Soiled and refusing to bathe/change. Any ideas?

rachelkp

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.    

Any suggestions? Based on all the bathing threads I've read in this group, I'm assuming others have been in a similar situation?  We're concerned (and fairly certain) that if we try to force the situation (which I don't even know how that would be possible), either ourselves or by bringing in a home health aide, she will get very physically aggressive.  Thoughts?

Debdg

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.

sunnydove

Can you tell her that a neighbor reported the smell and that adult protective services has said that if the situation doesn't improve they might take her to a home? I hate to go negative,  but since asking nicely or for nice reasons (to see the grandkids) didn't work, maybe fear will motivate her more. Good luck. Hygiene is so hard in these situations!

HappyCatCA

When my dad was refusing showers, we sometimes had luck suggesting it when he was already in the bathroom doing something else. We would have towels and a change of clothes in there, ready to go ... and the shower chair already in the shower. We had luck with this approach more than half the time.

rachelkp

Thank you.  With Thanksgiving this week, that is what we are trying.  The reality is that if she doesn't bathe by Thursday, my father and her won't be able to go to Thanksgiving dinner at my cousin's house.  I suggested he pick up a new outfit and undergarments for her, and suggest that she take a bath or shower and put on the new clothes so she feels nice for TG dinner.  He's going to try that tomorrow morning.

rachelkp

We've been avoiding going negative.  From our experience with her, anything negative or assertive likely leads to even firmer avoidance and sometimes aggression. We've talked about how if she doesn't shower or bathe she could get sick, and even that hasn't been a motivator so far.

Marta

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.

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Red Tulip

We have learned with my dad that when it comes to certain things affecting his health, we do not ask him his opinions.  When we did ask him, he always refused.  So instead, we say something like, "Dad, we are going to change your clothes", "Dad, we are going to go into the bathroom and take a bath".  He always complies.  We surround these activities with lots of positivity, laughter and tell him what a great job he is doing.  We involve him at what level he is capable - "here's a washcloth so you can wash your face".   At this point he doesn't have the judgement to make decisions so it's all very instructional which is what he needs.

Marta

Seroquel 12.5 mg daily at bedtime could work wonders.

rachelkp

Marta, can you share more about your experience with Seroquel?  I talked with my Mom's MD team and we are first going to try increasing the Lexapro dosage, and then they're recommending Seroquel if that does not help.  My father is extremely scared though of using an "anti-psychotic" drug.  Any positive experience to share?  Any significant negative side effects you've experienced with your LO?

Marta

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.

jfkoc

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.

ghphotog

My wife hates showers, cries and sobs when it's time but through all of the emotion she does comply and she always feels better when she's dry with clean clothes on. I only make her wash her hair every other shower. Something about washing her hair adds twice the drama.

jfkoc

Hair wahing can be frightening...it involves putting ones head back. closing ones eyes and getting water all over the face. 

Take a look at the hair washing protectors that let you keep your eyes open and face dry. 

Jo C.

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,

J.