So I have been taking notes on how other aides deal with dementia residents as I can add it to my repertoire data bank for future reference in case they have better luck dealing with impossible situations where there is no knowable way to come out ahead and the other aide I was working with was holding the resident's hands so she couldn't hit either one of us. Of course, you can't hold the hands too tight because that can cause bruises. So each time she had to let go of the resident she would say stop to the resident as the resident was hitting her. Of course, communicating with an irrational person because one is used to communicating with the rational type of people can seem like a waste of time. But I have noticed that there can be moments of clarity between the irrational times and the rational times. It is like it can be timed like stop film photography. If one was to diagram it on a flow chart it would like -rational-irrational-rational. Another way to look at it is if one was timing an engine with a timing light. So I thought I would try the theory out. Needless to say it didn't work out. I said, "You don't have to beat me up to show me a good time." The resident said, "Get out of here you s.o.b. and take that biotch with you."

wow!!!!

I relate to everything you are saying here because I work with the elderly, many of whom have dementia and alzheimer's .... One thing I have discovered is they respond not so much to words, but more to the "tone" of the words and not so much to touch, but to how the touch "feels"...If tone is soft and sincere and touch is gentle and reassuring they usually calm down and cooperate... Without rationale, the senses take on a stronger meaning, they are heightened. The dementia or alzheimer patient has an enhanced sensitivity level and they react accordingly

That makes sense. After all the brain which contains the mind is a sensory preceptor; Hence it is called the suprapharyngeal ganglia. When I worked for Handicapped Services for the college in Wichita I found that when one sense such as sight went down or was not available the other senses such as hearing were enhanced and heightened. The event helped me to understand though that it wasn't because I was a male that she was upset with me as evident in the labels she bestowed upon us. We both did our level best to not upset the resident which we had to deal with because of state mandates and because we are both care givers. Because of pressure ulcers our two hour turns have had to be modified and it has taken on a whole meaning for me since I never liked being the 'bad guy'. It is like this damned if you do and damned if you don't type of situation. It has been like this real honesty question of whether it is better to hurt someone's feelings by what could be construed as abuse with a normal person or hurt someone physically by neglect. It has been a real moral dilemma for me but since the resident is not in their right mind I find it is the neglect which is the greater evil. It does remind me of a catch-22 at times but then when the resident comes back to their right mind it is like the event never happened. Of course, that always freaks me out.

It is hard to verbalize "how" best to deal with a dementia or alzheimer's patient/resident but what I tell techs is this, "Physically, handle them just as you would a newborn, gently and with feeling, verbally, talk to them just as you would talk to any person, respectfully and in a tone that is inviting, not agitating, talk "with" them, not "at" them.... In my experience, they almost alway respond in a positive way....It is very important to establish a good rapport with these patients...It takes time and commitment....

Okay. I have had good results trying that with another resident with dementia. The other one I was talking to them like a new born. To both of them I was talking to them and not at them. The other one at first reminded me of the woman in the 'Exorcist' movie. But gradually I did build up a trust with her. Now she has the hysterical laugh but is non-combative. I was actually being respective to the one I was having a problem with and when she is in her right mind I noticed it did make a difference. They both respond well with a voice of authority. Primarily the one that has the laugh as she used to be militarily trained. I call her 'my little buddy' and she seems to like that. She is actually quite submissive while the other one has a dominant nature. It just seems to me this state mandate of the every two hour turn is quite barbaric but who I am to argue with those who made the policy. I even went to the D.O.N. about it and asked her how she would feel if every two hours someone was to wake her up. It just seems to me that people in prison are treated with more humanity. It has been a five year commitment for me. It is just difficult to wake people out of REM but I am getting better at it. The hard part is learning how to wake up the dementia ones without terrifying them. With this one I just have to take it real easy and gently. It is like any sudden movement or sound brings her to an agitation state. I have to call her name real softly until she can wake in a calm state.

Couple of things...I didn't say "talk" to them like they are newborns, I said handle them physically like they are newborns...In other words handle them delicately, tenderly...Talk to them like they are adults, normal adults, not babies...
In regards to turning every two hours, this is absolutely necessary for the resident who is physically not able to turn on their own. You need to learn more about pressure sores and not only how quickly they develop, but how fast they progress and how very difficult it is to cure them once they reach a certain point. ...I don't know if you work as a team (two techs per hall) but if you don't, you need to ask a floor nurse or another tech to assist you with a resident such as the one you describe....If you have the resident on a chuck, two people can turn them without waking them. If you are strong enough, you can do it alone too...You use the chuck to raise them, remove the support (usually a pillow), lower them, move to the other side of the bed, raise them by lifting them up with the chucK and insert the pillow....

oh my heart goes out to both of you...thank you both for caring so much and loving your job well enough to do it well...I took some nurses training way back in the day and learned quick I could not do it...of course I was quite young and impatient back then...anyhow...you are both angels...thank you again.

