Basic Hygiene

RobertsBrown

What do you do when your spouse refuses to shower, bathe, or change clothes?  I was managing the every other day, then the every few days, but I am not dealing with the total refusal to take care of basic hygiene.  We are also refusing to wear pants these days.

A few days ago we had a dental appointment, and I was insistent that she take a shower and get cleaned up before we go out in the world.  She dug in, and it was clearly going to be a row, so I just called and cancelled the appointment.  For the last few days she keeps asking about 'that other thing we have', which translates to dentist appointment.  I explain to her that I cancelled it and why, but......

IT'S ALL POINTLESS.

You can't reason or argue or negotiate with a damaged brain.  It's this ridiculous tyranny of obstinance and delusion.  I have seen her try to wear sweaters like pants, and today she was very aggressive about the fact that 'people don't wear pants'.

So, here is a new chapter.  This is the one where I stop trying to take her out on errands, and where her world gets smaller and smaller until her whole life is lived in a few rooms.

I do have professional help coming.  Home care for 1 or 2 days a week, so I can shop and work, and do stuff.  It is my hope that a stranger with skills may succeed where I am failing.

Rick4407

Hello Robert.  My DW showers about once every 2-3 weeks.  Its always a joint exercise with no build up.  I just start getting ready and encourage her to as well, very matter of fact.  Just normal activity with no explanation of why.  Lots of encouragement and small comments, "I like the blue towel", "this liquid soap is nice".   Other things like the dentist, ophthalmologist, dermatologist just get cancelled.   If she asks why, I blame everything on the virus.  

When she gets stubborn, I ask an unrelated question or make an unrelated comment and after 15-20 seconds just gently continue on.  

When we go to the grocery she pushes the cart and we cross the parking lot holding hands.  

She's gone from a closet of 8' packed with clothes to 3-4 items, pull up culottes from Buck and Buck have been her summer wardrobe.  She wear a mens sizes small tee short on top, or one of three B&B blouses.  She has one pair of practical shoes with a velcro strap.  Fancy shoes, lingerie, skirts and dresses are all gone.  Her plain cotton underwear will be next as we move to absorbent ones.  

All her good jewelry is put away and she wears one Mexican silver ring.  I try to think like a politician.  When she askes where her other jewelry is I answer:  "You have been wearing the Mexican ring for a while now, we got it on vacation 2 years ago".   I respond but not to the question that was asked.

Reading here and trying to anticipate what is coming has helped me considerably.   I try to shrink her world to what her brain can handle.  

I keep my own sanity with my constant companion iPhone where I can follow national news, the markets, the virus, and international events.  My normal outside chores are all now done by a man I pay or a contractor.  We are fortunate we do not have her family interfering, they are distant an/or uninterested.  It's 24/7 and a new career when I thought I was retired.

Take care and good luck figuring out what will work with your DW.  Rick

White Crane

Hi Robert, I'm sorry your having such a rough time.  I gave up trying to get my DH to shower more than once a week...and sometimes even that is a battle.  Once in while he goes two weeks between showers.  It's not the way I want it but it's the way it is.  He insists he hasn't done anything to get dirty.

I, too, have cancelled Dr. and dentist appointments when DH was being uncooperative.  Now I try to keep appointments to a minimum.  Only those that are necessary...mostly to get his Rx's refilled. 

It's rough, I know but I'm glad you have help a couple of times a week so you can get out and do what you need or want to do.  Hang in.

LadyTexan

Good morning Robert.

The hygiene routine has changed in our house as well. 

Before Alzheimer's, DH used to take one to two showers a day. Floss his teeth and shave daily. Brush his teeth at least 2xs per day. Use antiperspirant and cologne. His finger nails and toe nails were trimmed and clean.

Now I am grateful if DH has a shower once per week. I shower him. Now DH allows me to shave him about every 10 days. Now I am fortunate to brush DH's teeth once per day, before bed. Now DH needs assistance for all toileting activities and dressing. DH is very resistant to washing his hands sufficiently or effectively. I keep a container of wet wipes handy to clean the gunk off his hands.

