I really need some suggestions. MIL is in later stages of dementia, but she thinks that it must be mild dementia because there's "nothing wrong with" her. That's making it extremely difficult to get her to cooperate with anything! Especially hygiene. When she does go in for a shower, she comes out almost as dirty as when she went in. She refuses to bring her clothes out to be laundered, since she "just put them on" and puts them back in her dresser. Washing her hands consists of running them under cold water for 5 seconds and drying them with toilet paper. The last straw was last night when we had someone cut her nails (which she argued about), the girl started gagging because of the odor. To make matters worse, I have a one-and-a-half-year-old toddler at home who, of course, puts everything in his mouth! We have to figure out a way to get her properly cleaned! I hate to threaten her with a nursing home, but trying to be tactful and/or not make her defensive is not working! I'm sure I'm not the only one that has had this problem.. Please, does anyone have any suggestions???
The following user gives a hug of support to TimeToLiveLife: scorptired (12-08-2012)
Time, what you described is typical dementia behavior. If you try to resolve the problem as if she was thinking normally, it is not going to work.
First, she does not realize how bad her dementia is. In ways that is a blessing and in ways that is a curse. Her mind believes what it perceives (as warped as that reality is) as strongly as you believe what your mind perceives. When Mom says she has bathed she honestly believes it. Having no time line... she has showered. It might have been weeks ago but in her mind... she has showered. Telling her that she has not showered is telling her she is lying. That would anger you if she did that to you. So confronting her, telling her she is wrong, is not working well for you.
The second problem is her inability to see what you are telling her. Literally she can not see the problem. Her vision has probably been affected by this disease, as has her sense of smell. If you take two toilet paper tubes and look through them like binoculars, that is what late stage dementia patients see. If you look down, you can't see your shirt so you have no idea it is dirty. The sense of smell is also damaged so she can not smell the dirty you want her to smell. Then you have the color and depth perception changes that have occurred. So what she sees is not what you see. Pointing out dirty or telling her to smell it is relatively useless.
Third you have her inability to actually take care of her own hygiene. She has no idea that she is dirty. It is not intentional. If she knew better she would do better... if she was able to do so. Just the process of cleaning one's self is difficult/impossible for those with dementia. The start to take off their clothes and don't remember why they are doing it. They look at the shower and don't know how to turn on the water. What do they need for a bath, they have no clue. How do they get that stuff (if they see it) out from under the fingernails? They have absolutely no idea. Telling her to go take a bath is useless, even if she remembers you said it she has no idea how. Again their vision plays a part. The water and the shower/bath can be a huge obstacle. It is all strange and visually warped in her eyes. The white tub bottom may seem bottomless to her. Dad thought he was going to step into a bottomless pit of liquid. Then you have the number of steps it takes. You can not say take a shower. They have to get clothes off, find supplies, get in the shower, figure out the water, get the soap on the rag, get a different soap on the hair, get it all off, turn off the water, figure out how to dry off, where is that towel, and get dressed. It is SO much easier just to say it has already been done (even if that was a month ago)!
Once you understand this, it could be easier to help her. You can't not send her to do it, you have to help her do it. It is going to take a lot of manipulation of her reality... and a change in the way you are thinking. You need to find the right time. When did she usually take a shower. If it was morning before she dressed then do it then, or at night before she goes to bed. It is easier when the clothes have to come off anyway. Go to the bathroom with her. Once she is undressed, turn on the shower. It is a cue for her. Adjust the water and have everything needed. You can not force her in the shower but you can make it easier for her. If it doesn't work the first time, try again the next time. Once in the shower, give her cues and prompts on how to wash. Put the soap on her wash cloth, put the shampoo in her hand and guide it to her hair. Get a little brush and scrub her nails for her, or let her do it. Do not expect her to function normally. You have to help her do what she can't do anymore.
