resisted this transition! You'd think after 11 years as a caregiver, I would know that exhorting Mom to do a better job wasn't going to help, but I nevertheless tried this ineffective strategy for several weeks before it became apparent even to me that she had lost the ability and initiative to bathe independently. And then we had to get past Mom's resistance and resentment. That was the biggest hurdle for us, and was surmounted by my friendly but relentless insistence that bathing had been ordered for her by her doctor (I'm sure he would have ordered it if I'd asked him to...) and just had to be done (tinge of regret and empathy, firmness in my voice). For a couple of months she resisted my help but over time she adapted to my assisting her in this way. Things are much easier now, just a normal, not-too-time-consuming part of each day. 

Every caregiving transition has been characterized by these steps:
1)  Denial--I deny that Mom has lost ground and try ineffective strategies--or stick my head in the sand and pretend nothing is wrong (if I ignore the problem maybe it will go away).
2) Resistance--I resist having to do more caregiving work, and Mom resists my intrusion into areas that have previously been fully under her control.
3) Upset--characterized by a fairly tumultuous transition phase during which even calm and kind firmness on my part may be met with anger and resistance on Mom's part.  During this phase I know it is ineffective to lose my temper, but I generally lose my temper anyhow. I also know it is fruitless to allow my my feelings to be hurt by the spiteful resentment of a dementia patient, but I generally get my feelings hurt anyhow. 
4) Resolution--Mom and I both adapt. Dementia patients can learn new behaviors, but it takes many repetitions and gentle insistence on the part of the caregiver to establish effective new routines. These routines will eventually provide the security of familiarity for the care recipient.   
Some situations are intolerable and should not be endured over time. I would never recommend that a caregiver submit to violence or constant verbal abuse in the hope that the situation will somehow improve.  But I do want to encourage caregivers, myself included, to always give a new challenge a little bit of time before giving up. When needed changes require the cooperation of a dementia patient, we must allow some time for those changes to occur.


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  1. Mom gave up the initiative to bathe herself quite some time ago and she is afraid and resistent to shower so it's washes at the sink. I agree, Linda, each time her mental status begins to deteriorate more, I wonder "how much longer can I do this alone?" Thank you for sharing your honest feelings here.

  2. Not that this will help at all, but my grandmother loved the pampering and as long as the robe was fluffed and warm and the bathroom was steamy hot, any reluctance on her part melted away. And we did have all the right equipment...the shower chair and the bars for stability. After her shower (every other day), I did her hair and gave her a foot rub with her favorite lotion, and once a week a manicure. It was a real sorrow when she no longer had her nails polished. I did this for about ten years because my mother was reluctant to take care of her own mother this way. It was a lot of work, but I did try to make it pleasant as possible. Nice smelling shampoos and sweet smelling lotions, massages, and the cozy factor all helped. We had a hand-held shower and Nan was able to use it for spraying down her legs and feet, which made her feel like she was doing something. One time, I opened the shower curtain and she let me have it full force with that hose. I as drenched, the bathroom was a sopping mess, and Nan was laughing like crazy. Now I am smiling to type this today, At the time, I was furious!

    You are wise to take a wait and see approach. You are one of the most resilient women I "know."

    1. What a beautiful ministry you had with your grandmother--truly anointed and blessed.

  3. Wonderful advice! My uncle is losing so much independence recently. It's very hard on my aunt. I will pass on your advice.

    P.S. I've had a few days to relax and enjoy another few chapters in your book. I enjoy it so much.

    1. So glad you enjoy your time in Karola! :-) I love to think of you relaxing and reading. Thanks, Georgene.