DH went through a phase where he did NOT want to wear pants. He would go out on the front porch in his underpants to smoke. I finally gave up on that argument and hoped the neighbors would be understanding.

DH has a closet full of fine clothing, but now I dress him in t-shirt or buttonless long sleeve shirt and elastic waist pants over his disposable briefs.

And honestly, my routine has changed too. My daily care giving "uniform" is yoga pants, a t-shirt and athletic shoes. My hair is wash and wear. Make-up is a rarity. I can't remember the last time I wore sexy clothes or luxurious lingerie. 

For us it is this way now and that is okay. Our life has changed incrementally to adapt to Alzheimer's.

Hang in there and know that you are not alone.

Buggsroo

My husband will tell me he has taken a shower. He runs the water and shaves.

I now supervise shower time and talk him through the steps. He stopped brushing his teeth awhile ago. He doesn’t have many teeth left, it will be time to take him to get his teeth cleaned. He wears sweatpants, T-shirts and socks all the time, plus his slippers. I do his laundry and manage to take care of stains etc.

Sometimes he reeks to high heaven but the back chat I get isn’t worth the price of admission. I cut and file his manky toenails, make sure between his toes are dry. 

He used to really take pride in his appearance and daily hygiene. That has all gone. 

This disease takes no prisoners.

sandwichone123

I wonder if dresses would help. There are simple dresses like oversized t-shirts, or button/zip front or back that may be easier to deal with than shirt and pants.

The conversation reminds me of when my mom was near the end of life, but still sitting in the living room talking. My brother called to say they were about an hour out so I warned him: "We're all pretending not to notice Mom has no pants on." They're a pretty conservative family, so I thought they needed a heads up.

tcrosse

Exactly the same here trying to get DW to shower. The hard part is getting her clothes off. She fights and screams bloody murder, and I am reluctant to resort to brute force. As a result, she stinks, but I have gone mostly nose-blind. What's ironic is that she used to work at an adult daycare where she was trained in getting reluctant folks into the shower. But she never showed me how.

Gig Harbor

My husband is only recently starting to argue that he does not need a shower. I am trying a different approach and it seems to be working. I simply say that in order for him to live with me in our house he has to shower at least every three days. I remind him that refusing to shower was the reason his sister was placed in memory care. I say that if he becomes smelly he will have to move. He will grudgingly shower. I take all his clothes at that point and put them in the laundry but I try to have him put on clean clothes every two days. It sounds harsh but it is the only thing that has worked. He doesn’t need any help showering and once in the shower he stays in for 30 minutes.

Palmetto Peg

I have seen on this thread and others about the problems you all are having getting your PWD to shower.  Why is that?  What part of the disease creates this dislike of staying clean - especially if someone else is going to shower them and there is little effort on their part?  Right now my DH still showers once or twice a day, always has on clean clothes, and brushes his teeth regularly, etc.  At what stage does that change?  For the men with this problem with their DW, do you basically just physically pick them up and take them into the shower?  I would never be able to do that with my DH, he is much bigger and stronger than I am.  It must be so hard to fight this battle over and over - and I know it is only one of many battles you face every day.  So much to know and get ready for...............

Ed1937

I like Rick's technique, although a little more often would be better. For those who are having problems with this, if you can find a technique that works well without outside help, that's a big plus. If you can't find something that works, if your LO has a close relationship with a neighbor, friend, or family member, that might work. We have a daughter who can talk my wife into just about anything, when I have no chance. When I have a problem that gets bad enough, I just call her, and she talks her mother into doing what needs to be done. Many times someone other than the caregiver has a better chance of success.

