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cleanliness

Posted by sabro (My Page) on
Sun, Dec 13, 09 at 14:43

I have been reading this forum recently because my 88 year old mother with is living with me. My problem is that she will not keep herself clean nor let me give her a bath. She swears that she washes herself yet never wets a washcloth. On top of that, she hides her soiled laundry by folding it up and putting it in her clean clothes. When you find it, there's twice the laundry!

She has been diagnosed with Alzheimers and has good days and bad. As long as a routine is maintained, she does really well but when someone new comes into the house, she cannot make a connection as to who it is (her grandson) and worries it over for hours.

She does have a little dog that is the center of her life so that keeps her occupied most of the time and she seems to be content to sit and rock with it. Her physical health is deteriorating because she doesn't want to move around much. So far she can be left alone for 30 minutes or so while we check cattle and do chores. We keep a bird feeder by the window for her and our dogs are entertainment. I guess what I am saying is we are in a holding pattern right now that I can live with if the bathing issue could be solved. Any suggestions?

I have enjoyed reading all your messages and have wept with empathy for each of you because it rings so familiarly.

Sarah


Follow-Up Postings:

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RE: cleanliness

Oh how I remember those days. Hidden laundry oh yes.
All I can say is be a little firmer and I remember when I said to her
I know how you always wanted to look and dress the best, but I have to tell you that you have an odor about you and I know that you would want me to tell you rather than let other smell it.
One of the things I started doing was bringing her a pan of water with soap in it as she sat on the edge of her bed.
She would let me wash her back and lotion it. Slowly we worked through it.
I also made sure she had a small squirt bottle of warm water and she would flush herself with this water while on the toilet.
Good luck-Love her and BE Firm, just like you would if she were you child.
Another thing, if she has a Dr. you might put a bug in his ear and have him (her) say something about you know as you age you must be sure to clean yourself more often. It was amazing what she would do for the Dr. that I had ask many times but because the Dr. Said it it was more important.
Connie


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RE: cleanliness

This is a pretty typical problem with the elderly and particularly with those suffering from Alzheimer's and other dementia. You may have to "think outside the box" on this one. For instance, instead of trying to get her to use a washcloth & water, you might try the wipes made specifically for the elderly and others with injuries or limited mobility. You can find them at most drug stores, medical supply stores & websites. I can even find them at my local grocery stores, right next to the Depends. They're pre-moistened and can even be warmed up a bit in the microwave. They're very soft too. Sometimes the elderly develop strong aversions to any kind of water and their thinning skin sometimes makes washcloths very uncomfortable. One problem with water is that even if it's warm, it tends to cool the body both during the application and drying. Most elderly are quite sensitive to cold (or what they perceive as cold).

Another possibility might be the foaming and rinse-free soup products. I bought some at a local medical supply store for my mother and my husband when he came home from a hospitalization. Just apply the foamy soup and then wipe off. No rinsing needed. Again, this eliminates the water.

The hidden laundry and hidden soiled underwear or Depends are pretty much par for the course. My only suggestion is to simplify & de-clutter your mother's possessions so that it's easier for you to spot where the surprises are hiding. Dealing with a dementia sufferer usually means that the usual reasoning, explaining, and training simply do not work.

Connie is right about tackling delicate subjects as though she were a child. The big difference is that the child can learn and be directed toward maturity. Just the opposite is happening with a dementia sufferer. Does your mom allow you to help her bathe or clean herself up? You may need to start small, as Connie suggested, and work up to you cleaning the most odor producing parts of her body. Just treat is mater-of-factly, as though it's no big deal.

Good luck!