As for nails, That is probably a function of improper toileting hygiene or eating habits. No, again, she does not know the process for washing hands. To that end I had spa time with Mom where I would let her soak her hands, then use a brush to scrub under those nails. I also cut her nails weekly. BY keeping them very short and scrubbed daily, you do not have the odor.
Mom can no more clean herself properly than your toddler can. It is up to us to do the same for both
Wow! Thank you for the view from her perception. I knew that she just didn't know, but I didn't know the why or the how. I thought she was just being stubborn. I think maybe the problem with her is the loss of her independence. (She's only 63) I've gone into the bathroom and tell her, here let me get this for you, this faucet is real tricky, everyone has a problem with it. Anything over and above that, she catches on and gets highly offended and defensive.. She'll say, "I'm a grown woman, I've been doing this all my life. Don't you dare treat me like a child." (Sometimes she says that when I'm not trying to "help") It's not in my nature to be confrontational (especially to an elder) so I just say I'm sorry, I'm just trying to help, and then I scoot!
Others in the family are much more confrontational (they'll confront, but not actually help) but it doesn't do any good anyway. I'm just running out of ideas. The spa is a great idea! I've tried taking her to the hairdresser, but as soon as they're out of earshot she'll tell them, no, no, no, don't bother washing my hair, I just washed it. So, of course, they don't wash it.
If I go in her room to find laundry, she gets angry and says I'm trying to take her stuff. I don't want to be disrespectful, rude or insulting. A couple family members say, well, what are you going to do? Just leave her alone. But I can't do that..
Before she got sick, when people would talk about her they'd chuckle and say, Oh her? yeah, she's a handful! I guess that much hasn't changed
It just seems like no matter what I try to do, it's the wrong thing..
One thing you can do is being tricky. No way one can confront her without any arguments and etc. That is why other members gave up and let her be. But this doesn't help caregiving. She needs help to be clean! e.g., if you want to take her dirty clothes in her room for laundry, do it behind her back. If she forgets a lot, she may not notice. I am not saying you need to be tricky which sounds like you are "cheating" her, but the fact is she needs your help, you are doing what you can to help her. If you can do some stuff to help her behind her, so be it. It is the way it is... One example: my late FIL had early moderate Alzheimer's back in 2006. His bathroom was a mess and didn't allow the caregiver to clean it. His office table had been dusty for years... I finally figured out that he would not remember, so I cleaned them all behind his back (it was upstairs and he was downstairs.) After that, the caregivers could help him and clean it and he said nothing about it because he forgot. It seems cruel to use his memory loss, but at least we were able to help him properly. Sometimes the trick is necessary to help her.
About the bathroom, since she doesn't let you, maybe you can say that you will draw her a bath and set the water for her (say that you are preparing it for her.) She may think you are helping her this way. The details surely are up to you to be creative...
I know some people seem to think this is wrong - we trick him/her.... But look at it this way: if he/she comes down dirty, the health care professionals can still say you abuse her without taking care of her.... You cannot win if you don't take care of her. So think of some tricks and try to see if this improves. At least, you can wash her clothes behind her back.
Last edited by ninamarc; 11-29-2012 at 12:57 PM.
The Following User Says Thank You to ninamarc For This Useful Post: TimeToLiveLife (11-29-2012)
Timetoluv, hi there and welcome, sounds like you really have your hands full a toddler and your mil...how about asking mil to wash the dishes, if you have a dishwasher tell her it is broken, or maybe with really close supervision mil can help the toddle bath or help that little one wash her hands, I found if I asked for help instead of telling it went alot smother and the results were better, after all this is about mil helping herselve to make things a litte easieri for you, as for bathing that is a hard one, how about telling mil that the shower is broken and everybody needs to use the bathtub...I really like the spa day thing, maybe mom would feel better if someone came to your house for a manicure and hair do, as for cloths I would do as suggested and just take the cloths telling mom you needed them to finish filling up a wash or I have spilt something by "accident" on my moms pants or shirt and appoligized and said hurry and change so I can fix it, I have followed my mom and kept telling her that it will be like new with a wash, I would wait intil she changed went in and grabbed the item and maybe anything else's I could grab..it really is thinking outside the box, I can say it will do no good to be confrontional mom will just get mad, trust me you will not win. Don't fight the battles if they are not worth it.. If mom wears two different socks who cares in the big scheme of things and if it bothers you then get rid of all the socks and replace them with all the same kind and color, voila case closesd on the socks. We learn what works and what does not, trial and error with a lot of good suggestions from all the great people. Here
Was just wondering if you can duplicate her clothing and Just do a switch ...if something is really soiled accidentally rip it beyond repair..Blame the washer!!!
