help with dementia patient please!

Flare, ASN, BSN · Jun 10, 2011

It sounds like social work and case management needs a swift kick in the behind to get moving. From an administration POV, if he has been there for 2 months without any medical reason to be in acute care, medicare is going to deny the claim and at the end of the day the hospital may have to absorb the costs of his care. We've dealt with that quite a few time already this year with long term patients on acute floors for no good reason not being covered. These people have no money and usually no family so the hospital has to eat the costs.

Rob72, ASN, RN · Jun 10, 2011

Pretty much what Jenni said. In basic terms, try not be be definitive in responding to their questions (i.e., "I let the dog out...") Qualify with things like, "I believe your brother/sister/mother/whomever is taking care of that...", "I'm really not sure, I'll have to check on that when I have a moment..."

The one re-orientation mechanism that (IME) does work, is reminding them that you don't know who/what/where is being discussed. E.g., "I'm sorry Mr. X, but I haven't met your son yet. Is he supposed to....? I'll see if I can find out about that in just a munite or two..." YMMV, but it has been successful for me.

Don't be too attached to reality. Its boring.

Ruby Vee, BSN · Jun 10, 2011

mom has alzheimer's. she's in assisted living, thank the diety, and for the most part is happy there. she believes, though, that she needs to "go home and take care of your father." dad died years ago. i call her every day, and when she gets on a rant about going home, i tell her that "you live here in town now." and when she asks why she can't go "home", i tell her "your memory is getting really bad, mom." she usually settles down and tells me she knows her memory is too bad for her to live alone and then starts telling me about her mother's dementia. she's going to get worse, and this won't work any more, but for now it does.

Jenni811, RN · Jun 11, 2011

mom has alzheimer's. she's in assisted living, thank the diety, and for the most part is happy there. she believes, though, that she needs to "go home and take care of your father." dad died years ago. i call her every day, and when she gets on a rant about going home, i tell her that "you live here in town now." and when she asks why she can't go "home", i tell her "your memory is getting really bad, mom." she usually settles down and tells me she knows her memory is too bad for her to live alone and then starts telling me about her mother's dementia. she's going to get worse, and this won't work any more, but for now it does.

^yea. you need to be careful with that with some of dementia. majority of the time i've used it, it has worked. where yo tell them "your memory just is not what it is used to be and for your safety it might be best that you get help on certain things such as cooking and getting to places." majority agree that it isn't safe to go home and thank you for the help.

it's kinda trial and error with dementia patients. good thing about dementia, is if you fail at one thing, they will forget it 5-10 minutes later so you can try something new. stick with what works for that patient. they are all so different.

and yes, i agree rob. you don't tell them a lie. because a lie would be "i let the dog out for you" (no you didn't) you validate, this means telling them something that is a "stretch of the truth", let's say their dog is dead and they need to let the dog out...something more along the lines of "your sister is taking care of things for you at home." you didn't lie about it, because you never brought up the dog, yet your telling the truth, or something completely logical...because that sounds logical as opposed to "i let your dog out"

steelydanfan · Jun 11, 2011

I need some advice on how to work with a dementia patient. I have looked up past threads on here about this but I couldnt quit find the answer for my particular situation. It seems that most of the advice I read was in regards to pts in LTC, but I am working on a med surg floor (as an extern, i'm still a student). We have a patient who has been on our floor for 2 months because we're still working on placement, we've had issues with making his daughter his POA and such. He's not so advanced that he doesnt know who he is and he knows he's in the hospital and because there's really nothing medically wrong with him he doesnt understand why he's in the hospital. Yesterday he was getting really angry and yelling that everything is bullsh** and we're just trying to keep there and push him to the side. He started packing up his things and putting on shoes and said he was going to leave to go live with "billy". I had no idea how to respond because I cant just say "you're here because you have dementia" since he wont understand that and doesnt know anything is wrong with him. I tried saying that we're finding a good place for him to leave and as soon as we have one he can leave but he just responds that he already has places to go. I try to observe how the nurses talk to him but most of them seem to just tell him things like 'its late in the day, just wait till tomorrow' and get him to agree to wait till tomorrow. While this works for the moment I dont think this is the best way to respond to him because his dementia isnt that advanced, he eventually gets angry again that we keep trying to make him wait "a few more days" and that has turned into 2 months now. I've seen a lot of people say to 'redirect' or 'reorient' dementia patients but can someone explain what exactly that means and how to do that in a case like this? Thank you so much for any tips/advice!

Dementia is simply unpredictable and you have to become comfortable with the fact that the symptoms change from hour to hour; or minute to minute. The patients internal cues are not always discernable to their caregivers, and we are left to try to discipher them. A hard job at best.

He is a "difficult placement", sad to say. He needs an Adult Altzheimers unit that can promote his independance while safeguarding him at the same time; think VERY expensive.

WittySarcasm, BSN · Jun 11, 2011

I work in a LTC facility however we have a resident there who sounds just about the same as your resident. The first thing I would suggest- if you have them- is some kind of wander-guard or some alarm system or something that will alert you if he gets to a certain place.

Secondly the "it's too late right now to go out," though it does not seem as nice usually is the easiest way to get someone who is packed up to wait. With our resident we tell him that the bank is closed until tomorrow. Or that the buses have stopped for tonight and he should try again tomorrow. The thing is, if his memory is just right at that moment, he won't remember so he will ask again tomorrow. No matter how long you talk about it, the patient is never going to remember that he has a progressing disease that makes him forget. He won't understand that you are putting him in a new place and that's why he's here. And so on...

Also really important is to keep your voice calm. Explain things carefully, anger is normal and sometimes talking to someone he knows will help. Is his daughter able to talk with him on the phone? Is there any family or friends that he has talk to? If so it can help distract him. Plus hearing it from a familiar person, the same excuses or asking him to stay for just a little longer, can help lessen the blow.

Keep Ativan or something handy. A PRN order is a life saver for when he gets really agitated or if he ever starts swinging. I don't know if he's gotten to that point, but it does come when an arm will swing out. It's...normal...for the anger and frustration. So ativan or something will help him.

Distracting him with crosswords or other activities he likes can help. Ask him to tell you something about him. Ask him what his hobbies are. Chances are it won't be the truth if he cannot remember but just talking to him will help. Or start up a random conversation and even though he may lie about it, he should talk back with you. I tend to randomly start talking about my lunch like- "Oh you know my cousin cooked today for luch, let me tell you she can NOT cook! I swear she could burn cornflakes." Then just ask him if anyone in his family ever cooked something horrible.

Or if he says Billy is going to take him home. Just start asking about Billy. Tell him you can try to contact Billy. And most likely he will forget.

I hope that helps a little.