New Medication Strategy

Meds on the napkin 2017-05-02 06.40.49

In an attempt to keep Mother’s pills off her lap, off the floor, and for them to actually reach her mouth, I’ve switched from the small Dipping-Cup-As-Med-Cup, which worked fairly well for the past year or so, to Meds-On-A-Black-Napkin.

With the dipping cup, she would feel for the pills and get two or three at a time, and they didn’t all always get to her mouth. She couldn’t see if/where they dropped and didn’t much worry about it, either. I would try to stand by and monitor, insisting she pick up one pill at a time, but then the dogs would bark to come inside, or the phone would ring or who knows what. She would also swirl her finger around the bowl to check how many were left, and end up swirling one or more out onto the tablecloth without realizing it.

So, a new strategy. Pills spread out across a high-contrast background so that only one comes easily to hand at a time. I still have to stand there, but at least one of us can better see what’s going on.

New Alarm

New Alarm for Mom 4.11.17

Sometimes I’m slow.

Most days, after Mom has her morning coffee and cookie, she moves to the couch and manages to fall asleep for the 10-15 minutes she has before it’s time to get dressed. I’m doing stuff around the house, the time slips by me, and suddenly it’s almost time for her ride to arrive, and she’s still sitting on the couch in her gown, dozing to the morning’s news.

It’s only taken me a year to figure out how to fix this.

Sunday Shopping

We go grocery shopping on Sunday afternoon. Every week, Mother looks forward to it and I dread it. Recently, I talked myself into trying to reframe it from “my weekly grocery shopping trip that I have to take Mom along on” to “Mom’s weekly outing wherein I also get to buy groceries”. And I really tried yesterday. I really did.

Around 4 pm, I hear Mom move from the couch to her bedroom, and I know she is getting ready for our grocery outing. After dressing, she goes into the bathroom to comb her hair and apply her lipstick. I remind her that she needs to change her briefs. When she strongly protests that she just did, just before she got dressed, I allow the look on her face to convince me that, even though I didn’t hear her go into the bathroom, perhaps I just wasn’t paying attention at that particular time. I don’t really believe her, but I don’t want to argue with her, just in case she’s telling the truth.

When it’s time to go, I check the back of her pants to make sure they’re not wet, and we head out to the car. When we arrive at Publix, I don’t think to check her pants when she gets out of the car, so I don’t see the saucer-sized wet spot beginning to spread across the back of her legs until she’s maneuvering to sit on the bench just inside the front door. I briefly consider ignoring it and getting on with the grocery shopping, but I know it will just be that much worse later. I bend over to say loudly into her ear, but at least not yell out to the entire supermarket, “You need to get up. We need to go back home.”

“Why?”

“Your pants are wet.”

“They’ll be fine.”

“No, we need to go back to the car. Your pants are wet.”

“I don’t have any pants in the car.”

“No, we have to go home.”

She realizes I’m not going to let it go, and slowly stands to move toward the door. I pull aside a young bagger to let her know that someone should wipe down the middle cushion of the bench.

When we get to the car and are pulling out of the parking lot, I say, “I WANT TO TELL YOU THAT I’M ANGRY.”

No response.

“DID YOU HEAR ME?”

“No, what did you say?”

“I SAID, I’M ANGRY.”

“Why are you angry?”

“I’M ANGRY BECAUSE YOU LIED TO ME ABOUT CHANGING YOUR BRIEFS. AND NOW THEY’RE WET AND WE HAVE TO GO HOME.”

“Well, I don’t want you to be angry.”

“AND I DON’T WANT YOU TO LIE TO ME ABOUT CHANGING YOUR BRIEFS. AND I’LL BE COMING BACK TO THE STORE BY MYSELF.”

“By yourself?? Why??”

“BECAUSE YOU LIED TO ME ABOUT CHANGING YOUR BRIEFS AND ENDED UP WITH WET PANTS. THAT’S NOT OKAY.”

When we get home and inside, I move to block her way to the couch so I can direct her into the bathroom to change. I wait to take her pants so I can put them straight into the wash, along with the pad she was sitting on in the car.

“Can you bring me some more pants?”

“No, just go on in your room and put on a housecoat.”

In the laundry room, I use a stainstick on the blots of lipstick spotting the front of her white pants before putting them and the pad into the washer. Over the splashing of the water filling the tub, I faintly hear my husband call from the other room that she’s yelling for me. I finish what I’m doing and go into her room to find her sitting on the bed.

“I need some pants.”

“No, just put a housecoat on.”

“I don’t have one.”

“They’re in your closet.”

“Will you hand me one?”

I pull a bright yellow, snap-front housedress off its hanger and hand it to her. She struggles to put in on, as if she’s never done it before. At this point, I’m too annoyed to be sympathetic, and while I help her put it on, I insist that she snap up the front herself.

