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.
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.
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.