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Soiled and refusing to bathe/change. Any ideas?
We have a quickly escalating situation with the lack of bathing/hygiene issues. My mom's stomach was upset yesterday, and she either had a bowel accident, or did such a poor job wiping herself, that she is soiled through her clothes. She is still refusing to change her clothes or bathe (it's been months). I just talked to my father a few minutes ago (her primary caregiver), and he is going to try again getting her to bathe, offering a nice bubble bath, discussing the importance of staying clean and not having germs so she can see the grandkids this week, etc. At this point, if she doesn't bathe, my Dad can't take her anywhere, and it is quickly becoming a health risk for both her and my dad.
Rachelkp, you might tell her that you are going to a fancy party and she needs to get a bath and have her hair done for it. If she is very uncomfortable being naked and wet because it it cold you could try to warm the bathroom more. If she is embarrassed you could cover her with a towel and just expose one part at a time to wash.if she is unsteady then a shower chair with a towel on it might help.
I wish you success, the situation sounds dire at this point. But you just can’t force it, as you realize. You must convince her she wants to bathe and make it comfortable for her.
No amount of reasoning is going to convince your Mom to get cleaned up. Her reasoner is BROKEN.
At this point you need to call the office of her PCP to get a prescription to reduce her resistance and allow two family members to team up and get her cleaned up.
Obviously the Doctor's call specific to that patient, but what are some of the names or family of drugs that would help with resistance?
Most of the drugs mentioned in this Forum are the long-term treading water memory drugs or ones to calm down a patient/lessen aggression.
But which may work for resistance and stubbornness? In the past pre-ALZ ,I could talk through these character traits, now of course impossible since there is no reason just an imperfect brain falling back on the old habit: "just say no." Thank you.
Rachel: I am a prescriber and have used Seroquel for many patients when the potential benefits would outweigh the risks. I cannot imagine that sitting in one’s own waste products and refusing to get cleaned up is preferable to the small, but real, risk of heart attack or stroke associated with antipsychotic medication.
I also used this med with my own husband to modify negative behaviors, with success.
Please...if you think reasoning including non immediate consequences is going to work then you need to start with Caregiver 101.
It is all in the approach.
Now re the bubble bath. Your mother may be very frightened of the bath or there may be privacy issues. Sometimes a bribe works but it must be short termed ie after you have your new clothes on we can ---------.Please switch to a shower and be certain that the shower head is hand held.
Make certain the bathroom is warm, the towels laid out, the water the right temp and perhaps some singing before and during the shower as a distraction.
Hello rachelkp; that certainly is a significant challenge that has reached a point of even having health ramifications; it must be terribly frustrating and concerning. I apologize in advance for the length of this, but there is much to think about and ponder.
First: Is your father the best person to try and get your mother to bathe? What was their relationship like prior to dementia and even now? How well does he interact with her? Is he loud, is he pushy or demanding, does he get verbally frustrated and a bit angry? Does he tend to be gentle or unintentionally a little rough with his hands? How does he approach the challenge to make matters a bit easier?
If part of the problem may be his well meant but less than effective interaction, it may be helpful for you to softly try to make the bathing happen. However; no more than one person in the bathroom while the bathing is in process and everything soft, slow and reasonably quiet with no pushing or demanding.
Is she having any pain as in even having arthritis in some joints such as knees, back, shoulders, etc. that make manipulating for bathing more painful for her? If so, relieving the pain prior to bathing may be helpful. Has she had fear of water since childhood or through a negative experience? Was she mistreated in younger years making being naked a threat? If either of those exist, then one can manage the process in a better understanding manner.
Is this bathing effort being tried in the tub or in the shower? Which setting seems to be more anxietous for her? Is the bathroom warm enough for her comfort?
Does she have a high level of being embarrassed at being naked in front of the family - if so, try letting her keep a long Tshirt on and simply bathe her through that, washing one part of the body at one time and doing it slowly while keeping one's voice soft and if it works; perhaps even softly singing small songs she may be familiar with may be helpful and lessen the anxiety.