“Okay – I’m going back to the grocery store.”

“And you’re going to leave me here.”

“Yes, I am. Do you know why?”

“Because you don’t like me.” (This is a joke/not joke reply. She doesn’t really think I don’t like her. But she knows I’m irritated with her.)

“No, because you lied to me about not changing your briefs.”

“Okay, okay, ” she says as she looks away. This is her way of ending the conversation. She lipreads as much or more than she actually hears. If she’s not looking at my face, I know she’s no longer participating.

I move to the door and, 45 minutes after my first attempt, leave, once again, to go buy groceries.

 

Another Friday Morning

6:18 am – Mom is up before my alarm, having awakened and turned hers off. I hear her in the kitchen and hurry to let the dogs out and get in there. By the time I make it, she has already poured her own coffee and dribbled half-and-half on the floor. Gracie will take care of that shortly.

6:20 am – I feed the dogs.

6:22 am – I hear “clickety-click-click” and turn to see one of Mom’s pills from yesterday morning come to rest on the floor behind her as she settles into her chair. Where has it been hiding since this time yesterday? Who knows? I pick it up and show it to her, explain where it came from, and try to reinforce the idea that she needs to put ONE PILL AT A TIME in her mouth. She says, “Okay.” “Okay, what?” “Okay, whatever you said.”

6:25 am – I get Mom’s morning meds for her. I stand by to make sure she takes ONE PILL AT A TIME. Towards the end, she grabs two. I bend down, holding up one finger – “ONE PILL AT A TIME!”. She nods and sets her pill cup aside because she can’t see the last bright orange pill against the bottom of the bright orange cup. I tell her there’s still one left. She feels around the bottom of the cup three time before finding it. She asks if she should take the one from yesterday that I found on the floor. I tell her no and throw it away.

6:30 am – I let the dogs out after their breakfast.

6:33 am – I fill my coffee cup and settle at my desk for morning journaling.

6:36 am – I hear Gracie barking and let the dogs back inside.

6:42 am – The dogs bark at a passerby.

6:48 am – The dogs bark as our neighbor across the street backs his car out of his driveway.

6:59 am – I open the front blinds. Too early to wake Mom from her doze on the couch, as she will tell me she’s waiting for 7:05. Or 7:06. Or some other arbitrary time.

7:13 am – I arrange Mom’s walker straight in front of her and wake her so she can get up to go get dressed. She gathers up all the paper napkins (five? six?) she’s arranged across the middle couch cushion to transfer them to the basket on her walker. I take them from her and throw them away, along with the one on the lamp table that Gracie is waiting to chew up when no one is looking. I walk over to the dining table to put exactly three paper napkins in the napkin holder by her seat at the table. I notice the coffee spill from her overfilled cup on my white and pastel striped tablecloth.

7:15 am – Mom calls from the bathroom because she has no toilet paper. I ignore the ringing phone and let the confirmation call for her ride service go to voice mail. There are three or four such in my voicemail box from other days.

7:20 – I hear Mom come out of the bathroom and enter her bedroom. I retrieve three pairs of socks from under one of her Bingo prize pillows on the couch and make it to her room just in time to put them in the hamper along with the clothes from yesterday that she is reaching for to put on again today. “No, Mom. Get clean clothes from your closet.”

7:32 – Mom comes out of her room so she can sit on the couch and see out the window while she puts her socks and shoes on. She looks at me, smiles, and says, “Peek-aboo! I see you!” I smile back and wave.

7:36 am – I take a chance at brushing my teeth and hear the dog alarm go off. Mom’s ride has arrived. I rinse my mouth and go to the living room, where the dogs are barking and jumping at the door, and Mom is watching TV. Can she really not hear them or is she too involved in I Love Lucy to notice? I can’t tell. I open the door to the studio so the dogs can run in there to bark. I close the door behind them. “Mom, your ride is here!”

7:40 am – I comb Mom’s hair in the back as she makes her way to the front door. I open the door for her. “You have a good day and I’ll see you when we get home. Tell Steve to have a good day, too. Night-night!” I wait until Mom makes the step down off the porch with her walker, then wave to the driver, Walt. I close the front door behind her. I let the dogs out of the studio. They run to bark at Walt through the front window. Now, it’s my turn to get ready for the day.

Reframing

Grocery bags by the door-2 2017-03-27 08.08.56
Bag o’ grocery bags, waiting by the door

Every Sunday afternoon, we go grocery shopping. Every Sunday afternoon, I dread the time leading up to grocery shopping. We usually leave around 5:00 pm, give or take a few minutes, but Mother starts asking about it shortly after lunch.

