I am the main caregiver for my uncle who has advanced Parkinson’s disease, associated dementia (Lewy body), and a recent diagnosis of late stage four lymphoma. His sister (my mother) and I opened our home to him and are providing him excellent care. Despite the fact my uncle and I are not close and he has been very hurtful to me in the past, I agreed to help since living alone had become extremely dangerous for him. I do most of his care most days, as I have a small (now suffering, lol) business from home while my mother works out of the home.
My uncle has a home health care team that comes to the house. Several times his care team has communicated with him to do activities or lifestyle changes that require my support or assistance without consulting me.
For example, I have been making almost all of his meals from scratch according to his extensive dietary requests. He loses weight easily and so he eats a lot (probably about 6,000 calories a day). I am cooking constantly. A social worker visited and she suggested we try meals on wheels for him on some days just for a break and a change for him. So we signed up for that. Less than two weeks later (we hadn’t even received any of the meals yet) a nurse visited and told him he should be eating organic and advised strongly against meals on wheels for their low quality ingredients. I understand meals on wheels isn’t the best, but we really needed the break from the time and expense of feeding him so much and now if we go ahead with the meals on wheels my uncle will feel neglected.
Another example is a physical therapist came and was very forceful with him about increasing his activity. She told him he needed to do more exercises despite the fact he is exhausted from multiple appointments this last two weeks. Within a week has had a pet scan at the hospital and will be having an MRI and a biopsy and an appointment with an oncologist and a follow up with his primary in the next 10 days. That’s on top of multiple home visits. She told him he wasn’t exerting himself. He said he doesn’t much like the exercises. So she says well instead of doing them then he can get up and walk around the house multiple times a day but never alone. Always supervised.
So now — in addition to handling all of his arrangements and appointments, cooking all his meals from scratch, shopping for him, cleaning him, helping with toileting, handling all his medicines and entertainment needs, reminding him to do his daily exercises, helping him make phone calls, putting him to bed at night, and getting up with him during the nights when he is unable to go alone to the bathroom, not to mention he can never be left alone because of his dementia (learned the hard way that I cannot shower or take naps unless my mom is also there because someone has to always be paying attention or he does unsafe things) — now I’m also expected to supervise random walking episodes multiple times a day whenever he feels like it. She told him if he doesn’t do this he will get sicker and weaker. So if I say, “Hey, this won’t work for me,” it will look like I’m the one making him weak and sick. Again, he will feel neglected.
My work has cut back drastically to maybe twenty percent of what it was and my uncle does not compensate me for my time and assistance. I have no social life, no privacy, I am exhausted and am drowning in tasks for him already. And every time the team comes, they add to my task list without asking me if I have time or ability or situation to do these extra things (like switching his food to expensive, hard-to-find organic ingredients).
I am upset and feel his team is hypercriticial of what is, again, already excellent care. Before reaching out to his team to discuss this, I wanted to ask here if I am out of line for my feelings? Thank you.
I worry about you burning out - and possibly losing your business.
You need to take care of you, make sure you're ok, because if you're not, you are no good to anyone else.
His care team can make recommendations, but that doesn't mean you have to upset your routine or go out of your way to accommodate them! Like cooking organic food. Yeah, that would be nice, but not necessary in this scenario.
The extra exercise your uncle doesn't want to do, he doesn't have to do.
It is a recommendation - from a therapist who breezes in for a short visit, and in her ideal world, he should be getting more exercise. It is her job to suggest so.
But you and your mother and your uncle need to do what works for you!
I may be wrong, but I'm assuming his prognosis is not a long, healthy life from this point forward. He will continue to deteriorate, and is nearing end of life. He will not recover from any of the diagnoses you mention. No amount of exercise and healthy diet can change that. Not that healthy diet and exercise are not beneficial, but only to the extent you are able to provide.
If he needs, or insists on receiving MORE than you and your mother are able to provide, then it is time for him to be in a care home. Memory care or a skilled nursing facility.
You are sacrificing yourself and your income for him. Which is nice. And maybe your mother was convinced this was something you could do. But we all have to recognize our limits.
I'm thinking as I write this that perhaps getting Hospice care is in order now.
You would ask his primary doctor to evaluate for hospice- or simply call a hospice provider, and I think they will do their own screening to determine his eligibility. You would still have a care team coming to the home, but with a different set of care goals. I'm suspecting your uncle and /or your mother are in denial about approaching end of life. Many people insist they are going to live well past their reasonable lifespan. And, those people will insist on staying fit, eating all organic, seeing as many doctors as they can, and taking specialized supplements, with or without proven results.
Seriously, do as well as you can to help meet his needs and care for him if this is important to you. But, Don't stress over what you are Not able to do!
Do what you can, and if he needs more, then place him in a care home which can provide more.
I gently observe that it’s time to find placement for him. You and Mom are wearing yourselves to a frazzle doing the work of a staff that has a shift and then goes home to rest.
What are you trying to prove by your mostly thankless, possibly unpaid work? Saving him with your guilty pride?? Your caregiver days are over, so send him out, get yourself out of work you did not sign up for and get a life for yourself!!
