Dear Family Advisor

What can a hired caregiver do about a woman who threatens her grandmother -- who has Alzheimer's -- that the family will send her away if she doesn't take her medicines?

Last updated: Jun 30, 2008

I have been a part-time caregiver to a woman with Alzheimer's for about six weeks. Her granddaughter is also a caregiver to her. The young woman is in her early 20s and grandma is in her 80s. The lady's doctors have changed some of her medicine due to side effects, and she is becoming less social, wants to stay in bed, and doesn't want to get dressed or take her morning medicines. But the granddaughter is very impatient with her. She feels that she needs to force her grandma to get dressed, and she chases her from room to room, threatening that the family will send her away if she doesn't take her medication. This truly distresses the older woman -- she gets very agitated -- and it upsets me too, as you can imagine.

I am at a loss for what to do. I have discussed this with the girl's mother, and she agrees that the medicine change is causing this new mood and that it's best not to force matters when the grandma feels this way. I play music for her and give her some snacks and visit with her a little, if she lets me. We do fine. But the granddaughter is there quite a bit and she has different ideas. She's a nice young lady, but she gets very upset if Grandma doesn't do as she thinks she should.

First, I'd like to commend you for taking such an interest in this family. Professional caregivers are a vital bridge to families. People like you keep our elders safe and assist us in providing them with quality care.

Your role as a professional caregiver is one that requires a delicate touch, as I'm sure your past experiences have taught you. As a new caregiver, there's just so much you can say or do -- if you appear judgmental, the family may shut down to you. But as you gain their trust and respect, they'll find your insights and experience invaluable. That may take some patience on your part.

It seems that the family wants what's best for the grandmother but is overwhelmed and uneducated about the disease. If you're able to steer them toward what's truly important and will make the biggest impact in the grandmother's life -- such as changing her meds and getting her on an even keel -- and then gently guiding the granddaughter toward a more positive approach to care giving, they'll be able to enjoy (or at least appreciate) these last years with her. Just take it one step at a time.

First, I'd focus on the grandmother's medicines. Since the daughter already agrees with you that the new medication seems to have altered her mood, this is a good place to start. Are you comfortable encouraging the daughter to talk to the grandmother's doctor about the effects of the new medicine? If she works all day, you might even offer to take Grandma to the doctor yourself, so that you can share what you've observed about the changes in her mood and behavior. You should also make sure the grandmother can still swallow easily. If not, there are therapies that can help with swallowing, and the doctor can advise on those.

In terms of getting the grandmother to take her medicine, the most important thing is to keep that time of day consistent, pleasant, and nonconfrontational. I'd also suggest that the same person administer the pills each day. Ideally, the grandmother will willingly pick up the pill and swallow it, rather than having it forced on her, but her mood may fluctuate, so you have to be prepared with alternate plans.

You might suggest ways to deliver the pills that are easier to swallow, so to speak. When my mother had Alzheimer's, she would drink a shake that contained liquid vitamins, and that was one less thing for us to fight about.

Since you've already registered the granddaughter's threats with the daughter, you could now try educating the young woman about Alzheimer's in some subtle, nonthreatening ways. Here are a few suggestions:

  • Encourage the daughter or granddaughter to contact the local Alzheimer's chapter or a care-giving organization that offers workshops or support groups. Or go online and get some information that you can share with them or leave around the house. That could help both of them understand more about the disease and how best to care for someone with it.
  • Let the granddaughter know that, as a young person, she has much to offer her grandmother, but that you also sympathize with how difficult this is for someone her age to go through. If she's receptive to talking about it with you, suggest she visit Caring.com’s Alzheimer’s support groups or the Alzheimer's Association's online caregiver boards -- there are other granddaughters and grandsons who talk about the unique challenges of care giving when you are young. She'll see that she's not alone.
  • Subtly offer hints as to what her grandmother likes or responds to. Focus on the positive, because if the granddaughter starts to feel defensive, she may close down or even pressure her mother or other family members involved in the decision making to seek a less "aggressive" caregiver. If this happens, you may lose your job, and the family may end up with someone who doesn't look out for the grandmother's best interests, as you do.
  • Let the granddaughter know that care giving for someone with Alzheimer's can be extremely frustrating and difficult at any age, and that you're there to help. If she is threatening to send the grandmother away out of sheer frustration, she may feel relieved to hand off some more of the burden to you.

Other than that, the best thing you can do is to quietly teach by example. Take care of the grandmother as consistently as you can. Realize there are days that the granddaughter or others may throw you off your routine, and that it may take a while to get things back on track. Your ideas of playing music and finding other mood lifters for Grandma will help lift everyone's mood and educate them -- and it's a great example of how to influence the situation without being preachy or judgmental.

This family needs your wisdom and watchful eye. The granddaughter is young and she doesn't have the experience or education you have acquired. Her exuberance, youth, and connections to the outside world can ultimately add a nice dimension to the grandmother's care, but she needs to learn how to communicate with her. She may also be torn about her loyalty to her family and her desire to move on with her own life. Her mother is older and more mature, and she will grow to respect your opinion and input, if she doesn't already. Once these two women see you as part of the team, they'll begin to view each person's contribution as necessary and unique. That will not only create a more caring atmosphere -- it will make your job easier and more rewarding.