I'm generally happy with this aide, not about the pushback. Need to figure out best way to deal with it that won't result in the loss of the aide.
As background Mom is stage 6 and IMHO on the cusp of stage 7. We did a dentist appointment and the dentist instructed the aide to brush my mom's teeth and told us we now need to have visits every 3 months. My assumption is my mom is no longer capable of properly brushing her own teeth. Aide says my mom can do it and if we take away the responsibility it will speed up her decline. I go with the medical advice.
My current idea is to sign up for pallative care and have a professional nurse as intermediary so I'm not the villain.
Does she instruct your Mom in a gentle way and say, "It is time to brush your teeth. We want to keep that beautiful smile," and then smile back at her.
Have you ever watched how the aide tries to get her to brush her teeth? If the aide is not nice about it, then your family member will likely not do it. Alternatively, if the aide will not brush her teeth for her, then you need to find a new aide or new approach. Dentist don't like to do dental work on senior people with dementia. I have walked down this road. Better to have the whole care team approach this as preventative than have her loose all her of teeth . Good luck.
if speak to the manager and get another carer allocated to you
maybe it’s a chore to get mother up?
maybe a basin and tumbler and get your mother to brush and rinse spitting into a bowl then wipe her mouth clean
maybe that can work ?
Get her some mouthwash to swish, or hand her the toothbrush with the paste on it and wait and watch. Or brush along with her!
So few people seem to understand when our loved ones Don't understand.
I have been caring for my husband for 10 years. He has been a totally different person from the man I married. But, I try and understand. I can see a glimpse of his former intellect and his attempt to adapt to current circumstances. But, his mind is broken. Every. Single. Diaper-change. is a fight. Sometimes, he thinks he is helping, but he just doesn't understand.
As you say, it's all in how you sound. No anger, no shouting, speaking in a fun tone of voice, like dealing with a toddler. If you become angry or stern, the dementia patient feels vulnerable and attacked, and will rebel.
I have been guilty of being angry and yelling. Out of frustration. Now, I think my husband sees me as the crazy, angry woman. Although I know not to react with anger, sometimes the frustration takes over. I try and keep a positive attitude and a positive voice, which yields much better results, even if not perfect. We are trying, and both doing our best.
God bless you!!
As far as trying to brush their teeth, that is one of the hardest if not the hardest thing to get them, the patient, to do, especially when they don't like being told what to do!! Many of them will not cooperate with the aide. I have been hit just trying to change a Depends or their clothes. I mean with a fist in the back by a man. A woman would not allow me to even touch her but instead she came at me with a can opener while her daughter insisted that I make her go to the bathroom every 2 hours!!! You can't make dementia patients do things.
You might offer them something...a treat that you know they will like if they will brush their teeth or do something else that you would like them to do and they need to do. Ordering or demanding that they do something normally never works. They don't understand danger.
If they like going for rides in the car or whatever it is tell him hey let's go do such and such after you brush your teeth! And it's all how you sound..no anger, do not shout. Speak in a fun tone of voice! Keep things light-hearted!
Aide or not, I would brush and floss my moms teeth or watch her do it if she were not getting the attention she needed, until she did. Things can go downhill pretty fast if she already has problems and it can affect her overall health. Good luck with this.
I'm guessing if the aide is doing the right thing there shouldn't be an issue talking to someone in charge. Just let them know she's very good at everything else.
Aides can have their own boundaries and list of tasks they simply will not take on. Teeth brushing doesn't seem like a big deal, unless your aide is just lazy and making excuses. Having a professional nurse will not make the aide do something she isn't doing for you. Although, a Nurse Practitioner as PCP, could refer someone else to come in and provide oral care.
The caregivers at her Memory Care helped mom brush her teeth. An electric toothbrush was too much for her gums, so a regular toothbrush was used.
At this stage of the game, fastidious tooth brushing is the least of everyone's worries imo. Others can give me pushback on that, it's fine, but with advanced dementia at play, I believe in letting them be. Why fight with them at all about anything?
Best of luck to you.
Also, teeth brushing should be built into the very end of day care as a routine thing.