VNS sent and RN to assess our home for what I guess you'd call adaptive equipment.
She recommended my parents get a contraption that would be permanently attached to the side of the bath tub, for gma to hold onto. We only had one bathroom.
"And how am I going to bathe my 2 year old?" my mom asked.
As I like to say, I learned to put my family's (spouse and childrens') needs first. And how to say "no thank you" politely and firmly.
I am curious if there has been a Care Plan Meeting with all the "know it all's" (my words)
Do they actually consult with each other, read each others notes in the EMR? (Electronic Medical Record) They should ALL have access to the notes each has written.
You need to tell them enough is enough. I can not do more than what I am currently doing, and what I am doing now is more than I can manage. If this continues I am going to have to step back.
I think you should step back. The fact that he has been hurtful to you makes it more important that you take a step back. And if he continues to be hurtful discontinue the help that you are currently giving him. I realize this places your mom in a position where she is Primary caregiver and it might be more than she can manage. So at that point the option again is...
Hiring caregivers.
Your Uncle can hire caregivers.
or
Placing him in a facility that can meet his care needs.
Decide how much time you can realistically give to both your work and caring for your mom and uncle. Not everyone is financially independent, so honor your own limits. Bless your heart for all that you’re doing and be sure to share with your care team that you are doing your best.
In my experience, some families qualify for government-subsidized home care or may have some funds available to pay a caregiver for a few hours a day. Even a small break can make a big difference for your mental and physical health.
It may also help to speak with his doctor to find out what stage of Parkinson’s he is in. The Hoehn and Yahr scale is commonly used to measure Parkinson’s progression and can give you a clearer picture of what to expect moving forward.
Your uncle needs help in a facility because he is beyond the help that you and your mother can provide.
Trust and believe this will burn you both out.
Caregiving someone who is beyond home care will become a challenging situation. You cannot work twenty-four seven and be expected to get anything done for yourself. Not being able to shower unless your mother is nearby, is not okay.
No, you do not have to prepare organic meals for your uncle. Is there a reason he cannot have a regular diet?
If he needs all of these calories, he needs to be in a skilled nursing facility or hospice care at this point where they can monitor him.
One thing though with your uncle, if you all decide that the care goal at this time is primarily to just keep him comfortable, especially at least through the cancer treatment, then maybe you can communicate to the home health team that. Then maybe they will back off some.
Personally, I'd probably be so fed up I'd cancel the whole home health thing. But, like others have mentioned, just consider the things they say as suggestions, and either just ignore them or let them know your not going to do that. And I would definitely speak to them about making sure to discuss with you before doing or "suggesting" anything.
All these doctors, nurses and therapists are giving you not just information, but direct instructions, without talking to you about what you can manage. You and your Mom need to take control of the situation.
These folks are in the mindset of prolonging life for as long as possible, and pushing him to be as strong as he can be. That is what they do, so that is their mindset. If that is the focus all of you, including you Uncle, want, then let them know what you are capable of managing for him, and what you are not. Be completely honest. Your Uncle may need a facility placement, so you and your Mom don't get burnt out.
But what does your Uncle want? How does he want to spend his time on Earth now, with these diagnoses? This is where the tough conversation comes into play. With Parkinson's, if you don't move around, you can't move around after a while. But if he hurts every time he moves, he may not want to push himself to move much. If lymphoma treatment means going thru operations, chemotherapy or radiation, does he even want that? If he has dementia, does he understand what they are wanting to put him thru? What are the odds he can be cancer free even with aggressive treatment? Is he even a good candidate?
Has your Uncle expressed advanced directives?
It would be good to contact Hospice. Hospice provides comfort care for individuals who do not want aggressive treatment. They look at maximizing the quality of life the person has left, without aggressive treatment. It's quality over quantity.
I am not trying to be harsh. My husband has Parkinson's and some dementia. After a fall, he was not ambulatory. Even after months of PT, he couldn't stand and walk again. He HATED therapy. He was glad when it ended. It was very painful for him. He's been on Hospice for a year. He receives muscle relaxers and pain medication for when we have to turn him and do diaper changes. Would he like to be walking? Yes. Could he tolerate the extreme pain to continue PT? Absolutely not. It was his decision. Can I blame him for stopping? Absolutely not. Parkinson's Disease will progress.
Your family and Uncle have a lot of discussions coming up, with each other, the care team and hopefully Hospice. I wish you well.
And don't feel that you are neglecting your Uncle by not buying expensive organic foods and not being Superwoman with limitless energy. You are human, trying to do the work of caregiver, cook, medical coordinator and physical therapist. It's not realistic that you can sustain this.
Have our responses helped?
NO organic foods unless you typically buy them already. He needs to eat the same types of foods you eat. Others meal planning, shopping, and cooking gets out of hand and stressful. He needs healthy calories, and giving him that is more than adequate care!
Physical therapists are used to giving a “best care scenario” list of suggestions…even if they say they are necessary, you just help him do what is easy for you…nothing more. Have his home health aides do exercises with him every single time they come - that’s what they’re there for, once the necessary health/hygiene/meds are taken care of first. But as for you, don’t worry about added things you can’t do. His decline will get to the point where he can’t do any exercise. Yes, keeping him moving will delay this physical decline but don’t prioritize his exercise advice your need to work and care for yourself. His sister should help, as well as his aides.