Lots of hugs. Judy
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Last edited by jagsmu; 11-29-2012 at 09:43 PM.
The Following User Says Thank You to jagsmu For This Useful Post: TimeToLiveLife (11-30-2012)
Jags had some very good ideas. The duplicate clothing idea is a great one and I have seen that work. Making that decision as to what to wear is difficult so they just leave on what they have on. If you have 5 pairs of the same elastic waist black pants and 5 identical shirts, it is easy! Mom actually had equal numbers of black and white pants. Two choices. The shirts are identical with a variation of pink. Not hard at all. All her socks are white and identical. It's a drawer full of mix and match that all go together.
It sounds like you are doing many of the right things, you just give up the on success a bit too early. Take her in and tell them to wash her hair no matter what she says. Stay close by until the job is started. As she says no no no, they will be washing and then you have to finish. "No" could be nothing more than she doesn't understand what is going to happen or the idea scares her.
Dad was my difficult one. If he had his clothes on there was no way to get him in the shower. Talk about a stubborn sort! By picking the morning when he usually took a shower it was possible. I could cox him out of his underwear any way possible. Love skid marks when they were present! Then I turned on the shower, set the water temp, and headed him in that direction. The old habits took over. I would soap up the rag and hand it in to him. He might balk but I would just smile and say I had this soapy rag that needed to be used. Then I would put some shampoo on his hair. Once started he did ok. I made many excuses, said I was sorry as many times, but I never gave up until it was obvious that he was NOT going to get in. I was never confrontational... just persistently going about the chore at hand with a happy smile and calm attitude. I would give up and try again another day if absolutely necessary. As time went on it got easier. Another thought, make sure there is a heater in the bathroom and it is warm. They do NOT like to be cold. If modesty is a problem then drape a towel over the shoulders. It gives the feeling of being covered but you can still help them wash. While Dad was in the shower I brought in clean clothes and the dirty ones disappeared into the washer. Everything he wore was brown. Dark brown pants and brown plaid shirts. They all looked alike so he rarely realized that they were clean. That was the ONLY time of day I ever got my Dad in the shower. He fussed the entire time but if I kept it light and pleasant while still being persistent I could make it happen every other day, or maybe every third day.
I have always thought this disease brings out all the creativity we have. By understanding how they are thinking and knowing they are not just being stubborn... it does help. That way we can out think them
The Following User Says Thank You to Gabriel For This Useful Post: TimeToLiveLife (11-30-2012)
I think it's kind of a common problem with dementia patients not to recognize their hygiene issues. My husband was always very clean shaven, neat, and took care of himself diligently. This year, I noticed he wouldn't shower until I said something. Then, it got to the point where he was not doing a good enough job of rinsing down and things like that so he would smell strongly of soap and break out in a rash in different areas. I've started coaching him through his showers to make sure he cleans up properly. He's at the point where he doesn't know which way the tap goes for hot or cold or how to turn it on. The doctor told me that there will come a time when they don't even know what they're supposed to do in the shower. I also groom his nose, ears, and buzz his hair, and give him a manicure and pedicure to keep his fingernails and toenails clean. For the manicures and pedicures, I will soak his nails in warm soapy water with a little bleach before cutting them just to make sure, they're disinfected and clean. I've also noticed that if I make it sound like it's some luxury service, he's all for it instead of a maintenance routine. Best of luck!