"I have a question. My father has always been a bit of a slob. Now that I am caring for him, he absolutely refuses to change his clothes. It is embarrassing. What can I do?"
Do you have an elder care issue like this? If so, you may have found some frustrating advice online. Most caregiving support communities and even medical professionals are so hung up on the fact that you and your loved one may have limited time together that they tell you things like:
"Try to reason with him. If that doesn't work, don't force the issue. He is asserting his independence."
Advice like that is really easy to give, but not so easy to live with. After all, you are supposed to be a great caregiver, so how does it look when you take Dad to the doctor for the third time in a row in the same stained, reeking outfit?
Caregiving is definitely not all peaches and cream. When you care for someone who either develops really bad habits or simply allows old habits to get worse, it can cause added stress to you and your family.
The following issues are not un-common in caregiving, yet many people like to pretend they don't exist:
1. Overly Slovenly Behavior
For some elderly, this happens because they are no longer aware of what they are doing. But what if they are perfectly lucid and just refuse to maintain any semblance of hygiene?
One caregiver that I know admits that she is tempted daily to place her mother in a home for this reason. According to the woman's family, this behavior is not age-related. It was always present. Everyday, they struggle with these issues:
- She refuses to change clothes for weeks. If she bathes, she wants to put the same clothes back on. Including socks and underwear, even though she has dozens of new pairs.
- She absolutely will not wash her hands after using the restroom or before eating. She will leave the bathroom and go right to the refrigerator. If they protest, she says her germs never killed anyone before.
- She will only agree to a bath about once a month or more. She won't even wash up before a doctor's appointment, even though they make the baths as warm and comfortable as possible.
- Since they never have to replace the toilet paper in her bathroom, they know she isn't using any. She says it is a waste of money.
Although it is not always deliberate, this behavior certainly can be at times. Especially if it was present at all stages of the person's life.
2. Jealousy
Sometimes elder caregiving can mean dealing with the so-called "green-eyed monster". You will see references to this on advice sites, usually worded like this:
"My aunt is extremely clingy. She is afraid to have me out of her sight, and will try to draw my attention away from my husband and kids."
Sometimes jealousy can be much more serious than this though. Consider these two scenarios shared by caregivers:
- "Even though we gave my mother 24 hour attention most days of the week, she was still extremely jealous whenever our grandson would come to visit. She would cry, yell, throw things or hide in her room until he left. We made the decision to put her in a home after our suspicions led us to place a video baby monitor where he was napping. We caught her pinching him to make him cry, because she knew his mother would take him home if he became "fussy". We were afraid that she might get more violent as he grew older."
- "When my father moved into our home, I stayed home to become a caregiver while my wife continued to work. During the day, Dad was friendly and cooperative. Whenever my wife came home he would say that there was no place for him in our lives. Soon, he began telling my wife that I was having affairs while she was at work. That led to a lot of fights, as I felt she had suddenly become unreasonable and jealous. We went to counseling and eventually discovered the cause of our 'issue'. The sad part is, my wife was one-hundred percent supportive and it had been her idea to drop one income to make sure Dad had good home care."
3. Lying
Normally, people tend to lie to protect themselves if they have done something wrong. This isn't always the case with the elderly. They might lie just to create a little excitement. Or for no reason at all.One of my grandmother's favorite pastimes is to lie to people who call her on the phone. She actually managed to get over thirty people fighting with each other before her phone was struck by lightning. (and yes, the symbolism of that was not lost on us.)
Her method was to tell person A that person B had said something about person C. And word kept getting around until it create total chaos. Since caregivers need support from extended family, this type of behavior can be emotionally devastating to everyone.
Lying can also be a big problem when it involves doctors. Elders may lie and say they are perfectly fine, when they aren't. Or, the may lie and say that they are not being cared for when they are. Either way, it is hard for a doctor to make correct diagnoses when faced with an untruthful senior.
4. Hypochondria
Two common problems of caregiving involve medication. In one case, it is very difficult to co-erce a loved one into taking their medication. In the other case, they forget that they have taken medication and double dose. (or skip doses).
But what about the third scenario that isn't mentioned as much? This is the person that shows signs of hypochondria. They LOVE taking medicine. In fact, that is all they want to talk about.
We had once such person in one of the nursing homes where I worked. Every few minutes she "needed" a dose of something. According to her, she was a sufferer of:
- Constipation
- Diarrhea
- Heartburn
- Headache
- Arthritis
- Colic
- Gas
- Colitis
- Fallen arches
- Bunions
- Corns
- Malaise
- Fatigue
- Insomnia
- Dry skin
- Oily scalp
- Itchiness
- Numbness
- Heart palpitations
And just about anything else you could find on WebMD. And not just occasionally. She had all of these all the time. (yes, she would ask for a laxative and a pill to prevent diarrhea at the same time.)
What was her real medical issue? She had a touch of arthritis and high cholesterol. She was in therapy to improve speech after a mild stroke.
When my own grandmother came to live with us (because of failing eyesight), she packed a pharmaceutical suitcase to rival any Walgreens. When we mentioned to her doctor the amount of OTC products she was using on a daily basis, he came very close to needing medical care himself, and ordered all of it to be thrown away. That led to a year of tantrums, fits of depression, and night-time escapades where she would get up in the night and rummage for any kind of pills.
If you asked what she needed, she might say:
"I have heartburn. Its killing me. Or maybe its just a headache."
The medication actually had to be moved behind locked doors, because whenever she would discover a bottle, she would dose herself without ever questioning what type of pills she was taking.
When Does Annoying Become Serious?
To a certain extent, all of these behaviors can just be minor annoyances. However, they can escalate into major health and safety issues for all involved.
1. Poor hygiene
Endangers the health of your loved one and and everyone else too.
Refusing to change clothes or bathe can lead to nail infections, skin breakdown, rashes, urinary tract infections and more. It can also spread bacteria (such as those that cause food poisoning) to others.
2. Jealousy
Can lead to emotional trauma and broken families.
It can also lead to physical aggression that can endanger the physical safety of the caregivers.
3. Lying
A lie is only harmful if it is believed. If it IS believed though, it can lead to strained relationships among family members. It can also lead to investigations of abuse.
4. Hypochondria
Can be managed if you take care that all medications are safely locked away. However, that might not stop someone who is desperate. Overdosing on OTC medications can be deadly.
What are the Solutions?
Unfortunately, there isn't much advice available on any of these issues. I would recommend bringing any of them to the immediate attention of your loved one's doctor. Keep a journal or take notes/photos/videos to document the behaviors. Make sure you let them know that these are important concerns and that you want answers. DON'T let them brush you off with the common:
"She or he is just old."
If you, your family, or your loved one is in danger because the behaviors have become more than you can handle, consider getting help from a home health service.
If this isn't possible, it might be time to consider a nursing facility. And caregivers, don't feel guilty if you can't manage alone. Even in facilities, it is sometimes difficult for an entire staff of trained professionals to deal with these behaviors.
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