When his care exceeds the abilities of you and his sister, then it’s time to place him in a care facility. It was a huge relief once we placed my Mom…you get your life j
my husband is in the same situation and I am the only caregiver for him. I had a break down from all the stuff I had to do and ended up seeking psychological help it was so bad. Being a caregiver takes the life out of you. I’m not ready yet but I’m already considering assisted living for him even though financially will be a burden. Depending on where you live, contact your county and ask for senior waiver. This will help you financially though not full financial aid but somehow will help.
lets get back to basics
you’re in charge not them
you tell them what you want not the other cheeky way around
anyone who you feel not listening to you request a change of person
yes- in an ideal world we would all eat organic -we would all do xx hours exercise !
but we aren’t living in an ideal world
I would make an appointment to speak to the care team head and physio and tell them their staff are over zealots and stressing you out
share with them a workable plan
and tell them that’s the plan you’d like staff to work to
—
we have. CAre people come in for my dad - I’m always in the room with them- one was telling my dad off recently !
I told him to stop - just stop!
he stopped for two minutes them told me off for not passing him something ..
he actually got me shout at him
I reported him to the head and advised I didn’t want him here again.. and that’s the end if him
the head mentioned a few others had reported him also and he had been suspended for two weeks . I have made it clear he’s not to come to my house again
—
as for physio- ours-
they actually tell us not to do too much
so I’d say your ones a bit over zealous
maybe start with them
your plan is not workable so I’d like you to revert to the original plan/exercise of xxx
its also stressing relative out so you’d like things relaxed
as for food
thank you for your suggestions
what I can manage is ….
so I’d like you to work with that please
( they may have good intentions and yes packet food full of sugars and sodium/salt causing more issues but balanced is ok
some days you aren’t available to cook and they need to realise that
They prob have great intentions to make him worlds healthiest but it’s not practical and they need to work around you
best wishes
I had to take my Mom to ER for a broken shoulder. She was asked all kinds of questions by the desk clerk. She told them she was sure she broke her shoulder. We get placed in a bay. No one but one other person is in there but us. An RN walks by and throws a gown on the bed. Then says, put that on her. I told the nurse I thought that was her job. No way was I going to hurt my Mom trying to take off her top and putting a gown on. She had a broken shoulder. The nurse put on the gown.
These people need to justify their jobs. But you in no way have to follow thru on what they suggest. Tell them, sorry, I don't have the time.
You tell the care "team" that you are unpaid and helping out of the kindness of your heart and if they want him to have all the things they're demanding for him, they can damn well come and do it themselves or arrange for others to make them happen. If that can only be achieved in a LTC facility, so be it. You are not responsible for him, not do you have to be on duty 24/7 doing the work of a full staff in a LTC facility.
You DON'T EVER take orders from these people. Not a one of them. You put them in their place at once. Not a social worker, nurse, physical therapist, NO ONE. You let them know what level of care you are willing and able to provide for your uncle. If they don't find that adequate, they can figure out how to get what he needs.
When I worked private-duty cases I never took an order from a nurse, social worker, or physical therapist. I take suggestions. If a 'suggestion' is unreasonable or I found it ridiculous it was refused. With private caregiving it's often up the the caregiver themselves to bring in other caregivers if 24-hour care is necessary and to make sure the client gets that care. That's the person giving the orders. Not the others. Don't forget it and don't let these people complicate the situation. You don't have to allow them to.
Good luck to you and please stand up for yourselves with these people. They aren't the ones in charge here, you and mother are. You work with them, not for them and if it's not working for you it is their responsibility to see that it does or to make other plans for your uncle's care needs.
As others have mentioned, no one can provide 24 hour care alone. Following through with therapy recommendations and an expectation of organic cooking(good grief) are not the big issues here as I see it. Based on what you’ve told us, the situation is untenable and the social worker should be able to help you navigate a solution, be it adding private caregivers at home or finding placement.
I would be very surprised if the home health team is judging you as harshly as it feels or that anyone would ever see you as making your uncle weak or sick. It’s time to consider your own health and well-being.
- Shopping for supplies
- Shopping for food
- Meal prep
- Meal service
- Cleaning
- Bathing patients (dressing and toileting)
- Administering Medication
- Physical therapy
- Entertainment and mental engagement
- Paying bills
- Visiting Doctors on site
- Nursing staff
- Laundry
- Building maintenance
- Transportation
That's only 15 jobs that I can think of. It takes a group of professionals to do what you're doing. None of the people do anything but their one job. You're doing it all. It's unsustainable.
You say ok, to these care bullies. And, When can we expect the help cause you are not trained or qualified to manage.
Maybe your GP can vouch for your inability to provide the care without injury to your health and well being.
Was your uncle a veteran? My friend's husband got a lot of assistance from the military but he developed Parkinson's disease from exposure to Agent Orange.
I'm so, so very sorry for your nightmare. You're extraordinary.
And what’s your mother’s role in all this?