Live-in RN advice

[lauraline]

I am not a live-in nurse (although I am still a student). But I am in dire need of advice from your perspective.

I have hired live-in nurses to care for my 88 year old grandmother who has some early signs of Alzheimer's among many other medical conditions. The problem is that my grandmother keeps firing them all. There are no real reasons, just irrational things like "she was sleeping in my house", or "she was getting paid too much."

I have gone through 3 frustrated nurses in less than 1 month, and now it looks like I have to hire another. I try to reason with them, but eventually they get fed up with grandma.

Has anyone had experience with this type of situation? Anyone have advice for me? What is a nurse supposed to do in a situation like this?

Please help, I am desperate and don't know who better to ask than the nursing professionals themselves. Thanks.

[meanmaryjean, DNP, RN]

I would tell the nurses that they work for YOU, not her, and only you can fire them. If there is a dementia diagnosis- she cannot logically make these type of high-stakes decisions. I feel for you- dementia is so incredibly difficult to deal with.....

[NC29mom, ASN, LPN, RN]

Are you hiring NURSES? or nurses AIDES?

If nurses, why does your grandmother need that level of care? She doesn't sound end stage...if shes still talking in complete sentences...

Does she need around the clock care? Does she live alone? Are the "nurses" you are hiring young? Maybe an older nurse, with more patience/ compassion/ apathy/understanding of her disease process? What exactly do the "nurses" say about what went on? Maybe there's something thats going on you don't know about...

Or...maybe its time to make some adjustments to her medication regimen.....

Just brainstorming. ..

[lauraline]

Thanks all for the comments. To answer some of your questions, my grandmother has a. fib. and a really bad mobility issue. I am working on having her tested again for Alzheimer's and dementia, but I am almost positive it is there. I have hired LVNs and HHAs mostly. They were all very experienced and older, and mostly received their education outside the U.S. (not sure if that matters). She lives alone, so I really need at least 2 nurses to share shifts 7 days/nights per week.

My grandmother is extremely difficult to deal with, because she scolds the nurses, and wakes them in their sleep to kick them out. She is not supposed to be walking around, but she insists on doing so at all hours of the night. She has insomnia, despite sleep medications. She requires someone to be there, because she often falls or gets into predicaments. One time she left the house on her own in the middle of the night! I have tried convincing her to consider living with a relative or a facility, but she absolutely refuses.

It's all very frustrating. In the meantime, I am resorting to calling an agency for last minute help. So, I am pretty much at a loss on how to find some normalcy.

Again, ANY advice or ideas are welcome! Thank you.

[lauraline]

Just to mention a few things that the nurses have said happened, they say grandma wanted to kick them out because she didn't want them sleeping in her house, she thought they were burglars, she thought that they were grandpa's (deceased) mistress, she tries to fire them or tell them she is only going to pay something ridiculous like $5, she often tells them that she needs no help and to go home, which they know is wrong, but these things happen literally everyday, so I keep having nurses quit and one stopped showing up.

[Isabelle49]

The nurses or home health aides you hire should have a strong knowledge of the symptoms of and progression of dementia. If they have this foundation, they will not have much of a problem caring for your grandmother. I agree it does sound like your grandmother has dementia or Alzheimers, since she seems to be having irrational or delusional thought processes. I would definitely try to find someone to care for her who has experience and knowledge in the field of dementia/Alzheimers.

[turningred15]

Does she have a HCPOA and if so, has it been activated? (Two doctors signed off on her incompetence)

Until this has occurred she is free to make her own decisions about the care she is receiving. She can choose not to have the care although I agree that she needs it.

I believe the point of focus should be to activate the POA so that as more care is required it can be given. Good luck - this is never an easy thing.

[NC29mom, ASN, LPN, RN]

Wow....thinking someone is their husband's mistress is so typical of Alzheimer's/ dementia. So sad...

HPOA is a good idea; however, it sounds like the aides\nurses are leaving because they are unable to effectively deal with her behaviors.

Not sure what your feelings are regarding antipsychotic medications....Might be something to consider to give her a better quality of life in regards to delusions. Just know she will be at a greater risk for falls initially r/t SE.

Sounds like you just haven't found the right worker yet, too. That, and the right medications, are what you need....

[CrunchRN, ADN, RN]

You need to consult an elder law attorney and become POA.

IF she does have dementia this is not going to get better and a facility may be the only choice. Safety has to be the decision maker in that case. Not everyone is able to stay at home sadly. Medications might help though. Also, it would be helpful for the caregivers to get some special training in how to deal with these typical dementia related behaviors.

[elkpark]

If it's her home and the individuals are there to care for her, she is within her legal rights to refuse care and order them out of her home unless she has been found to lack capacity to make those kinds of decisions or ruled incompetent by a court and a guardian appointed. If her condition is expected to continue to decline, guardianship may be the way to go.

Tough situation -- best wishes!

[systoly]

i agree that a large part of the problem may be lack of training in dealing with dementia

perhaps you could ask prospective care staff if they have or would be willing to take some

of the training offered by the alzheimer's association

perhaps some behavioral interviewing

i've worked in several memory centers and for the life of me i cannot

understand why professional care staff wants to argue or insist on reality orientation

rather than concentrating on the fact that the patient feels threatened and is afraid

who cares if the patient says, "I'll pay you $5" - the patient probably thinks a loaf of bread costs 50 cents

it is always difficult to find someone with a heart, but that will be your first challenge

then what others have said

look into medical management

and legal aspects

you have a huge job on your hands and you don't have time for poorly trained staff

who wants an easy patient

i wish all my patients were easy, but then again, they probably wouldn't need me if they were

[NC29mom, ASN, LPN, RN]

i agree that a large part of the problem may be lack of training in dealing with dementia

perhaps you could ask prospective care staff if they have or would be willing to take some

of the training offered by the alzheimer's association

perhaps some behavioral interviewing

i've worked in several memory centers and for the life of me i cannot

understand why professional care staff wants to argue or insist on reality orientation

rather than concentrating on the fact that the patient feels threatened and is afraid

who cares if the patient says, "I'll pay you $5" - the patient probably thinks a loaf of bread costs 50 cents

it is always difficult to find someone with a heart, but that will be your first challenge

then what others have said

look into medical management

and legal aspects

you have a huge job on your hands and you don't have time for poorly trained staff

who wants an easy patient

i wish all my patients were easy, but then again, they probably wouldn't need me if they were

Great advice...i second that!