Beachfan

Ed,

I agree with Rick’s approach as well, although showering for DH  is every other evening (so far) without fail.  Sadly, I’ve downsized DH’s “wardrobe” drastically over the last several years.  Yesterday, our 13 year old grandson appeared wearing one of DH’s “cool” golf shirts.  “Dad and I are going golfing- - does pop have anymore of these nice shirts I can have?” It’s nice to see them re-purposed.  

LadyTexan

@PalmettoPeg

From what I have read (and what I have observed with DH) there are several reasons why PWD resist showering. For example, the shower experience itself:

1. the noise of the water, 
2. the sensory overload of the water on their skin, along with the noise. 
3. many PWD have difficulties regulating their body temperature because of the brain's deterioration. As a result, the PWD may feel very cold in a bathroom that would seem comfortable to most of us.
4. the PWD's privacy and personal space are encroached upon by the caregiver.

My DH is ultra sensitive to almost any touch. If he brushes against any object, he recoils as if he were bitten by a viper. When I dry him off, after the shower, no matter how soft the towel, no matte how gentle I am, he tenses his body as if he is being tortured.

Another consideration is that PWD's sense of smell may become compromised. As a result, they are unaware they may smell bad and are in need of bathing.

Also because of memory impairment and brain deterioration, many PWD may believe they have recently showered.

Palmetto Peg

Thanks for the explanation - that makes perfect sense.  I remember how cold my dad always was near the end of his life.  He hated showering, but he did do it.  But going into their house was like going into a sauna.  I can also understand that hypersensitivity to touch, too.  There is so much a brain processes in a simple thing like a shower, and I just didn't think about how each little part of it could feel threatening if you aren't able to have all that processing working properly.

In some ways, these behaviors remind me of the children with autism I saw in the school district where I worked.  I wonder if in some way the same part of the children's brain is compromised just as our LO with dementia's is?  I have noticed my DH getting more frazzled when there is too much noise around.  We really can't eat out in a restaurant where it is loud.  He gets so agitated and we basically just have to leave.  Hard to explain to those who don't know about his diagnosis.  The children would cover their ears and try to get away when it got noisy.

What a wealth of information on this forum!!!  Thank you all.

amicrazytoo

OMG - I probably should be cited with elder abuse. My DH has not taken a shower in the sense of what a shower is supposed to be for, for more than a month, he has not shaved, he refuses to change his shirts, currently wearing three, 2 t-shirts and 1 sweatshirt. I have begging and pleaded with him to no avail. He will get in the shower to finish his defecating and will bathe from the waist down.  That is sufficient for him. Last night when he had a bowel movement, his underwear were so soiled even he rinsed them out and threw them in the hamper. He did put on clean underwear, but reused the three shirts and shorts he was wearing before his half shower. He has no family willing to deal with him. I had him evaluated by Hospice, but  he's not to stage 7 in their opinion. Even if they did accept him, he would fight tooth and nail with them and they will not force help on anyone. He has an appointment with his PCP next week, I am hoping she can get through to him the importance personal hygiene.  In his better days, he was fastidious in his appearance. showering and shaving daily, long showers at that, he would stay until the hot water ran out.

Hope Still Exists

My DH has not showered or shaved for 3-4 months.  He changes clothes everyday, sometimes 2-3 times per day.  However, he pees on the carpet and uses his blankets for toilet paper.  Needless to say, the washing machine goes nonstop and I have a Bissel carpet cleaner that helps.  But the house is on the border of being unsanitary.  He is aggressive and its easier for me to just clean up after him.  Thanks for allowing me to get this out.

JJAz

Teepa Snow is the 'dementia whisperer.'  She has this podcast on this topic

  https://www.youtube.com/watch?v=7OLrilAeT1U

RNS

I am so happy to find this site. I'm 67 and my husband is 87 and in moderate stages of vascular dementia.  I am his full time caregiver.  We are in what I call the "twilight zone".  He has very few medical problems but has very little short term memory.  He doesn't shower, brush his teeth, can't pick out clothes, doesn't cook, (thankfully), has no idea what medication he takes, won't run off, has difficulty in holding a conversation of any type, etc. etc.  However, he insists he doesn't need help. I tell him that's because I do everything for him.  He just laughs.  

