My mother is being really difficult in her nursing home. Any advice?

Staff in Nursing Homes deal with residents like this all the time . At times it makes you not want to go to work . But then you always think of everyone else that you are helping . Obviously your Mum has unresolved issues & is taking everything out on everybody , Staff & including her family . Sometimes ignorance is the best option , as all the nursing staff will be aware of her behaviours & constant complaints as it would be heavily documented. Sometimes you have to be cruel to be kind , maybe she might calm or slow down with her complaining if she knows that no one is listening anymore . And you not being at her beck & call , then she might start mingling with the other residents as well as going on bus trips etc . Maybe when she starts behaving appropriately then offer her rewards like taking her out etc . As these she will definitely look forward too .

My mother is also defiant with all requests, but is at least semi polite. She also doesn't want to be with other residents and says things about them behind their backs. The staff has learned how to handle her and we never agree with any of her complaints and always back up the staff. She has vascular dementia. You are doing everything you can and we just learned to "live with it" and apologize to the staff if she does or says something.

Definitely side with the staff. When in doubt, side with the staff. You and the staff need to look like you are in complete agreement with her care.

Unless you know the staff can make bad life threatening decisions, in which case, you need to move your Mom out of the facility.

...and just to be fair, if the story your Mom is telling is plausible, side with the staff ("Oh I'm sure there is a reason for that"), then start asking probing questions to your Mom to see if the story really is the whole story. If there is enough evidence to wonder, ask the staff for their version.

Just in case something really happens to your Mom, you don't want to completely shut her down. You do want to know if the facility is not performing up to your expectations, and your Mom is the person who would alert you.

Funny story: My Mom is in MC. For successive days, my Mom said that the staff did not give her a bath. Her hair looked like it had not gotten washed and her odor was "different." so the story was plausible. When I talked to the staff, they said that my Mom was refusing to bathe, saying that she didn't need it or thinking she had already taken one. I went back to my Mom and I said, "I heard you are refusing to take a bath." She said "they try to give me a bath 2 times in the same day and I tell them I don't need it." I told my Mom, "If they ask you to take a bath, you take that bath. I don't care whether you thought you already had one or not, just take the damn bath." She argued, I repeated myself. That night, when the caregiver came to give her a bath, she said "I know I already had a bath today. But, I better take the second bath or my daughter is going to be mad at me." We all got a good laugh. Success!

I am thankful every day for the wonderful staff at my FIL's care facility. I keep reminding myself that they are trained for anything he can throw at them. But good lord can that man try the patience of a saint! He has even managed to alienate his sister that not too long ago I was worried would be a constant flying monkey.

He has managed to make life a living hell for us since he has been there - because he was used to getting his way and used to the immediate meeting of his needs thanks to years of jumping when he said jump first by MIL and then by SIL. And he simply cannot wrap his brain around the fact that the world does not revolve around him. So of course no one ever does anything to his standards, quickly enough, well enough, the food is not good enough, the people are "old", THEY have problems (as they roll down the hall in their wheelchairs while he watches from his bed because he still hasn't been cleared by PT to even get out of the bed without help yet! The list goes on and on. Sufficed to say...he's driving us all crazy...And I'm almost certain it is on purpose.

The staff there are wonderful and take it all in stride. He has caused them more problems than anyone has a right to in his short tenure, but they don't even seem phased by it. While we sit and worry that he'll get himself kicked out.

LOL, unlike you - we have no qualms about remonstrating him. We just tell him to knock it off and be nice. That he needs them a lot more than they need him. He pulled a fast one the other day and broke the rules and we were immediately as a family conferencing him in and having a "Come to Jesus". He was pouting because he got in trouble and lying that he didn't know he had done anything wrong and we just told him that he knew exactly what he did and now he had lost his privileges and there were consequences for his actions.

We don't know yet if other residents will want to know him. He doesn't want to know them. He avoids them. He went to the dining hall exactly once and said he would never go back - because "those people didn't talk to me". We asked "well did you talk to them? Smile? Say hello?" His response? "Well what difference does that make?" Yeah that's about what we figured.

Now he's killed his phone - somehow deleted his contacts. And until we visit in a few days, he can't get them back. (there is no point in calling cell company - he'll never be able to do what they need him to do, and we would never ask anyone there to help him- even though he would). He was pouting saying that he talks to his FRIENDS every day on the phone and now he can't talk to them. Finally after all of the whining. and him calling me 8 times in 15 minutes on the first day it happened and at least that many times the second day, he said it again "I talk to my FRIENDS every day on the phone and I can't now!"

I said "YOUR FRIENDS HAVE YOUR NUMBER DON'T THEY? If you talk to them EVERY DAY why have they all called YOU? It seems odd to me that you all talk every single day but now that you don't have their numbers and you can't call them, you haven't talked to them at all! Why aren't they calling you?" "Well I'm sure there is something wrong with this phone!!! I need to call the phone company!" (for the record - nothing wrong with the phone).

Hang in there. The staff really is trained to deal with all kinds of stuff that we cringe at. It doesn't mean they SHOULD have to. But they know how to and they can. They are saints and they don't get paid enough that's for sure!

