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I appreciate your concern for the family and for your client, but what you are describing - to me, anyway - doesn't really constitute abuse at all - it's just a mindset when it comes to nutrition basically (more on the doctor visits in a bit). And your client probably has the same basic mindset. I think about my mom and frankly, it wouldn't matter what I bought or fixed her, or what I told her - as you probably know, dementia affects taste and appetite as well, and I've watched my mom (and watched my MIL too) get more and more limited - on her own - regarding foods she will eat. Now it's to the point where she has zero "balanced diet" and basically wants sweets and starches, period. She's malnourished at this point and has had Ensure prescribed to try to meet her basic vitamin and mineral requirements but even getting her to drink those is hit or miss.
My mom gets constipated due mostly to a very limited diet, very little fiber, and very little activity. But she - on her own - will not eat what she needs to eat, and won't get up and get more active.
Honestly, an 89 year old, very ill woman with dementia, dealing with side effects from meds - well, that sounds like constipation in the making. I hate to say it but you're lucky that the family reimburses you for the groceries you buy - some families wouldn't even want you to be that involved with planning her meals, and might even resent what they would consider your "intrusion."
It sounds like several family members are involved with your client and her care on a very regular, consistent basis, which is more than what some elderly people get from their families. You seem to know - and guess - a lot about their family, personalities, etc. and I think they may begin to resent what will probably feel like meddling in their business over time. Like I said, whether you agree or disagree with their mindset about nutrition, or their relationships outside your employer/employee situation, it doesn't sound like your client is being abused or neglected by her family. THAT would be alarming, but it sounds to me like she is tended to in a regular, consistent manner.
To me, it sounds like you should stay around if you can manage the hours (I understand that sometimes the granddaughter is late and that bothers you - you may need to address that and establish some healthy boundaries in that regard) because it sounds like you have a good relationship with your elderly client, and surely some of what you are doing nutrition wise is helping her. I take it you're getting paid for the hours you work, and you seem like a caring person who has a good relationship with your client. So if the job isn't keeping you from other jobs or from having your own life outside of work, and if you can get the "these are the hours I work - period" thing straight - then why not stay? You can only do what you can do, and you are not going to be able to change the way the family thinks about nutrition, but there are many worse scenarios out there than this, believe me. If you care so much about your client, why leave her? Disengage from the family dynamics and keep things on a professional level - that's my advice.
As for the family and the medical appointments, ask if you can be added as a HIPAA contact. You can also email the doctor and report your observations without getting info about the client FROM the doctor - then he or she can bring up the concerns about meds with the family the next time and possibly change her medication. You state that they accompany her to the doctor appointments - once again, that's more than some families do, so honestly, they sound engaged and caring.
I agree 100% on the bolded part. And the rest for that matter.
It is a challenge for me as a caregiver to come up with foods he can chew, his dentures hurt him- so he refuses to wear them. So I have to find soft foods and utilize a food processor.
The hardest part is he will say he hates shrimp, when that has always been his favorite food. That is the dementia part. He also does not ever say he's hungry. I notice he will eat until his stomach bulges way out. He has no cut off point. So I am very careful with portion sizes.
I have no advice 'M' but I wanted to tell you that you are a fantastic caregiver and anyone would be lucky to have you. Your concern for your patient is obvious and touching.
My experience with my mom leads me to believe that there is not a lot of concern about nutrition in that age group - my parents eat what they want, when they want it with no regard whatsoever for labels, sodium, potassium or anything else. It's not well-balanced and it's not good.
The major thing right now is that mom wants dairy products - milk, cheese, butter, cream, half and half, powdered cream - she is not supposed to have it because it causes severe lower GI issues while she's recovering from c diff infection. And yet my dad let her eat cheese grits and cream in coffee yesterday at brunch and then got pizza for them for dinner.
Yeah frustrating doesn't even begin to describe it.
I didn't mean to derail or hijack - my comment was intended to let you know that you're not alone and that it seems to be the mindset of so many in that age group, with dementia combined on top of everything else, that makes it so hard to deal. It's so much worse in your case because the family thwarts your efforts when you're not there - or if not thwarting, at least not seeing it as a priority. Until now anyway, with the son maybe coming around.
Again, I think you are fantastic - all the best while you are sorting out whether to stay with this patient or not !
Edited to add - when you leave there at night or Monday or whenever it is, I know you know that you did the best you could - you are not responsible for what the family does when you're not there - rest easy that you've done a great job laying the groundwork at least.
Being inactive can cause constipation also. Walking massages the internal organs, and helps produce bowel movements. We know enough to walk our dogs to get them to go poo, but don't understand that exercise works for people too. Those meds are making a bad situation worse. It sounds like she was more active until "they" medicated her.
My mother was a director at an assisted living facility for 20+ years. She'd seen and heard it all regarding the elderly. Some of it made for some very funny stories!