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RE: cleanliness

We are presently going through the same thing with my MIL. She is 87. I've been using baby wipes for several months now due to the fact that when she wipes after going to the bathroom she would leave some bits of the tissue--she developed a yeast infection. The wipes work well and don't fall apart. She does not clean herself well and will tell me she does. I also rigged up a squirt bottle for her to rinse with after going to the bathroom (she is often incontinent and she requires assistance cleaning).
She is diabetic and her kidney function is not what it should be. ( her Dr. was not suprised considering) Her skin is very fragile, she chills easily. Due to her decreasing mobility, she has become prone to trying to develop pressure sores on her tailbone. We have memory foam U shaped pillows in her chair to try to relieve the pressure and I encourage her to reposition often. It seems like we are fighting a battle on a daily basis to keep her skin clean. This week she has developed another yeast infection. Apparently with the Diabeties, she will be prone to this. Her Dr. has written a prn prescription for medication. She also hides her soiled things and washcloths. I rearranged her room and simplified it so that her clothing is neatly folded on open shelves so she can "see" what she has to wear--although she will want to wear the same thing all week and will not put on clean things unless I "strongly" suggest it and help her dress. We are to the point that I do have to be kindly firm with her as I would with a child. She lacks the capability to judge when she needs to be cleaned or changed. She balks at the idea of the shower ( another kind/firm situation) but always enjoys it when I get her on the shower chair.
Is anyone else out there dealing with skin issues? How about yeast infections? Any suggestions? thanks


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RE: cleanliness

Hi, falldowngobump,

I don't know many ways to prevent the yeast infections other than keeping the skin as dry & clean as possible--A slightly warm hair dryer is a handy tool after cleaning, and leaving the depends off for a while every day (have her lay on a disposable incontinence pad) so air & light can get to the area will help too.
I do think that a good zinc oxide barrier cream helps too (like Desitin). Some people feel that adding yogurt with live cultures to the diet helps with prevention--but this I don't know.

There is a product that you can apply to the skin which puts a barrier film on it to help protect it from urine etc. if cleaning and applying the barrier cream seems not enough. There is more than one brand, and it comes in wipes, tubes and spray. Skin-Prep is one brand, but it stings a lot if the skin is already raw. There is another brand that is no-sting and can be used on already raw skin but I can't think of the name right now. You can get these in the ostomy supply section. They will protect the skin for over a day. However, you can't use them during a yeast infection since they will keep the medicine away from the skin too.

Hope that helps, good luck.

Raee


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RE: cleanliness

Thanks to all of you for good suggestions; I hadn't thought of the baby wipes. I finally decided I had to be a little more direct so yesterday when I found fresh long underwear put on over soiled long underwear, I told her we had to take at least a sponge bath because she was starting to smell ripe. She said "I am?" I put out everything I wanted her to change into and she willingly took a sponge bath and wore clean clothes. I will get the baby wipes and maybe we can get the urine odor under control. Thanks again, it's great not to dither alone!

Sarah


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RE: cleanliness

I have been using the baby wipes on my husband and find they work well. He requires complete assistance in the bathroom. The spray with warm water sounds like a good idea, I will have to pick up one. I also noticed today that his behind has a little redness so I'll look for some of that cream too.


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RE: cleanliness

I've found in my own situation with mom that one terrific help was to create a showering situation that was easy and convenient -- at first for herself, and later with assistance.

Getting into and out of a tub and/or standing in a shower both became uncomfortable and hazardous. She had begun avoiding both.

Present situation has a sturdy plastic chair in the shower-stall with an easy-to-control hand-held wand for the shower. Both are inexpensive modifications. Easy, quick and pleasant for her to shower herself when she's able or to be assisted when she isn't. Made a big difference in cleanliness overall and in her own attitude about it.

Also -- if you haven't had this yet, you will -- when the occasional toilet-disaster happens, bodily cleanup from even the messiest catastrophes becomes quick and easy.


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RE: cleanliness

Oh, yes, the hand held shower head is super-helpful! In my mom's case it was long enough to rinse her off on the toilet, if I was careful to not turn the spray on strongly. Anyone who has a walk-in shower (no tub) in this situation is so lucky...


