Managing combativeness for incontinence care

Ed1937

@LaneyG tigersmom has it right. If I were you, I would order samples of at least two different options to try. What works best for us might not work best for you, so samples really help there. The number to call is on the website. Ask for recommendations for two different options, then ask for samples. There might be a small charge, but it's worth it. Parentgiving.com has some very good options to consider, and they are a very good company, IMHO.

M1

She's on Zoloft and Seroquel Dio. Yes im actively working with the staff, so we'll see what shakes out. It will take time, and so far there have only been minor urinary accidents. But we all know it's coming.

harshedbuzz

@M1

I imagine you've probably tried this, but I'll put it out there anyway.

When dad initially went into MC, the aides allowed him to just say no to showers for a week or two which mom found disappointing. Pre-dementia dad had been not just handsome but well-dressed and well-groomed and it pained her to see him looking like a Yeti. We had a meeting and asked about a plan. They said they often had to give a new resident some time to acclimate to their new home and caregiving team. To their credit, they tried different times of day-- first thing, after lunch (when his mood was best), before dinner (dad often showered before dinner/after work or golf) and even before bed.

They suggested he might become comfortable with the shower protocol if she did the showers for a time as you are doing now. I was suspicious as he'd not been compliant around her helping him at home and because PWD don't really "learn" in the sense that a child would. But it did work-- faced with a her vs them she had better compliance and cooperation than at home. After about 2 weeks of her solo showering (which she reacted to with much the same I'm-paying-good-money-for-them-to-do-this attitude other posters have expressed, one of the aides inserted herself into the routine. First observing and handing mom supplies, and then slowly assuming more of the process-- toweling dad off, then shampooing, etc. Over about a month, they were able to shower dad solo.

Dad seemed to develop sensory issues as his dementia progressed. Being naked unnerved him. He sat in a commode chair without the bowl, with a towel draped over his shoulders and lap which seemed to make him feel less exposed. She would reach under the towels to wash him and get to his "undercarriage" via the opening in the commode from behind him, rinsing and replacing with dry towels as she went. She washed top-to-tail and dried as she went putting him in a dry terry robe as soon she could. The process took a bunch of towels, and the robe generally needed a spin in the dryer but the job got done. He liked the bath sheets from home better than regular bath towels, btw.

I know you have mentioned your DW's scoliosis before. Is she self conscious about it? My mom has significant scoliosis and finds things like skin checks and surgery very awkward even though she admits she has no problem being seen in a swimsuit. Draping for "modesty" might help her here.

I appreciate that your DW is an outlier to an extent I have never seen described here or elsewhere, but I thought I'd throw this out anyway.

HB

M1

Thanks HB, I appreciate any and all suggestions. So far, attempts to incorporate the aides have met with resistance, but we’re going to keep trying. She’s not particularly self conscious about the scoliosis, but the sensory issues are definitely present. She’s always cold, and with her bad back is uncomfortable sitting on the hard shower bench that is built into each shower —-more comfortable standing (so far). I’m going tomorrow to look at a walk-in tub they have in a separate part of the building that may be something else we can try.

of course the incontinence issue is going to take this to a whole new level. I think it’s going to be like Ed’s wife, probably a three person job for every brief change, But we’re not quite there yet. I don’t find the showering unsustainable, but it’s obvious that I can’t handle the incontinence alone.

yes, definitely an outlier.

ghphotog

Lord willing my DW will be in MC by the end of next week and sensory issues are by far one of the hardest aspects of this to manage. She is deeply ashamed and distressed when she has fecal accidents which is every morning now but she doesn't know how to express that other than hysterics. I just try to assure her that she's not in trouble and she didn't do anything wrong but it's always a battle.

She also is unnerved when undressed even with me so I can't imagine how much more difficult she might be with strangers trying to wash, change and redress her. She is cold all the time and has fibromyalgia so the slightest wrong touch she is yelping in pain. I can't even come her hair without her yelping every time I hit a slight snag with the "wide" toothed comb.

She will be challenging for them but they assure me they know what they are doing and she will be well cared for. Once she is dried, warm and dressed she is fine. Only time will tell how it will go.

So many typos on my end anymore. Might as well quit editing to correct them We all know what we are trying to say but still I don't like rereading my posts and seeing so many mistakes. :)

I feel for you.

H

ButterflyWings

M1 just throwing some things out here.

• I wonder if she would use the showerchair without the bucket, and shower herself while she can, with a handheld spray thing? (technical term, I know lol. sorry)
• Also, before I gave up on bathing or showering DH I was just about to try bathing him with his swim trunks on. Could you try a shower suit like even maybe a unitard or swimsuit of sorts? 1x a week even? Or maybe the bathrobe is really the easiest if she will wear one throughout? or a long Tshirt to cover her? Of course if it is not modesty related, none of these strategies will work.
• We have been clean and hygenic with 100% sponge baths for years, IJS. If it comes to that, its OK.
• Theracran supplements per Ed, have been great! (open capsules and add powder to smoothies, applesauce, pudding) They seem to be a real deterrent to DH's previous UTIs
• We went from pullups to tabbed diapers back to pullups and this works really well for us now. DH still isn't that compliant sometimes, but I talk fast (but calmly and softly) and move fast. The pull-ups actually don't have to be changed for a few days if you can get her used to an incontinence pad insert. This is really preferable to having to take at least 1 leg out of pants or leggings each time you need to change unders. This way, I just change the pad (takes me 15 seconds except when DH has a death grip on his pants and is trying to pull them back up as I am pulling down and also wet-wiping him, adding zinc ointment moisture barrier, and making sure the pad's mini-flaps are out so the pull-up is only a supporting structure to the absorbent insert. I really talk to try and distract him throughout, and the changing plus cleaning at least 4x daily is manageable.

So much of this was trial and error, and the biggest help was that when I disappeared all his boxers and filled the drawer with Depends he voluntarily started using them. I didn't ever mention it. I am going to hope that your LO has a much easier transition than you fear. I really, really hope so.

jfkoc

There can be a real fear! That built in bench may in fact be slippery as well as the floor.

Bathing and Dementia - with Teepa Snow of Positive Approach to Care (PAC) (youtube.com)

Roll in chair with arms

Hand held shower...this overcomes the water onthehead

Fear of falling...I have that

Lack of control ...hand held shower

Interesting

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