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nhquilter Asked May 2013

How do you deal with a dementia patient who won't let staff care for his spouse?

my in-laws are in assisted living. he has dementia, she is in a wheelchair and has cognitive issues.
When the staff tries to take her to the whirlpool for a bath, he grabs her wheelchair and won't let them take her. He becomes argumentative and aggressive. He is very domineering and if they ask her if she wants a bath, she looks to him to answer.
She is a diabetic and he feeds her foods and snacks that are bad for her. He manages to get friends and family to bring him these foods, which is another constant battle.
Although my husband has health care POA, if the nurses insist on taking her, he causes a commotion which in turn upsets my M-I-L and nobody is happy.
We no longer know how to deal with him - unless we can get some ideas here (or anywhere for that matter) our options are separate rooms (which she would be okay with, but he would hunt her down), or separate facilities (which again, she would be okay with, but he would be miserable).
So how does one deal rationally with an irrational person?
So frustrated with him right now. We are at our wits end!

Jinx4740 Jun 2013
Yes, it's normal for them to not know they have dementia. They don't want to know. There is nothing wrong with them. Sometimes that is less painful to watch than someone who can recognize the horror of their situation.

nhquilter Jun 2013
He is on anti-depressants (in fact they just upped his dose last week). He seems to be a little better, but not a lot.
Is it normal for them to not know they have dementia?? I don't think he has a clue.

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Jinx4740 Jun 2013
So sorry you /they have this problem.
Have they tried antidepressants or antipsychotics on him? Sometimes they work wonders.

nhquilter May 2013
Thank you all for the kind thoughts and suggestions.
We are going to try having him go with her to the whirlpool and see if that makes a difference. We would love to have him scheduled for a whirlpool but he outright refuses.
I'm more concerned about her care and it seems my brother-in-laws are more concerned about how he is going to react/feel. (years of dealing with a domineering father?)
He has now begun not letting the staff get MIL ready for bed - he wants them to go to bed at 11pm and she is asleep in her wheelchair before 10pm, but he refuses to let them put her to bed.
The thing is, even though he doesn't have medical POA for either of them, he gets so upset and argumentative that it gets my MIL upset and then it's just pure chaos in their room.
We do not want to separate them, but that may be our only choice. She does wonderfully without him - happiest person on earth. Without her, he is miserable beyond belief.

horserider May 2013
Can't HE be scheduled for whirlpool baths and her "come along" (oh and goodie -- she gets one too!) . Why does she need to be whirlpool rather than chair shower? I honestly think that your in-laws bond with each other is FAR more important than the convenience of the staff at the ALF.
Just because your FIL has dementia doesn't mean he doesn't care about his wife & that they don't need each other emotionally. Separating them seems cruel to both of them (& a stress of that might send both of them in a tailspin).
If her condition is really that sensitive can you get her Dr. to write out a "to whom it may concern" letter about her dietary restrictions that you can send it to each of the guilty parties? If she can handle some "forbidden" food treats, maybe give the friends list of alternate "semi-bad" snacks that they can bring & roll with it (ie chips rather than donuts, small bag rather than the giant size). Sometimes if elders can think they are getting away with something it makes them feel in control (and you can pretend to not know about the forbidden treats as long as it isn't too much or too bad).

Eyerishlass May 2013
Jeanne has some pretty good ideas. I was going to tell you as well that you can't deal rationally with someone who is irrational, or in this case, with someone who has dementia. It sounds like they both need skilled care and I also agree with Jeanne that your FIL cannot be the one making decisions about your MIL's care.

There isn't going to be a perfect solution where everyone's happy but your in-laws need someone to start making some tough decisions on their behalf. Instead of trying to find that one solution that's going to satisfy everyone, try finding a solution that will work based on your in-laws needs.

Your husband must be very torn up about this, and you as well. I've seen dementia separate elderly couples before. Make the best choice you can under the circumstances and allow for an adjustment period.

Deeana May 2013
Are the facilities such that he could be allowed to accompany her to her treatment? Could he sit there and hold her hand during treatment?

jeannegibbs May 2013
What a sad situation. My heart goes out to you.

Let me state the obvious: A person with dementia can NOT be in charge of making decisions for another person's well-being. In most cases, a person with dementia should not be in charge of making decisions for his or her own well-being, although legally it may be hard to stop them until/unless they are legally incompetent.

If at all possible, it sounds like separate rooms, with his in the secure memory care unit, might be best for MIL. They could visit each other frequently and for long periods, but only with some supervision or monitoring. I would not want to separate them so that they couldn't see each other, and totally different facilities miles apart seems extreme, but he should not be allowed to interfere with her treatments and care.

Can FIL be enticed to participate in some activity or program on his own, and MIL's whirlpool bathes be scheduled for those times?

Your husband (medical POA) should sit down with ALF staff and discuss options to ensure that FIL, with dementia, is not in charge of MIL's treatments or activities. Make sure that you all are on the same page.

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