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RE: cleanliness

We have been using a sturdy shower chair for over a year now and she is frightened of falling trying to get on it. I assist her with this although she is capable of sitting and "scooting" over to position herself. I don't want her afraid. We also have a hand held shower for her to use. She is pretty much to the point that she makes no attempt to wash her own hair or anything else. I do have to hand her the washcloth and tell her to wash her private areas. I wish we had bought a hand held shower with a longer reach and one with the turn off and on on the handle. It would have been possible to have a sitz bath situation while sitting on the toilet when she soils herself. I bought several of those clear plastic "ketchup" type squeeze bottles and fill them with warm water for her to rinse herself with. Except for the fact that she keeps throwing them away they have worked out well. She by no means does a good job at cleaning herself but I certainly encourage her to do as much for herself as she can, I just "take up the slack" and get those places she cannot clean well herself. We have been using Desitin as a moisture barrier for several months now and when the tailbone area becomes red I use a Tough Pad to cushion and protect the area. They really stick well, but have a tendency to be difficult to keep clean especially on her tailbone. I've been feeding her yogurt and have been giving her acidophilus in an effort help her body fight the yeast problem. ( in addition to the prescribed meds) Her Dr. said it might help and certainly wouldn't hurt.
I'll tell you folks, I'm so tired. It seems like about the time one problem clears up, another one pops up. She certainly can't help what life has done to her or what she's become but some days I feel like I'm loosing the battle of simply keeping her comfortable and clean. I'm starting to question my own sanity and abilities--and I'm a retired nurse! I think I'm in serious need of a break. The husband and I have a dinner date (first one in over a year) Saturday night at a really nice resturant. I think we both need it.


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RE: cleanliness

falldowngobump
Get some help. I cared for my mil for 5 yrs and after about 3 I started getting some help in. At first it was just once a week, but later it was more. You will burn out to the point that you won't be able to care for her. I personally did not want her in a nursing home (I see people placing them in homes and doing so much running that they are going crazy trying to keep care of them there that I did not want to do that), but you do need to have some personal time for yourself and if you do not you will burn out.
Take Care
Connie


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RE: cleanliness

Well, silly me....I thought we had the clean clothes thing settled yesterday. Today, she got up and got her dirty jeans and undershirt and put them on. It's time for a break around here too.


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RE: cleanliness

Did I hear BREAK?? That sounds sooooo good!! I plan on having Home Health Care start coming after the holidays for at least once a week. Would they watch him while I go shopping or do I need to be here? They came last summer and did some walking therapy with him(just spent 20 min. or so with him) but he is much worse now and needs help at all times when he is walking or he would fall.

Yes.....a break would be nice! Mmmmm...maybe some tropical island just for a day!! :)


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RE: cleanliness

Going to toss this out and see if it bounces.

Over the years I've seen that in my own situation with mom sometimes an "outsider" can elicit cooperation that I cannot. In Sabro's case, for example, would the idea of someone coming in just to bathe her, or do her hair, or some other specific task be worthwhile. Would the outsider/different-person be responded to differently?

Not sure what's involved in the difference. Maybe illusion of authority? Maybe just a change of pace? Maybe perceived as something new and maybe enjoyable? Part of it here may the difference between my being a man and the hired help being a woman. I'm reluctant to suggest too strongly because I don't have any idea about general application.

Have noticed that when I hire a female to help, mom is more vigorous, determined, and careful about her hygiene, shower, dressing...almost everything. Almost as if she's trying to show the gal that she's still "got it". Probably an overstatement, but I think it may illustrate.


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RE: cleanliness

Yes, I will be the first one to admit my husband and I both need a break. Usually I handle what comes with no problem, but I think the holiday stess is getting to me. I'm a wife, mother, grandmother and caregiver, but recently it's been hard to balance all that. Throw in Christmas shopping and planning and I think I've felt overwelmed.
Two weeks before Thanksgiving, 2 of my grandkids (ages 5 and 12) and my son-in law came to visit. An overnight visit wound up lasting 3 days. I love my grandkids but the extra everything exhausted me. (and my husband) Not to mention it threw my MIL into a confused exhausted state for almost a week. I usually "do" Thanksgiving at my house, but I cancelled the big family thing and chose to have a quiet small dinner with just the 3 of us. I think I pissed the family off, but I don't regret doing it. I don't think they realize the amount of work it puts on us. Or how it stresses her to have her routine changed.
So...now I'm planning Christmas--it's tradition to have it at "Grammy's" (me) house and I always look forward to it--but not so much this year. With my MIL's declining health things are much different for us. One daughter lives close and is wonderful to give me a break, she visits regularly enough to know the meds and the care MIL requires. The other daughter ( the one with 4 children) rarely calls and doesn't realize how things have changed for my MIL. She just shows up with the children ( who will be charged up on christmas) and thinks things are the same as always.
So..having said all that I've deceided to simplify things around here. Insted of a lot of gifts, there will be gift cards and I'm going to play up the fact that the after chrismas sales will be great when they go to use them. The huge amount of food will be cut in half with just the favorites. I've enlisted both daughters with what they will cook and bring--pies and such. The youngest daughter has offered to come early and do a lot of the cooking for me. Her husband has offered to come and sit with my MIL and keep her intertained ( she loves that boy and so do I).
There will be paper plates, not the good china,and what I can get already prepared will be bought, not made here ( the restuarant down the road makes a mean smoked turkey).
I'm not gonna worry about how messy the house looks cause it's gonna look like a mad house once they all show up anyway.
I think I just might survive this after all.