But, a lot of it is just frustrating and wearisome. It takes a special kind of person to be a caregiver, and a good one at that. I applaud your efforts with this patient and her family. At the end of the day, the best you can do is to make your suggestions, take care of her as best you can when you're on the clock, and hope that some of what you're saying sinks in with the family.
Aside from that, I would also say that being a caretaker is your job, not your life. It's impossible to completely leave your job behind you when you "clock out" like a lot of people get to do with their jobs. But you do need to maintain some sort of work/life balance where you make a conscious effort to focus on you, or the next patient, rather than continue to dwell on what is happening with this patient while you're gone. I suspect you already know this, but sometimes our personal feelings can become a bit too personal. This is not always a bad thing, as I'm sure it makes you an excellent caregiver! But from time to time, it may be helpful to take a step back and redefine how you're dealing with this woman and her family.
I agree that you are doing a great job. However you have to pick your battles. There comes a point when an ill, elderly person’s diet is the least of their problems (allergies and drug interactions notwithstanding.) The goal becomes just getting them to eat something for the calories. The constipation is an issue but can be aided with Metamucil or moving around. Since her family (including granddaughter) seems to visit often I’m not going to fault them for their efforts. The elders in my family are lucky to get a phone call or email from their grandkids, let alone actual visits and food.
I appreciate your concern for the family and for your client, but what you are describing - to me, anyway - doesn't really constitute abuse at all - it's just a mindset when it comes to nutrition basically (more on the doctor visits in a bit). And your client probably has the same basic mindset. I think about my mom and frankly, it wouldn't matter what I bought or fixed her, or what I told her - as you probably know, dementia affects taste and appetite as well, and I've watched my mom (and watched my MIL too) get more and more limited - on her own - regarding foods she will eat. Now it's to the point where she has zero "balanced diet" and basically wants sweets and starches, period. She's malnourished at this point and has had Ensure prescribed to try to meet her basic vitamin and mineral requirements but even getting her to drink those is hit or miss.
My mom gets constipated due mostly to a very limited diet, very little fiber, and very little activity. But she - on her own - will not eat what she needs to eat, and won't get up and get more active.
honestly, an 89 year old, very ill woman with dementia, dealing with side effects from meds - well, that sounds like constipation in the making. I hate to say it but you're lucky that the family reimburses you for the groceries you buy - some families wouldn't even want you to be that involved with planning her meals, and might even resent what they would consider your "intrusion."
It sounds like several family members are involved with your client and her care on a very regular, consistent basis, which is more than what some elderly people get from their families. You seem to know - and guess - a lot about their family, personalities, etc. and I think they may begin to resent what will probably feel like meddling in their business over time. Like I said, whether you agree or disagree with their mindset about nutrition, or their relationships outside your employer/employee situation, it doesn't sound like your client is being abused or neglected by her family. THAT would be alarming, but it sounds to me like she is tended to in a regular, consistent manner.
To me, it sounds like you should stay around if you can manage the hours (I understand that sometimes the granddaughter is late and that bothers you - you may need to address that and establish some healthy boundaries in that regard) because it sounds like you have a good relationship with your elderly client, and surely some of what you are doing nutrition wise is helping her. I take it you're getting paid for the hours you work, and you seem like a caring person who has a good relationship with your client. So if the job isn't keeping you from other jobs or from having your own life outside of work, and if you can get the "these are the hours I work - period" thing straight - then why not stay? You can only do what you can do, and you are not going to be able to change the way the family thinks about nutrition, but there are many worse scenarios out there than this, believe me. If you care so much about your client, why leave her? Disengage from the family dynamics and keep things on a professional level - that's my advice.
As for the family and the medical appointments, ask if you can be added as a HIPAA contact. You can also email the doctor and report your observations without getting info about the client FROM the doctor - then he or she can bring up the concerns about meds with the family the next time and possibly change her medication. You state that they accompany her to the doctor appointments - once again, that's more than some families do, so honestly, they sound engaged and caring.
Amen.
Throw in she's 89...some of the hard core rules of life no longer apply.
Being inactive can cause constipation also. Walking massages the internal organs, and helps produce bowel movements. We know enough to walk our dogs to get them to go poo, but don't understand that exercise works for people too. Those meds are making a bad situation worse. It sounds like she was more active until "they" medicated her.
She could be dehydrated too. Starting the day out with a glass of water helps to get things moving as well.
I have to say, my grandmother ate decent,y for the most part. But there were certain things she really loved, like fried and junky Chinese food. She was supposed to be low sodium too, but when she wanted it, I got it for her. At 89, there is little to look forward to, good food is one of the few remains. I'd rather have her happy and live to 90 than unhappy and live to 92.
I have to say, my grandmother ate decent,y for the most part. But there were certain things she really loved, like fried and junky Chinese food. She was supposed to be low sodium too, but when she wanted it, I got it for her. At 89, there is little to look forward to, good food is one of the few remains. I'd rather have her happy and live to 90 than unhappy and live to 92.
Agree! If I make it to 89, Lawd...give me whatever I ask for...
Thank you for all of your caring answers, Everyone!
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