I'm lonely, angry and feel guilty. I am writing this to get advice about proceeding with respite in home care.  However, as I am writing this and seeing all the problems, I think I have answered my own question.  

How do you manage all this and stay sane?  

JulieB46

That doesn't sound harsh at all.  My DH is still showering daily, but if he gets to a point of refusal, I'm going to use your idea.

DrinaJGB

Stay sane? Not always. Who could?

   But I tend to agree with Seal. 'We're never going to survive unless we get a little crazy."

 Amen, Brother.

Lynne D

RNS my husband has mixed dementia (vascular and Alzheimer’s) and is in the exact same state as your husband. I am lucky to have a neighbor who used to be a caregiver and who currently assists her grandpa with dementia. I had her over to “help” me with some things around the house. She noticed my husband’s guitars and they hit it off. I now leave when she comes over because he is embarrassed to play in front of me. She is amazing with him. I feel I got REALLY lucky. 

Perhaps bringing someone new into the house under other pretenses and getting your husband comfortable with them would work.

He would pitch a fit if I ever said anything about a caregiver looking after him.

Gig Harbor

Hi RNS,

My husband is 81 and has no health issues but also no memory. He has forgotten all of our 50 years of marriage and looks at pictures we took with absolutely no interest. I stopped being able to leave him alone because he would go out for a walk and got lost twice. I hired two ladies who cover three 4 hour days so I can get out of the house. One likes to walk and they do 4-6 miles. The other will walk 3 miles but she likes music and plays songs for him and they talk about the songs. He never questions why they are here because I said they were in a program training to be caregivers. I think he enjoys the undivided attention he receives. That said there are days that I wish he could leave and I could have the house to myself. I will be looking into adult day care for the future but for now this setup works well.

Iris L.

RNS wrote:

  However, he insists he doesn't need help. 

How do you manage all this and stay sane?  

I think it helps to understand about anosognosia.  The PWD (person with dementia) truly believes he is fine, and will become upset if you try to convince him otherwise.  This is a characteristic of the dementia.  It will help to avoid trying to get him to admit to needing help.  This will never happen.  Learn work-arounds and other tactics from the members.  Best wishes.

Iris L.

markus8174

RobertsBrown,

I can feel your pain. It was this issue more than any other AD behavior than got me to place my beloved into long term care. She would sometimes go days without changing her incontinence protection (adult diaper), weeks without any kind of bath. She was increasingly hostile and beginning to get violent when I tried to force the issue. I could live with the odor and damage to the furniture, but for a woman to go weeks without bathing while dual incontinent wasn't healthy. Repeated UTIs, and finally UTI sepsis put her into the hospital with placement to a facility on discharge. I'm not happy about that decision, and my beloved wasn't happy with that decision, but I was left with no option. It was elder neglect to keep her at home any longer. I guess my point is, if you haven't shopped for a facility, now's the time. Talk to an attorney about estate planning. Get  durable and health care POAs if you can. Even if you can avoid placement for a while it will be easier if you have the groundwork covered.  This isn't a decision you want to make on the spur of the moment when a crisis occurs. Hospitals in my area are completely unhelpful in choosing a facility. They will put your loved one into any place that has a bed unless you have a few options you can ask them to explore.  Trust me when I say your choices are pretty much bad or worse. After weeks of research there were  only a couple facilities within 50 miles of my house that were even a tolerable choice for the love of my life. Both had long waiting lists for a bed. A hospital can often get a bed in chosen facility when the answer is "no beds available" when a family member asks.

Ed1937

Gig Harbor wrote:

He never questions why they are here because I said they were in a program training to be caregivers. I think he enjoys the undivided attention he receives. 

That is brilliant! Why haven't I thought about that? I've seen a lot of work arounds, but this is the first time I saw this. You can be sure I won't soon forget about it.