Noncompliant Caregiver Woes...

[AtlantaRN, RN]

Have had a patient for 6 months, end stage alzheimers, not oob for 6 months. Developed shingles 3 weeks ago, ordered acyclovir-5 tablets a day. Caregiver is noncompliant, says even with crushing, "she just won't take them..." Now her poor skin looks like cellulitus with blisters all over her. Getting social worker involved because acyclovir was a 10 day round, and bottle is STILL half full, encouraged caregiver that treating shingles wouldn't quicken or slow the dying process. I think he is just flat burnt out, but he doesn't want her in a nursing home...He won't even put benadryl on her skin because he says "she won't let me." I mean, sure she will get irritated, but as long as you distract her.

It's just so sad...even the nursing assistant was just flat out angry today...she said there was dried stool all over the patients backside, like she hadn't been cleaned all weekend. I believe he is getting depressed, with only us hospice folks helping him; he has children, but they don't visit anymore because their thought is "mom won't know it anyways..." yeah, but what about dad?

It's just sad.

[leslie :-D]

sounds like dad is afraid of ruffling her feathers.

he doesn't want to upset her in anyway.

my instincts are telling me that a referral to a snf would be met with resistance but would actually be a blessing in disguise.

sure, he'd feel guilty but a huge burden would be lifted as being the only caregiver.

do you think social services would agree with this?

or the licsw could also meet with all family members, encouraging more active participation.

leslie

[AtlantaRN, RN]

our social worker is a great person, and she will support NH 100%. Dear hubby is burned out...

[BeExcellent]

O I don't know about NH. Pt may die quickly and then CG will be left with hard to heal guilt on top of depression. Respite can be used as a middle breathing room step, if CG allows. I have gone chart combing to find secondary phone numbers of family or friends and gotten people that love the CG to rally around during this difficult decision making time. Sometimes family and friends just don't know what to do. Lastly, was the pt ever cognitive enough to indicate where she wanted to die? I hope things smooth out. Keep us posted.