Ten Depends a Day?

--Rebecca--

My dad recently transitioned to memory care from assisted living. After he moved, we noticed he is using 9-10 Depends a day. A caregiver there noticed that he is wearing three pair at a time. I have gently asked about how he uses Depends. "What may be going on, to cause a burn rate of 10 a day?" His replies are defensive, and are along the lines of "No I'm not." "How would you know?" I don't argue. I was trying to see if they were a poor fit, or if he had unasked questions about how to them. But he insists that he only uses one a day.

Quick case history: Incontinence increased after his wife's death in June. He was unsuccessful with learning how to use underware shields, despite his three children demonstrating multiple times, reinforcing the skill, labeling the "up" side.

By October he was open to trying Depends. He used them intermittently with cotton briefs. The briefs always wound up wet, in the laundry.

His cognitive decline after the loss of his wife was rapid.

Mid December, he transitioned to memory care.

I do not think anyone from MC is taking them. They actually brought it to our attention, (while we were already scratching our heads over this same issue). MC said they are seeing lots of unsoiled Depends in his trashcan.

There is a history of general hoarding. If MC stores them for him, and just brings him, say 4 pair a day, I'm afraid of new negative behaviors. He calls us during the week, worried, to tell us his supply is getting low. Which of course it is. He had 50 on Saturday, and by Wednesday the shelves are looking bare.

He is changing his own soiled pants himself and needs the autonomy to continue to do so.

Thanks, everone, for reading.

harshedbuzz

Rebecca—

Wow. Your story really demonstrates how much the loss of a scaffolding spouse can impact a PWD's abilities to function.

The "layered look " a pretty common caregiver complaint— several pair of pants, shirts, socks, etc are not unheard of here.

Are the Depends in the trash equal to the number "missing"? If not, it could indicate another resident "shopping" and it might be prudent to secure most of the stash and ration them out.

If several of the Depends are "soiled" as opposed to just urine-soaked, he should probably be seen by a doctor especially if it isn't normal for him to move his bowels more than 2-3 times a day.

Otherwise, the answer here, like it or not, is supervision in the bathroom. This behavior may be a harbinger of losing the ability to manage toileting independently.

HB

MN Chickadee

The staff may need to be more involved in the changing/toileting. This is a basic and core service of memory care. They should be trained at cajoling a person into changing (or not changing) briefs. Similarly, many PWD refuse to shower - not something that can go on long and staff have to insert themselves into helping. You may need to discuss this with the head nurse or whoever writes the care plan. They toileted mom on a schedule and during some stages she did most of her business in the toilet and briefs stayed dry. I'm sure it's easy for the staff to be hands off and let him do it, much easier for them, and let you pay for a million Depends, but that may need to end. Many PWD get obsessed with stuff, and staff have to be the gate keepers. Some have to wear adaptive clothing they can't get off alone to prevent stripping down all the time or removing underwear. My mother's things were all locked away in a closet of MC because she would destroy everything. If that makes him agitated then perhaps work with his doctors for a medication to keep anxiety at bay.

That said, they do go through a lot of Depends in MC. The staff checked mom every 2 hours during the day, I believe that was state law, and if it was wet they changed so some days in later stages when she was less able to get to the toilet it was easily at least 6 a day plus night time briefs. You may not get a whole lot less than 10, but having unused ones layered up and discarded is understandably frustrating, they aren't cheap.

--Rebecca--

Just had the care plan this week. We all want my dad to feel independent, and in control, since he's lost so much control. The care plan was to include his assistant taking clean Depends out of the trashcan and putting them back on his bathroom shelf.

I live out of town, it's hard to monitor if Depends in the trash=Depends off the shelf. He got a psych evaluation on Friday. I will see if anything insightful comes up from that. No residents are taking his Depends. If it is staff, they know I'm monitoring the Depends stash.

This may mean the end of independent toileting, but I will give him another month or two as he is adjusting to the shock of shower assistance. So he also has assistance now getting dressed. I will ask for them to check that he is putting on one pair during dressing/undressing times.

Maybe move Depends out of the bathroom, into his main room closet? He gets dressed with assistance. So they hand him one Depends from his clothes closet. The assistant then puts one Depends on the shelf in the bathroom each morning. Assistant can check at lunch and dinner. Replenish the one Depends back in the bathroom, as needed?

harshedbuzz

Rebecca said:

 We all want my dad to feel independent, and in control, since he's lost so much control. The care plan was to include his assistant taking clean Depends out of the trashcan and putting them back on his bathroom shelf.

I can really appreciate wanting to preserve dad where he is given how dramatically his life and capacity have changed since June. That said, the above seems like a big ask given that soiled and clean are being comingled.

Not leaving them in the bathroom makes the most sense. I think you're onto a strategy that could preserve ADL/independence for now. Since we presented Depends as underwear rather than a diaper, we'd always stored 6 or so in his drawer with T-shirts and socks and continued that in the MCF. Perhaps that could work.

Are you his POA? You mention a sibling group; do any of the sibs live near enough to dad to monitor this for now? If you're POA, moving him nearer you while you have the option might make the most sense.

HB

JDancer

Your story clearly illustrates the loss of function that comes with dementia. So many people think it's just about memory loss, but they lose so much more.