It would be helpful to know your mother's medical diagnosis. As well, her history over decades.

Why is she in a nursing home?

I wonder if her personality / behavior is a combination of a narcissistic personality disorder and dementia?

The staff is doing what they can do: basically ignore her and do the job they are paid to do.

No, I haven't been in this situation although I had a vile client for three years**.

I called it 101 caregiving bootcamp.

It was my first ongoing/weekly job (15-20+ hours weekly) for three years. She could get very mean and demeaning (to me, as well as other residents ... one resident, legally blind, was walking in the hallway and my client, in a motorized scooter -in a hurry - said to that woman "get out of my way" as she zipped on by...

** Oh, how I remember those days wishing I had a nice client like I saw in that housing development ... I wondered how good 'life and work' could be if only I had a different client... then three years later, she died and I gained 3-5 lovely clients over the next 8 years. I did my time and paid my dues. I adored so many of my clients and still do. I couldn't leave... I desperately needed the job. The plus side is that I developed SO many skills sets as this client required just about all of them - management, shopping/research/writing, working with realtors... supervising contractors - everything I like to do and did. She was not pleasant although I loved the work ... and I learned a lot, including how to deal with a person ... like that. In all fairness to her, she had a 'nice side' where we really connected and most every night before I left, she'd thank me.

I do think ... 'but for the grace of God go I" - it is the only phrase in the bible (?) I know and I severely hope I am not like that when / as I age and need help / support from a care provider.

I am not sure what you are asking us. What should you do? What can you do?

It sounds like the staff, residents, and the family don't want much or anything to do with her ... If she were my mother, I'd med her up as much as legally possible. Mellow her out. [p.s. 'of course it is heartbreaking that a person could be so miserable. Imagine how she must feel inside ... to herself. Get her a massage, weekly. And perhaps a therapist].

Gena / Touch Matters

BertieBanks: Continue to show kindness to the staff as you are doing with cakes for tea break. While they certainly know that she's a difficult person, your kindness will be appreciated.

The staff is used to it. Even the newer young ones catch on early as they see how the older staff don’t take it personally . Maybe Mom isn’t quite as bad when you aren’t there as well . She could play it up more as a guilt trip or just to be nasty to you in general. Either way , the staff likes to eat. I don’t know where your mom is so not sure what eats are available , but by me we have hot soft pretzels from Philly pretzel factory with various dips delivered , big hit with the staff. I’ve also had 6 foot deli sandwiches sent .

My poor mother had many of the traits you describe which dementia and nursing home placement only exacerbated. To my amazement and delight psychiatric medication stabilized her to an extent I’d never seen. Soon she was expressing her love for me - an expression I’d never heard before in my life. She became buddies with nursing staff.
I regret that this happened 20 years ago so I do not recall what meds worked for her.
Your situation is difficult and I applaud your effort to get help for your mother.

Be sure that the observed behaviors are being communicated to her PCP, ( primary care physician) for their further assessment of her cognitive status.

Make your visits short, and tell her ahead of time that you are visiting because you love her, and want to have a pleasant visit; and, that is she starts being negative or hostile, that you will leave, as this is not healthy for her nor you ( nor anyone else).

If she is cognitively able to communicate correctly ( that is she has no mental dementia illnesses as defined by her PCP) then she should be able to start to understand the consequences of her behaviors. If she in fact has a dementia diagnosed illness, then she may not be able for various reasons to identify and control her negativity and hurtful behaviors. It is not unusual for patients with dementia illness to demonstrate hostility, negativity etc. etc.\

Be sure that she is being visited frequently by a licensed social worker who is made aware of her behaviors. They may be able help .

Be sure that she is being visited frequently by her faith leader of choice or if she does not have one, then a community chaplain or other community faith leader of your choice . Providing her with both social ( emotional support via the SW) and Spiritual or faith support( via an appropriate faith of her or your choice ) may be able to help address some of her behaviors or at least offer more input for you and the staff to consider.

She may also need to have addressed long term or recent grief ( if she is cognitively/mentally able to communicate correctly). Grief associated with life experiences past or present are often not addressed with senior citizens. this may be a place to start also; a social worker or chaplain may be able to help with this also.

Practice good self care for yourselves.... you deserve it and are important also....

Send thank you note to the staff and maybe a snack - tell them you know mom is difficult and you appreciate their hard work.

Get mom to see a geriatric psychiatrist. She might benefit from counselling and/or medication.

Hi, Bertie -- all I can share is my sympathy and wishes for things to change in some way for you, and the knowledge (which always cheers me a bit) that the members of this forum are in similar situations and KNOW the effects on caregivers of this kind of patient. I like to imagine a time when all of us have been set free from these things in some way, when we might all meet in a meadow filled with wildflowers for a picnic and give each other hugs and thanks. We come from many different backgrounds and beliefs about life and death, but we all know that caregiving can be thankless and terrible for one's health and desire to continue.

