Resistance

As a caregiver, you may experience resistance when your care receiver doesn’t do, say or agree to what you’ve asked them to do. Other than the emphatic “NO!” the response might be “I don’t want to,” “I don’t have to” or “You’re trying to control me.” When caring for someone with dementia, you may be frustrated by these responses to your best efforts to provide care.

Your care receiver may be resistant for many reasons. Sometimes they worry something is going to harm them, like the pills you’re giving them. They may protest, “I took a shower yesterday,” when it was actually last week. They may be afraid of something, like falling or having a stranger in the house as a paid assistant. They may feel embarrassed to wear adult diapers or use a cane or walker.

They may not want to deal with something, like the doctor telling them they have a memory problem or that they need to drink more water. They might not think there is a problem to be solved. They may be worried about money or fear they are losing control and independence. They may also simply be tired, hungry or in pain.

Regardless of what kind of resistance you’re encountering, it’s important to avoid power struggles, which usually only escalate the discomfort for both of you. It’s natural for caregivers to become frustrated, impatient and irritable when fighting the same battles over and over again.

Below are some common struggles that dementia caregivers deal with, along with some tactics to become more successful in these situations.

Pills

Many care recipients take multiple medicines and vitamins daily. You may find yourself endlessly explaining each pill and what it’s for. Sometimes your care receiver will flatly refuse to take medication, or they pretend to agree, but “pocket” it in their cheeks to spit out later.

If your care receiver takes a lot of pills
Discuss with their doctor if all pills are still necessary or if some can be stopped. Ask if fewer pills can be taken at a time. Spreading them out throughout the day might be less overwhelming.

Try medications in different forms
If your care receiver dislikes capsules, perhaps they will tolerate tablets or a liquid form of the medicine. Some medications can be disguised by smashing and mixing them in applesauce or jam.

*Try different medication times. Experiment with giving meds before breakfast or after, with a treat as a reward or after a cup of coffee. Some medications need to be taken at certain times due to interactions with food or other medicine, while others offer more flexibility for when they have to be taken.

“Your doctor says…”
If your care receiver has a good relationship with their doctor, have the doctor write a prescription for the medications that can be posted on the refrigerator. Refer to the prescription and say, “The doctor wants you to take these.”

Appeal to their interests
Tell your care receiver that a pill is for something they care about, for example, tell them, “This is to help your memory” (not “This is an antidepressant.”)

Acknowledge feelings, not actions
Show you respect their feelings by saying things like, “Are you worried the medications are going to hurt you?” “Are these pills hard to swallow? I can ask the doctor to get you ones that are easier” or “I know it must be hard to think you have to take pills, but I want you to be healthy.”

Showers and Baths

Oftentimes, people with dementia are reluctant to bathe. This may be due to embarrassment about being naked in front of you, feeling cold, or being afraid of slipping and falling in a bathtub or shower. It’s also a lot of work to take clothes off, bathe, dry off and get dressed again.

Memory loss affects a person’s sense of time, so your care receiver may think it was just yesterday that they took a shower. Figuring out how often a shower is necessary can reduce the number of times you have to fight this battle. Once a week is probably a good minimum. If they’re having incontinence, especially stool incontinence, bathing is important to avoid urinary tract infections. In that case, a shower needs to happen more often. It’s also important to check and clean folds as needed to make sure skin integrity is protected.

Make the bathroom as comfortable as possible
Turn on the heater, if available, to make the room warm. Have a shower stool or a bathtub transfer bench to make it easier to get into and out of the shower or bathtub.

Regulate bath time
It might help to have an agreed-upon schedule for bathing, for example, every Tuesday and Friday. Mark it on the calendar and then refer to it when negotiating their shower for the day.

Use bribery
Try saying something like, “Take your bath now and then we can go out for ice cream.” Or promise another activity they enjoy. Visiting with someone they enjoy can be an incentive, such as going to see a family member, friend, or their doctor. You can say, “I’m sure you want to be clean and fresh when you visit.”

Acknowledge their feelings
You can be empathetic with statements like, “Does taking a shower feel scary to you?” “I know you don’t want to take a shower, but I am worried about your health, so will you do this for me?” or “Taking a shower is a lot of work, so let’s do it now so we don’t have to rush later.”

If all else fails, try sponge baths
Have your care receiver sit on the toilet with the lid down and use a washcloth to wipe over them.

