When my wife, who suffers from dementia, tells a caregiver to leave the house, how do we handle it?

The caregiver can leave the ROOM instead.

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.

You will have to make it clear to all who care for your Wife that she isn't responsible and cannot direct them to leave, cannot fire them or make them leave and that leaving her represents a danger to her and neglect of their duties to her. Make it very clear that they cannot leave until you are notified and arrive to take over.

The caregiver works for you, so she shouldn't leave unless you tell her to, so that was good.

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.

As already stated, caregivers need to understand that they are to take direction from YOU, not the patient with dementia.

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.

In 10 minutes, your wife could have burned the house down, wandered off, or done any number of dangerous things.

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.

I would recommend the caregiver say something like:

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

Try and determine what precipitates this, Confusion about why she is there; time for a shower?, fear of her? I agree she should not leave the house. Is there a personality problem between the two? Does the caretaker's approach need to change, that may help, or change the caretaker. I see a lot of different ones in our facility with very different involvement with their clients. Is yours a "fit" with your wife?
Do you need to investigate placement in a memory care facility?

The caregiver can do any of the following
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.

I hope u have a Caregiver there more than 3 hrs a day if your still working, running and playing golf. Golf alone is a 3 to 5 hr game depending on how many are playing and how many holes ur playing. My husband is a golfer.

From what u posted, ur wife should not be left alone at all. Dementia is very unpredictable.

I’m wondering why she takes Ativan. It’s a benzodiazepine. Very addictive and Ativan (Lorazepam) is usually prescribed for epileptic seizures and can cause paranoI’d or suicidal ideation, impaired judgement and memory.

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.