Also best done during the time of day she is most relaxed and not overtired, hungry or in pain.
One of the caregivers here had the bathroom fixed like a little spa. She had bought new big fluffy pink towels and bath carpet, had soft lighting, put lovely smelling potpourri in the room which had been lightly warmed and had nicely scented soap and kept her mother gentled for awhile before approaching the bathroom. She also had a very large thick pretty towel to wrap across her mother as she exited the bath and quickly put a robe on her and also softly and quickly dressed her. Initially she had to wash her mother through a T-shirt, but as her mother became more accepting of bathing, the shirt was no longer needed.
My mother was a smaller challenge to bathing. She was best served by having a seat in the step-in shower and having a hand held shower head on a long hose which she held so she did not feel intimidated by water coming at her overhead. She absolutely refused shampoos in the shower and would go many weeks with refusals until I finally figured out an easier way. We would wash her hair at the kitchen sink with nicely scented shampoo while she bent forward with a tea towel covering her face so it did not get wet. She hated water in her face.
We found a hair dresser who did hair in home settings. She required that the client be freshly shampooed. We found that my mother LOVED having her hair done; after the first visit of the hair dresser, she delighted in her coming once a week and let us wash her hair at the kitchen sink without fuss and carrying on.
As for medication. My experience has been, that the Zoloft did not garner positive results so that was discontinued. I finally got my LO to a good dementia specialist. By that time, help was really necessary as the quality of life suffered from all of the acting out, care resistance, etc. Antipsychotics are used when all else fails. My LO was placed on Risperdal and the difference was truly dramatic in the positives and returned a decent quality of life for her. So much positive and no problem bathing or with acting out and no sedation or negative effects. I had checked on the safety concerns with my LOs primary MD and her cardiologist prior to starting the med and they saw no difficulty for her. Only the story of one person.
My step-dad had dementia; when the negative behaviors become consistent and no lesser measures were helpful and his quality of life was affected daily, his dementia specialist prescribed Seroquel. It too worked wonders and results were highly positive. Again; just one person's story. From the dementia specialists input, possible negative occurrences were very, very low percentage wise. We never regretted our LOs receiving those antipsychotic meds as the quality of life was indeed far better for our LOs. The routine for the meds is, start low and go slow. Many have been helped with this class of medication; but do discuss it with your dementia specialist and/or other pertinent physicians in regard to your mother's physical self and health history.
Rachel, it is all about the qualty of life and not living a hellish existence day after day. We must find relief for them if it is available. They cannot ask for this sort of help themselves, so we must be their best advocates and carefully do that for them.
Hopefully your mother has a dementia specialist and you can discuss the problem issues and medications with him/her. NOTE: Also; it is good to have your mother checked for a "silent" urinary tract infection. These UTIs are called "silent," as they have no overt physical symptoms, but they do indeed often cause very negative behaviors until the infection is treated. Your mother being incontinent of stool and not bathing for ages may well have caused a UTI, so it would be a positive to have that checked out. If an infection is present, it may be adding to the challenging behaviors.
In the meantime, if your mother will not go to tub or shower, perhaps she would let another female whether it is yourself or a bath aide, to sit her on a chair in a bathroom fixed up as described above and have her covered with a large warm covering such as a large bath sheet, etc. Then begin to uncover only one part of the body at a time, washing it gently - an arm, another arm, her chest, her back, tummy, a leg then another leg, etc. You get the idea. Gently done and softly quiet with her never being fully uncovered. The backside and genital area would be the challenge and left for last if she would stand while partiallycovered. ( A bidet could be helpful, but she would have to be able to tolerate the warm bidet water.)
As for a bath aide, that may work out better than family helping her. The aide should come into the house as a "social" call a couple of times before the bathing is set in place so that your mother is used to seeing her. Perhaps coming in for coffee and cookies and just visiting while being warm and kind to your mother. Then the day comes when bathing softly commences by the aide. (With no one else in the bathroom or visible from the bathroom.)
Sorry this was so long, but wanted to throw everything out there as I know how hard this is from experience. I send best wishes your way from one daughter to another,