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BrielleD11 Asked July 2019

New caregiver here, any tips for dealing with a combative dementia patient?

We recently moved my 82 year-old father-in-law in with us. He was showing signs of mental decline, but I think it's far worse than we thought. He already believes we've stolen his life savings because we took his checkbooks from him to lock them up (he kept misplacing them and then panicking and accusing everyone of stealing them. He would also write checks for thousands of dollars and then not know where to send them because nothing was due, but send them to random companies). He truly believes his money and CDs are gone since he doesn't have it in hand, has lost all concept of a bank.
When we went to clean out his house, he couldn't find the CDs (paperwork for the CDs that we already took to our house) and swore up and down that some kids broke in and stole them. That was the only possibility. I tried to assure him that they wouldn't be able to do anything with the paperwork because they aren't him or my husband (his attorney in fact), naturally, he didn't believe me. Then, as soon as we got home, I showed him all of the paperwork, but all of that was forgotten the next morning. Then, as we were leaving his house after cleaning, he was concerned that kids would break in and turn his water on and steal his food (food we left until we brought a cooler back).
Effective July 1, 2019, he has Medicare Parts A, B & D, yet he doesn't believe he has insurance since he doesn't work (he was working all the way until 7/1/2019 at a grocery store). His PC Physician, other son and daughter-in-law, multiple nurses, his cardiologist and phlebotomist have all told him he has Medicare and it's really good insurance. He believes no one - they don't know anything. Then, he'll say that it doesn't pay anything and that he'll be broke. He is combative when going to the doctor and when taking meds. By the way, any tips on giving him his meds? He firmly believes we are trying to give him a stroke or paralyze him, if not trying to kill him. I explain that he has to take his high BP meds and blood thinners or he WILL have a stroke or heart attack. He doesn't believe us. For example, it took us 45 minutes to give him his night meds last night. This morning, my husband spent an hour and 4 minutes. We really don't know what to do. We can't just let him go without his meds, but he's becoming more combative and once they melt in his mouth (he holds them in his mouth until they do), he will spit everything out. Any tips? Clearly, we need all the tips we can get. :) Thank you all.

rojo1215 Jul 2019
My Mom went through this stage. It is incredibly challenging. I love the answers of voiding checks, expired cards and trusted experts. Telling them 'NO' or 'insisting' on anything generally goes badly at this stage. We found crushed meds with syrup or jelly, anything extremely sweet to cover the bitter taste, worked best. My experience with 4 different nursing home recovery stays tells me that they are generally not prepared to handle this either. I'm sorry to tell you that but my Mom fell and sustained serious injuries and bruises at all places because staff were not trained in how to minimize the behaviors. In the end we were able to find a medicaid supported program for care in our home. It's 1 option. It's no picnic but it's what I could live with. The good news is that this is a phase. Most people become less aggressive as the disease progresses. My Mom passed last month. I have a scar from one of our early battles when I didn't know how to manage things. I kind of like it now, it's like a badge of honor, ha! Speaking of handling things - find all the articles you can on communication styles. Making eye contact, speaking softly, touching, learning the 'tells' of rising agitation. You can minimize the episodes. Good Luck and God be with you and you loved ones.
BrielleD11 Jul 2019
I'm so sorry to hear about your mom. Regardless how hard it is to care for them, the loss is equally as hard.
Ah, crushed meds with jelly is a great idea! Never thought of that! :)
To be honest, I am afraid to put him in a nursing home...our family hasn't had great luck with NHs. Part of me is afraid he's too far along for AL. My MIL was in AL and it didn't last long. As soon as she began falling, they shipped her to a NH.
I'm glad to hear that it's a stage, that's what I was hoping. As I've already mentioned, I firmly believe we're in an adjustment period where he's defiant because he just lost his independence.
Thank you so much!
JoAnn29 Jul 2019
You FIL needs an eval from a neurologist. He needs something to calm him down. This maybe a job u can't do. He may need more care than u can give him.
BrielleD11 Jul 2019
We know, his appointment is August 5. We're new to this (he's only been with us a month and this has seemed to progress quickly), but we're learning as we go. We're ready to care for him until we can't. My husband is a SAHD and is able to spend all day with him. He bathes him, feeds him, takes him to doctor appointments, etc.

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oyadancing Jul 2019
I'm so sorry, I know it's overwhelming. For your FIL, it does sounds like both a neurological and psychological evaluation are in order. This is very difficult, and there are no easy answers.

In the beginning when I started looking after her, my mother was extremely argumentative and uncooperative with me abut everything. I asked her PCP could he give her something to "take the edge off" and he said yes, but then I decided to try a few other strategies first.

