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My grandmother has Alzheimer's and Dementia and lives in Russia. I hired help/nurse to take care after my gradma since I live in the US and cannot take care of her personally. I would say my grandmother is in the late stage of dementia.
So, my grandma cannot brush her teeth, cannot wipe down her hands, hardly can wipe her private parts and cannot wash her face. E.g. nurse gives her a towel and tells her to wipe down hands and my grandmother has NO IDEA what she is being asked to do. Absolutely no idea. She just holds the towel and either does nothing or starts doing something else. Likewise for other simple things like putting socks or sweater on. But sometimes if told in commanding voice she does it.


Question: do we need to keep pushing/encouraging her to do things by herself or should we just give up and start doing things for her? It does appear to me that my grandmother is just being lazy sometimes and choses not to do things. Also, encouraging her takes toll on nurses. I see that because they have to tell my grandma to do things in commanding voice, otherwise my grandma won't do a thing. And talking like this all day is not easy.


Thank you.


P.S. There is no option for memory care where my grandma lives.

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I'm wondering if these "nurses" understand how a person who's suffering from dementia has a brain that no longer functions properly? Commanding the poor woman to do things is senseless and cruel. Your grandmother isn't lazy, she's confused and unsure of WHAT to do. She needs lots of help from compassionate caregivers who understand how dementia works and who are properly trained to care for her. You would benefit from reading up about dementia and from watching Teepa Snow videos on YouTube. Be sure to hire people who have experience caring for dementia patients and are familiar with how to properly interact with them...it is vital to provide your grandmother with capable and compassionate carers. She's not acting difficult on purpose....its the result of a broken brain that's making her behave this way. The more you read about dementia, the more you will understand the type of care your grandmother requires.
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You or rather the aides can do both.
After washing moms hands they can give her a towel to hold then they can sort of hold moms hands so the hands get dried but mom is holding the towel.
But as far as cleaning herself after toileting. Aides should be cleaning her.
Oral care, aides should be doing that. If they want to let mom hold the toothbrush after they are done that would be fine.
Eating, they should allow her to feed herself but sit and encourage her to chew, swallow, then take a drink. I would go so far as to gently rub the side of the cheeks to move any pocketed food. If she stops eating they should help feed her BUT when she keeps her moth closed or turns her head they should not force her to eat more.

Grandma is not being lazy..if the aide gives her a towel to dry her hands it can take as long a 45 - 60 seconds for her mind to process "what do I do with this towel?" And in late stage it may take even longer to process.

Late stage I am surprised she is even attempting to dress herself. She is doing better than my Husband was in his late stage.
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In my opinion the ideal would be to use a combination of encouragement and doing what it takes to actually get the job done. Teepa Snow's hand under hand technique is one way to do this, I'll link a couple of videos demonstrating how it works:

https://www.youtube.com/watch?v=6gLrH8mioCw

https://www.youtube.com/watch?v=iKT9YIVPREE

https://www.youtube.com/watch?v=nU60us7yb-A
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How can your grandmother do something that she doesn’t understand to do?

What is available for her if there isn’t any memory care?

Please allow the nurse to do things for her that she can’t do on her own. She doesn’t deserve being yelled at.
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Your grandma can no longer retain the information required to do these actions. Her aids need to be educated. Yes, they need to do all these things for her, and she will continue to need them to do more and more for her. Think of a baby, but the baby keeps learning new things and becomes more independent. Now, reverse that for someone with dementia/ALZ. They are unlearning, going back in time and becoming more dependent.
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When Mom went into the AL her aide told me she wasn't brushing her teeth. I asked if they handed her the brush with the toothpaste on it. Answer "No". As long as you did that Mom brushed her teeth. I used to let my Mom wash herself thinking the more she did for herself the better. I had to tell her everything she needed to do. My daughter bathed her one day and just went ahead and washed her, daughter is an RN. Said it was just easier to do it. Aides just don't have the time to take residents thru it.

There is no rhyme or reason to Dementia. Mom forgot how to put toothpaste on the brush but she remember what the brush was for. She knew what a washcloth was for but forgot how to wash herself. If having her do for herself frustrates her or the aides, I would just tell the aides do it for her. Its not like a stroke where by doing you are reprograming the brain. You grandma's brain is dying little by little. And as each part dies, she loses that function. Eventually the part of the brain that effects breathing and heart dies and so will grandma.

From your discription of Grandma I think she needs skilled nursing. Here in the US we have Medicaid to help with the cost.
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