Food Fights

Because people with dementia don’t read internal body cues all the time, they might not know when they’re hungry or thirsty. Many are resistant to drinking more liquids or eating when a meal is served. Even when a glass of water or Ensure is next to them on the end table, they may not see it or want to drink it. Sometimes, they understand that drinking means they will have to urinate more. So, in order to not have an incontinence problem, they avoid drinking.

People with dementia who are on restricted diets will often “sneak” food they aren’t supposed to have, which may upset you. They might just finish lunch and then ask when lunch is. Or, they may be served lunch and say they just ate, even though it was three hours ago.

Support hydration
Initiating a behavior can be difficult for some people with dementia. They might not think to pick up the glass of water in order to drink. They may not think about drinking at all, recognize that they’re thirsty, or even know that the glass has water in it. Instead of leaving water available, bring half a glass of water every once in a while, and offer it to your care receiver while you sit with them.

Offer foods that are high in liquid, like watermelon, oranges, cucumbers or soups. You can also suggest a drink of water followed by a treat, like a cookie or sherbert (more liquid than ice cream).

You cannot make someone eat or drink
Walk away and try again in fifteen minutes. Sit and eat or drink with your care receiver to make it more of a communal event.

Going to the Doctor

No one wants to go to the doctor and be told bad news—especially regarding a cognitive impairment or the dreaded word Alzheimer’s. If your care receiver already has a diagnosis, they may remember the feeling they had about it. They may be mad at the doctor and say, “What does the doctor know?! There’s nothing wrong with me.” It’s fruitless to attempt to explain why the doctor’s visit is important. Again, avoid a struggle.

Minimize notice of appointments
Do not give too much advance notice of doctor’s appointments. The morning of the appointment is enough.

Don’t rush
Get ready in a way that you don’t have to rush your care receiver.

Offer a reward
Offer to do something fun with your care receiver afterwards, like going out for lunch, ice cream or taking a walk, etc.

If necessary, lie
For example, say you’re going shopping and just “happen” to end up at the doctor’s office.

Incontinence

Incontinence can happen for a number of reasons, mostly due to not being able to get to the toilet fast enough or not reading body signals. Using adult incontinence products helps with this problem. However, your care receiver may be resistant to using them due to embarrassment and their sense of dignity.

Introducing incontinence products
Start with pads vs pull-ups. Introduce them as a way to protect from “leaks.” When moving to pull-ups, remove regular underwear from the drawer, stored out of sight, and replace with pull-ups so your care receiver has no choice but to use them.

Protect furniture
Put chucks on chairs and on the sheets in the bed to protect furniture when there’s a problem. *

Dressing and Changing Clothes

Picking out appropriate clothes and changing can be fraught with conflict. Your care receiver may not register what the weather is like and what would be appropriate for the temperature or activities planned for the day. Taking clothes off to put on pajamas can be a daunting task, including issues with buttons, snaps and things that go over your head. Be aware that your care receiver may not know exactly where to begin.

Encourage fresh clothes
If possible, make sure the clothes your care receiver has worn for the day are out of sight, so when they get up the next morning, it will be easier for you to help them put on different clothes.

Avoid sleeping in clothes
Your care receiver may want to sleep in their daytime clothes, preferring not to have to change into pajamas. Make sure that clothes get changed at least after a shower or sponge bath or incidence of incontinence.

Choose easy on/off clothing
Find clothes that are easy to put on and take off. Many options are available online at “handicapped accessible clothing.”

Exercise and Physical Therapy

A physical therapist has been coming and teaching exercises to help with mobility and balance. Your care receiver does all the exercises while the physical therapist is there. The next day, when you let them know it’s time to do their exercises, they say, “I’m too tired,” or “I’ll do them later” or “Stop bothering me.” You might get the same response when you suggest going for a walk.

Post a doctor’s order
Having a “doctor’s order” written and posted on the refrigerator so you can refer to it can sometimes cut through the resistance to exercising.

Use incentives
Incentivize exercise and taking walks with dessert or some other food or activity that would be rewarding.

Make it a shared activity *
Doing exercises along with your care receiver might encourage them to think it’s more of a fun activity rather than a chore.

Make it enjoyable
Play favorite music, watch an exercise program on TV and do activities along with your care receiver to make it more fun.