As a retired NH clinical staff member we all knew nasty residents. We felt bad for the families. We were less stressed by these older gals {seldom were the men as disagreeable}…I suggest you remember it is NOT your job to make her happy..you provide a safe place. It is her job to find a way to navigate in the world..even in the NH world. Do short visits..leave when she is mean. If she wants visits she will learn to play nice!!

Go with the kind words, thanks and snacks for tea break. In an effort to make the staff's work a little easier: I added an assortment of air fresheners and a mini portable fan for my mom's tiny bathroom. Be sure to "report" all the good things that normally go unnoticed.

Sorry to hear about you mother's difficulty in the facility. If your visit gets bad, just tell your mom that another time may be a better time to visit, sign out and leave.

This section may be off the topic, but you are going to see my opinion. When people get old, it would be easier to get rid of them when they have lived their lives and expect their children or other families to cater to them. Sort of like killing them off to stop burdens on their families and expensive care. Sorry I had said this and do not mean disrespect, just to get rid of burdens when it is not really companionship and love anymore. It is frustrating to think older people can outlive the younger generations.

As a hospital staff, I got training. You have to separate the personality from the disease and sometimes the gap is short. I have seen many mean people in my career. They tended to isolate themselves, and the constant callers would just keep calling. Let the staff deal with it. As for visits, make them shorter and call her on her abuse that the next thing she says will mean that you are unwelcome.

My sisters MIL was a self absorbed person her whole life. When she experienced dementia and inability to self care, she lived with them. My sister and her husband took her to the doctor and explained the situation. The foul language, lies, confabulations etc. were minimized with what my sis called her Happy Pill. I don’t know what it was, but it decreased the anxiousness and managed to soothe the old lady. Unfortunately, my sister wasn’t great about keeping a supply so the poor woman would run out and exhibit the behaviors that the med was modifying.
Bottom line: ask the medical staff for a recommendation. My own mom was always sweet and her behaviors declined to paranoia and fears/anxiety. The doc prescribed Olanzapine/Zyprexa. 10 mg to start since she was really over the top and then 5 mg. The positive is wonderful and when we tried to wean her off per her doctor (just to see if it was helping) she went back to mean, paranoid, anxious. We will never run out of these meds. The contraindications on the box are sobering, but I researched and read the papers of research and it is worth it for my mom since she is never going to get better and her terrors are abated with that little pill.

When i say i know your pain. I know it very well. My soon to be 87 year old mom has dementia and is very aggressive. Even to the point where I have gone in during her bed baths and assisted staff by calming her while she was being difficult. I felt so sorry for the staff that i kept apologizing. This is not the first time she has been this way. However, my point is my mom has always been quick to cuss and what i call verbally assault a person. Dementia and Alzheimer's have just put a label on behavior that I recognized many years prior to her being in the nursing home. The staff are trained for this. They actually call her Grandma Mary and she loves that. She is still bossy, but it seems to make her feel like she is with family. Believe it or not there will come a point where you will wish to hear her complaining, because eventually there will be silence from her and that will be the sad part. My mom has lost her spunky part and barely eats nor fuss. I don't wish that on any mom or daughter. Be the voice of calm voice and just try to find what quiets her. I wish you and you mom the best.

I’d suggest that you minimise visits, and take with you a packet of nice sweets. When mother is rude to staff when you are there, give a sweetie to the staff member and say “Thank you for putting up with it”. Leave when you get told you are the enemy too. Tell mother that if she thinks she employs the staff and pays their wages, she will need to go for a sanity test.

It sounds as though you have let your mother get away with this for far too long. But it's never too late to change.

I don't have an answer for you. My mom was a nightmare in her facilities..yes plural! She eventually managed to escape to her own apartment years ago. She now lives in low income housing with home health. I can image majority of patients in a nursing home are negative. It's not a great place to be. You need to assume the staff are professionals and can regulate themselves majority of the time to handle the behaviors in a professional and appropriate way. There are methods to handle grouchy and mean residents. Some staff take it way too personally. Some know exactly what to say to de-escalate.

The staff should be used to, and trained, to handle this, so it's their problem.

If she's so unpleasant during phone calls and visits, then she doesn't deserve the time you take to do so, so stop visiting and accepting her calls or calling her if she acts like a baby.

If she's always been this way, she won't change now. So you've pretty much done all you can. I'd avoid her as much as possible, she sounds like an energy vampire.

I think you answered your own question in your very last sentence when you said that perhaps just kind words and thanks to the staff along with some occasional goodies is all you can do. That can go a long way.
I'm sorry you have such a hateful mom, but that is on her not you. When she starts showing her ass when you visit, you just get up and walk out the door and tell her that you will come back another day when she is in a better mood. And you keep doing that over and over, until perhaps she gets it.
And if she doesn't it just means that you don't have to spend as much time with her as you probably have in the past.
So at least it's a win win for you.

To the staff, your Mom isn't the first one to be this way, and she won't be the last. Don't fret for them, they should know the drill by now. Maybe only visit on days/times when there is an event you can take her to, and this way you don't have to make conversation. Leave before the event ends. May be better to just call her or have a FaceTime with her, this way when she turns nasty you can just politely hang up. May you receive peace in your heart that you are doing your best. So many things are not in our control and we have to just rest in that fact,