Regarding money, finances, insurance, meds, in my case what I say doesn't count (I'm no expert from her point of view), so I had to figure out the simple pat "answers" with "experts" that would momentarily satisfy her (until the next time, of course!), stop the fussing, and we could move on. "Ed is handling all that" (her trusted financial adviser); I told Ed that he was my goto when needed. In the beginning she'd call him and he'd back me up, bless him; now I just have to say it and it settles her down. "Dr. S says you HAVE to..." (her long time PCP); she likes him and will begrudgingly do what he says, and I use that to my advantage. Between Ed and Dr. S, so far things have settled down. Good luck!
BrielleD11 Jul 2019
As posted, his evaluation is scheduled for August 5. Also, he just moved in with us a month ago. So, he's still adjusting from living alone for 40+ years to living with people. I believe a lot of his anxiety comes from that. We've adjusted our bill-paying strategy so he can regain control. He already seems to be doing a little better with the new strategy that we just implemented on Sunday. For the most part, we have his finances (hubby is financial and medical POA), insurances, etc. ironed out, but FIL is just stuck in his head believing he knows better. Eventually, after he adjusts, I think he will get comfortable that he doesn't have to spend his life savings on medical bills. I appreciate your response. It took us a month, but we finally figured out we were going about things all wrong. We need to allow him a little "control" in his life - even if faux control.
JuliaRose Jul 2019
its not an easy situation. I feel for you. As for the checkbooks, void all the checks and let him have it. It won’t matter then if he sends checks everywhere and the busy work of doing that might be a blessing. You can even give him fake bills that he needs to pay if he finds any sort of joy in feeling useful like that.

Also, give him a wallet with cards that are expired or store cards that can’t get him in trouble. Keep an extra wallet with you somewhere else so when he loses it and starts accusing you or your family, you can pull it out like magic.

Welcome to the caregiving adventure!
BrielleD11 Jul 2019
Awesome ideas! Thank you so much! So far, I've caught on to his "hiding spots" where he has been "losing" things, but I think that wallet idea may need to happen sooner than later. It's a great idea. Luckily, he needs a new wallet (his current is ripped and falling apart), so we can buy two identical without him knowing. It'll work perfectly.

Thank you!
Vinny101 Jul 2019
I am dealing with a 7th stage Alzheimer’s patient. I have the combative behaviours, the issues with having “no money”, everyone is stealing, etc, etc, etc.

What has worked for me is simply agreeing with her, telling her she has money in her handbag, may I help you look for your check book, I am so sorry you are going through this, are you hot/cold, are you hungry, do you need to go to the bathroom, are you scared, I am here with you. These are all the terms I use when getting eye level with her. I hold her dominate hand palm to palm, eye contact, and use my other hand onto of the hand I am holding. When she is screaming I mouth words softly so she has to stop screaming in order to hear me.i hope this helps you.

waltjeffries Jul 2019
My Mom was the same way with medicine. We started telling her that they were just vitamins and she started taking them fine.
BrielleD11 Jul 2019
Great idea! Thanks!
Dockson Jul 2019
Hi BrielleD11, my mom has Alzheimer’s and I’ve been taking care of her for 6 yrs now. She can’t swallow her pills anymore so I checked with her doctor to make sure her pills can be crushed and they can. After crushing I put the powder into a small amount of hot water to dissolve because some pills have a bitter taste and then I put it into her Ensure that she drinks 3 times a day. so I put them in her Ensure which she drinks 3 times a day. Or you can put a small amount of Ensure or his favorite drink into a cup and mix in the dissolved pills together. I hope this helps. Good luck.
BrielleD11 Jul 2019
Oh, great idea! I will check with his PCP and make sure we're okay to do that and go from there. Thanks!
CORGIMOM Jul 2019
As a retired RN I often had patients who thought I was trying to poison them or that the medicine was harmful. In pills that are not enteric coated you can crush them or open the capsules and empty the powder. If you aren't sure ask the pharmacist. I used applesauce, pudding or yogurt. Add the med to a small amount ( the size of a med. cup 30 ml.). Then add a little sugar or sweetener. This will mask the bitter taste. Mix everything just before you give it so it doesn't dissolve. Be sure to feed the mixture to be sure that they get all of it. On pills that you can't crush, you can sometimes put the whole pill in the yogurt, etc. and feed that spoonful as well. This doesn't always work, but sometimes it makes medicating a simple, pleasant process. Good luck 👍.

Jannner Jul 2019
My mother’s ( vascular dementia with behavioral changes, possibly ALZheimers as well) neurologist said change the subject. If they still rant and rave, make sure they are in a safe place then leave for a bit ( in your case, probably another room or maybe the backyard, just out of their sight line) . Often they will calm down. It will come up again but basically you can’t fix it so you want to reduce the outbursts as much as you can.
Sometimes the anger stems from frustration and anxiety. Anti anxiety meds may help with that.

if you decide to look for assisted living, some have Memory Care as well so they can move from one part to the next with as little difficulty as possible. Any change knocks them for a loop. Also talk to them about their philosophy of dementia care. Do they keep the residents engaged?
Also if he wears glasses or hearing aids make sure they are working as well as possible as those problems also exacerbate dementia. Same with infections, if you notice a change in his behavior, check for one.
Socialization and activities also helps so if he’s capable of going to a senior center or similar that may help. The less my mother is involved with activities the more anxiety and frustration hence anger she displays.

Rattled Jul 2019
So hard... and oftentimes so sad. Moving a dementia patient is confusing for them, especially when they feel they’ve lost control of their finances, decisions, and daily activities.
How about giving him things to “think about” so he can feel like he has some control, but you can narrow down the choices. Ex: “would you like to wear this or that?” Or “do you want to eat first or take your meds?” Or “would you like to pay your bills now with me or do you want to shower beforehand?” Then, write it down in front of him so he can refer to his “list”....
its a little suggestion, but my dad was a list maker, and writing things down on a bullet point list seems to keep him going..
best wishes. It’s hard, I understand totally!

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