“What time are we going to the grocery store?”

“I’m not sure, Mom; around 5:00, probably.

“Well, I’ll be ready!”

“I know you will.” (said under my breath for no apparent reason, as Mom can’t hear me unless I face her and yell.)

Around 2:30, Mom gets up and heads toward her room. I realize it’s time for me to prompt her to change her Depends. I move to the door of the office, and she looks up and says, “I’m going to change my Depends.” Wow. Good job, Mom!

After her trip to the bathroom, she heads into the bedroom, gets dressed, goes back to the bathroom to put on her lipstick, and moves back to the couch to wait until it’s time to go the the store. “I’m ready to go to the store when you are!” she calls out. It is a full two hours before the time I told her we’d be leaving. Every half-hour or so, she calls out, “Are we about ready to go?” No, Mom. This half of we is not.

I finally get my weekly meal plan and grocery list pulled together, and we head out the door. I grab the bag o’ grocery bags, and open the car doors for Mom to get in and for me to put her walker in. I try to hand her her purse with one hand while I wrangle the walker with the other.

“Just put in on the floor, here.”

“JUST TAKE IT!”

I get her walker into the back, get in the car, and start the ignition.

“Did you put my walker in the back?”

I nod. I wish I could say ‘I always put your walker in the back’, but in a distracted moment, about 4 years ago, I forgot and almost drove off without it. Now she asks every time.

I don’t want to be annoyed by our shopping trip every week, but it seems I always am by the time we get going. On the short drive to Publix, I’m thinking about how the circumstances aren’t going to change, so I need to somehow change how I look at the circumstances. Mom really enjoys going to the grocery store and seeing the people there. She looks forward to it all weekend. Except for the PACE Center, it’s her only outing. Her weekly outing.

That’s it! I won’t be going grocery shopping on Sundays anymore. Instead, I will be taking Mom on her much-anticipated Weekly Outing, at which time I will also have the opportunity to buy our groceries. I’ll let y’all know how that goes….

Refused

Mom's shower 2017-03-24 07.35.43

Last week, when my daughter and granddaughters were visiting, Linda, The Bath Lady, arrived at her appointed time on Wednesday evening, and Mom refused her shower. Mom has never refused bathing since we started having bath ladies come in. She has attempted to refuse at times, but I’ve always been able to convince her of their importance and necessity. Not this time.

So, mustering my best negotiating skills, I had a mini-meltdown panic tantrum, yelling and threatening, and eventually turning off the TV and putting away the remote in an effort to compel her compliance. She wasn’t having it. Linda’s lower-key attempts were useless once I had set the stage for a show-down, and Linda ended up finishing out her hour by doing ad-hoc therapy with me as I catastrophized about how Mother might never shower again and how if she refuses to shower, maybe she’ll refuse to go to the day center, and if she refuses to go to the day center, how will I go to work? It wasn’t pretty.

After Linda left, my daughter suggested that perhaps Mom didn’t want to “be showered” with all the extra people in the house. I rejected that idea because I don’t think Mom has any real modesty left. My daughter stepped in for more ad-hoc therapy off and on all evening.

The next day, I called Christina, Mom’s Social Worker at the day center, and left a somewhat coherent message, as I was a little calmer by then. She called back and assured me that bath refusal was not an uncommon part of the dementia disease progression, and that if Mom refused more than a couple of times running, then the team would make a treatment plan for her to have her baths when she was at the day center. I was very relieved by this conversation.

When Mom got home that afternoon, I asked her if she promised to have her shower with Linda on schedule on Saturday. She assured me she would. I gave her back the remote. One more crisis averted.

Medications

Mom's med box 2017-03-15 06.37.33
Our medication strategy

Mom's med key 3.20.17

When Mom first moved in with me almost 10 years ago, she didn’t have any meds. She also hadn’t been to the doctor in who knows how long. Even after I got her in and had some health concerns addressed, she only took 3-4 pills per day, and one of those was a multi-vitamin. We initially had her pill bottles on the breakfast table, but when I realized that she wasn’t taking them properly, I got a weekly med minder set up for her.

This worked pretty well until after her heart attack last year. After she came home from the hospital and rehab, she just never could get back into the rhythm of taking them herself. That’s also when her number of prescriptions increased. And she was more disoriented. After she woke up from an afternoon nap, thought it was 5 am instead of 5 pm, and took a her morning meds for the second time that day, the med minder moved from the bathroom counter to the kitchen counter so I could set them out for her each morning at breakfast and each evening at dinner.

With the increase in her number of medications, it became a little overwhelming even to me, and I had to set up a key and number the bottles to be sure I filled the weekly minder properly. I can’t even imagine how elderly people living alone keep track of all their meds on their own.