I have done a lot of work with elderly dementia people and something that consistently helps me when I am trying to do something in the night is to hum or sing softly.

If it is something non treatening like and era familiar to them or when they were in a happy time of life it can help a lot. When you wish up on a star, You are my sunshine, Michele Row the Baot Ashore, My Belle Michelle, even hyms or, Christmas sons in July can have amazeing effects.

And I don't call them by name; especially their last name because that tends to alert them (like someone is going to give them a shot, disciplene them, arrest them, collect a bill). I find something soothing like My dear, Sweet pea, Darlin. or even Sister usually gets cooperation. I know it is frowned on in some circles but my patients generally like being called BabyDoll or the Guys Teddy Bear but that may be my southern drawl.

If you know their first name and want to be respectful you can always address them as Miss Susie or Mr. Roy. If I know a guy well enough to know their history I may call them Top or Sarge or Chaplain or even Boss. One thing most military men do NOT like is being called Sir; the standard belief "Don't call me Sir I work for a living."

Smileing while you talk helps change the tone of your voice to something softer and friendlier. As will nodding and even visually cueing them by closeing your eyes, blowing through pursed lips, if you want them to calm down.

If words are not necessary or not understandable sometimes just a soft whisper whistle can be very calming. Or humming; they don't have to strain to try to remember the words or deciper if you are telling then something mid stream. Which sometimes you can actually do like Red Rover Red Rover send Tommy on over. Their are exceptions but most people relax and kind of flow with the music; especially when the conceptual understanding has deteriorated. .

Just softly talking through the steps of what you are doing is sometimes helpful. "Mr. Don we are going to roll you over, slide you up, straighten your covers, have you hug your pillow. Now your going to go back to sleep so nice and comfy.

There are some reflext points that sometimes helps patients move where you want them too. Sometimes a warm blanket or a cold pillow will prompt a change in position.

One thing most elderly don't like is being uncovered and if you can allow even part of their body to be covered while you are changeing them. Some elderly even like it nesting with their head covered and you can simple pull the covers up rather than down.

When a patient is combative it is a real challenge. Generally you want to Defuse/Distract/Redirect.

If a person is actually striking you obviously if you can just move back that is the best first move. Sometimes you have to hold on to their hands but if you can move them around so they are pounding a pillow or swaying sometimes you can disengage as the target or hug them. You want to be sure you are not going to get head butted because believe me some of these seniors can put cage fighters to shame. lol

Since arthritis is almost universally accute in the hands and wrists trying to restrain someones hands is going to up the anti as pain rockets through the body.

Something that often will calm a hysterical senior is to just sit down. As long as you are over them or approaching them on two fronts they are going to feel in jeapordy and paniced.

As quickly as you can move to a distracting behavior; espeically if is something they might want to engage in they will forget whatever it was that aggitated them.

When you can determin they have been distracted you can then try redirecting them.

The BIG thing is you can much easier stop and unwanted behavior by substituting a behavior that is tolerable than trying to make them stop doing something they want to do.

What WILL MOT WORK is Ignoreing a unwanted behavior.

Thank you for your response. Like Leigh said above it is easier if you have a partner to help you or the bigger chuck to turn with. Usually I have neither. Oh, we have a picture of the nice big chuck in the nurses' station and day-shift usually has partners. But that is when the family of the residents come to visit so it is important we look good. Also that is when state comes by. Day-shift is when we have our in-services and when the doctors come by. But on night shift we have to deal with this thing called sun-downers. Day-shift thinks that everybody sleeps at night so it is okay to run with fewer aides and nurse at night. It looks good on paper and the theory even seems sound. You are right as it is a labor of love because I can tell you when you work in the rural areas it sure ain't the pay or benefits because they just aren't there. I usually tell everyone who finds that this line of work isn't there cup of tea that all the smart ones leave. But then there are the angels and then there are the fallen angels. The hardest thing I have had to fight is the indifference. When it just becomes just clinical to me is when I have to get in touch with my higher power because one of the greatest benefits to me is what I call nursing home magic. It is a spiritual thing that drives me because sometime the only aide I have is myself because the nurse has three floors on night and I usually have the whole floor to myself. It is like a real treat when I have help. The D.O.N. is doing her best to get us more help. It is like most jobs though - understaffed and underpaid.

Thanks. I can see that sometimes you have to do the job by yourself and only had yourself to help you.

I am trying to encourage a nurse to stay. She said that she doesn't think this job is right for her.