The CNA is correct that Mom will lose her skills if the CNA does it.
It sounds like you have a CNA. CNA's are professionally trained to let the client function to their maximum on their own. They will not manhandle Mom to brush her teeth if the client (your Mom) does not want it.
The dentist may have seen the CNA with Mom and assumed Mom can't do this.
If Mom shuts her mouth and refuses to open her mouth for CNA to brush there is not a lot you can do other than retry the next day.
We changed to an extra soft toothbrush at one point. We also found the sponges on a stick were helpful at the end.
Have you personally sat with Mom to do tooth brushing and to evaluate how she does? That will give you some insight.
If your CNA is from an agency many will not allow the CNA to do tooth brushing.
Even if the CNA brushes Mom's teeth it will not be at the level of cleanliness that you get with a person with a good brain brushing their own teeth.
Great job on taking Mom for quarterly cleanings. We dropped the ball here. This is one of my biggest regrets with Mom because her teeth were crumbling towards the end of the 18-20 year journey with Alzheimers.
I had a call once with Mom's estate attorney who was also POA's along with me for Mom. He told me I had to lower my expectations with the CNA's and not be so picky. He said it is a tough job. I needed to hear this.
Also, if you have a good CNA, listen to them. Most have years of experience in nursing home care and assisted living. Listen to them.
Now, it's a whole other story if your mother is refusing and not doing it herself. The aide (or family member) is going to have to be persistent now and make her do it while they supervise to make sure it gets done. If your mother refuses to brush her teeth, she should at least be using mouthwash (the diluted Listerine and water) to help.
I can see the aide's point, but she is not the boss. I would tell her if she feels Mom can do it herself, than she needs to be there to make sure she does it properly. Guide Mom. Do you really need toothpaste? Maybe very little on the brush or none at all? Nighttime to me is the best time for a good brushing. There are little dental sponges on a stick you can order on Amazon.
If a regular one switching to an electric might be much easier.
(by the way if the dentist did not mention this switch to a toothpaste that does not contain fluoride. Fluoride can upset the stomach if swallowed and with dementia often the spitting out of all the toothpaste is difficult and the inclination is to swallow what is in the mouth,.)
You need to tell the caregiver that this is necessary and if she does not comply you will find another caregiver that will help with ALL ADL's.
Her telling you that taking away the responsibility of brushing teeth is like her telling you that she will no longer help mom in the bathroom because that is taking away responsibility. Or she will no longer help her dress....
The dentist is your intermediary here...the dentist TOLD her that that she needed to do oral care and she is refusing.
I have to ask is the caregiver using a swab to sweep your mom's mouth after eating to remove pocket food from between the cheek and gums? If not this is something that she needs to do as well. Leaving food in the mouth can be dangerous as it can be aspirated later it is also not good to leave food in the mouth for extended periods of time.
The caregiver is right about taking away responsibilities and the person declining fast. Any level of independence must be continued. I had a care client years ago who was homebound from dementia. She was still able to get food into her mouth on her own. She made a mess and it was disgusting to watch, but messes can be and were cleaned up. If there was a visitor around her mealtimes I told them ahead of time what to expect. Some would get upset and insist that I spoon feed her and I refused. This was the last independence she had and I wasn't going to take it away from her. Of course, I would spoon feed her if the meal was something she couldn't pick up with her hands like soup. Any independence is worth preserving.
Instead of getting on the caregiver and adding another task to what is already a very hard job, why don't you pay your mother a visit, set up everything she needs to brush her teeth, and see if she can do it for you. If she is unable to remember how to brush her teeth, then you and the caregiver need to have a talk. If her caregiver is a trained CNA, you will not need the dentist to show her how to brush teeth because she is already trained for that.
People always assume that it's laziness with an aide when they don't do something. Always a lazy aide. Never a lazy nurse or a lazy family (and mind I've seen my share and everyone else's over the years of these two groups), it's always a lazy aide. Care clients and their families expect a lot from an aide. Far more than the other care staff on a case who make two, three, four times and more what that aide gets paid.
When someone is waited on hand and foot and treated like an infant, it will speed up their decline. Yes, it will. I have seen it happen.