Walkers and Canes

“I don’t need help. I can hold on to the furniture and get around just fine.” This is a power struggle that many caregivers deal with on a daily basis. Safety is understandably a primary concern.

Post a doctor’s order*
Having a “doctor’s order” written and posted on the refrigerator so you can refer to it can sometimes cut through the resistance to use a walker or cane.

Tug at their heart strings
Have someone who is very close to the person, like a beloved grandchild, talk about how much they love them and how worried they are that something will happen. “Would you please use the walker for me?”

Give it some flair
Decorate the walker with bright tape or fabric and make it a work of art rather than a dull drab piece of aluminum.

Acknowledge their feelings
Agree with the emotion behind the refusal: frustration, embarrassment, denial or fear of loss of capacity.

What’s in the way?
Ask your care receiver what would make it easier for them to use the walker.

“Don’t Tell Me What to Do!”

Your care receiver may protest, “You treat me like I’m incapable of doing things,” “Why are you trying to control my life?” “I’m not a child” or “Don’t tell me what to do.”

When this happens, acknowledge the feeling. Say something like, “It must feel awful to feel like you are being controlled.”

Don’t explain or defend yourself. If you need to de-escalate, change the subject or walk away and come back with something totally different.

More Tips for Success

*Don’t get into a power struggle.
*Walk away or change the subject and return to issue later.
*Keep a routine as much as possible.
*Don’t give too much advance notice.
Don’t explain why something needs to happen.
*Bribery works. Try ice cream or your care receiver’s favorite treat or activity.
*Acknowledge feelings rather than explain why you are right about what needs to happen.
*Fiblets”, or therapeutic lies may make it easier for you to gain compliance. (See FCA fact sheet, Ten Real Life Strategies for Dementia Caregiving)
*Stand in front of your care receiver when talking to them so they can see your face.
*Use people who have a relationship with your care receiver to encourage a behavior, for example, a favorite child, grandchild, friend, pastor or neighbor.
*People with dementia have good days and bad days or good times of the day and bad times of the day, especially if they suffer from sundowning. Try to pick a time when you might be more successful gaining compliance. When tired or hungry, they are more likely to be resistant, even if they don’t acknowledge they’re tired or hungry.
*Try music. Sometimes singing a command or request will be heard differently than speaking it. The brain processes music differently than language.
*Help your care receiver get started on a task. Not knowing the first step in an action can be what keeps them from complying.
*Take classes to understand dementia and the skills needed to communicate and handle tasks when caring for someone with a cognitive impairment
*Take care of yourself so your frustration doesn’t cause you to escalate a situation. Forgive yourself on the days you “lose it” with your care receiver.
*Use your relationship as a motivator. Say, “Will you do this for me, so I don’t worry.”

When Your Care Receiver Does Not Have Dementia

When the care receiver does not have dementia, this “stubbornness” can sometimes be even more frustrating. Under these conditions, you can explain why something has to happen using logic and love.

But that still might not work. Sometimes this is part of who they have always been. Sometimes it’s a result of fear of illness or disability, fear of decline, fear of losing independence or a fear of death. Pride also plays a role, for example, if they refuse to wear adult incontinence products.

If someone does not have a cognitive impairment, they have a right to a “bad” decision. However, the caregiver usually has to pick up the pieces when things go wrong. You may opt out of ongoing contact and wait for the inevitable to happen. Or you can still try to find ways to convince your care receiver to take better care of their health.

You can’t “make” your care receiver do anything. If they’re able to go to the store and get the things they shouldn’t eat, there’s little that can be done short of taking away the car keys. And if your care receiver is competent, they can find a way around most obstacles you can come up with.

You have to work particularly hard to maintain equilibrium under these circumstances. Getting as much support for yourself as you can from extended family (particularly siblings), community or a support group will help. Enlist those people to help you get agreement from your care receiver. See if the pastor, doctor and your care receiver’s best friend will get on board to play “tag team.”

Sometimes the best thing you can do is back off and not visit for a few days and do other little things that help. Then try again. Bribery can also work. You can try making agreements, like if you do this for me, I will do that for you. Reassure your care receiver that you are not trying to “take over their life,” but that you are worried and want what’s best for them. As much as possible, have discussions at a time when there is no pressure for something to happen right away. Use music, comedy, guilt…whatever works.