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RE: cleanliness

Asolo, I think you're on to something. I do think elderly women feel more at ease in the presence of a female caregiver when it comes to "private parts." Also, as you've indicated, when the child suggests something, often the elderly parent balks because it's a change in the old chain of command. However, when it's someone else, outside help, there isn't that need to protect one's territory. And, definitely, the showing off for someone else is a factor. I've seen that many times with my own mom.

FallDown, your plan sounds wonderful. You've obviously put a lot of thought into it. Sounds like you'll have a great Christmas celebration but with a lot less stress. If you can cut out more, do so. The important thing is that your family is together and enjoying each other's company. Fine China, fancy side dishes & desserts, perfect presents aren't important. And with your MIL's declining health, who knows how many more Christmases you'll have with her. So make it as stress free and enjoyable for her and you.


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RE: cleanliness

I too have noticed that Mom is really confused after company has gone. She stews about who they were (all her grandchildren), who the little kids are and if someone takes care of them and so on. It takes her several days to get back into her usual good mood. We did Thanksgiving but I have passed Christmas over to my son's family. We'll see how that goes. Merry Christmas everyone, try to relax and get some peace.

Sarah


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RE: cleanliness

I can understand how frustrating it is. Remember with dementia, though, it means you 'meet new people every day' and it will be a lot less frustrating for you when you accept that they will remember NOTHING and the clean clothes thing will be something you have to do every day - she just won't remember. All she probably has now are the long-term memories. Get used to repeating yourself, it really takes no effort and it will mean a world of difference in regards to how YOU cope.


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RE: cleanliness

I would like to address the question regarding yeast infections. Quite by accident, I discovered the wonderful qualities of the diaper rash ointment, Desitin Creamy (not the Desitin original). Unlike the original it does not serve as a moisture barrier but it contains zinc oxide, smells good, spreads easily and seems to solve a number of skin problems including chafing, yeast infections, etc. It even works as an underarm deodorant in a pinch. When I was caring for an elderly relative with cleanliness problems, I used Desitin as a preventive and was very pleased with how well it worked.


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RE: cleanliness

Thanks so much for the Desitin tip. I've been using the original Desitin but am more than willing to try the creamy. Here's hoping it helps!


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RE: cleanliness

For what its worth... An adult potty chair works much better, in a shower, than a regular bathtub/shower chair... It has arms, you can adjust the height and the hole in the seat makes it much easier for them to clean their private areas with a handheld shower.

The Home Health Care that's available to me, that Medicare and HAP pay for, will not stay with the patient while I go shopping... I can have someone come in to take hubby's blood pressure and check his general health or have someone bathe and/or help dress him or get physical, occupational, speech or language therapy or dietetic consultation or social work services come in to give me referrals to community agencies...

Hubby had a hairy fit after the female 'nurse' who came to bathe him left and told me, in no uncertain terms, that it will not happen again... But the good thing is that I can now get him to take a shower without too much trouble... So, some times, outsiders do help. The hardest part is asking for it.

Rita


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RE: cleanliness

If wearing dirty clothes gets to be a problem, then add another chore to your list. Get in the habit of removing today's clothes from her room every night. If you can, lay out fresh ones on a chair or rack for her so she won't have to decide.

I think that a lot of problems come from the difficulty in deciding what to do. It's just easier to do what worked yesterday.


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RE: cleanliness

This is obviously many months after you asked your question, but I have one other tip to assist with bathing. My MIL complains about taking a shower since the bathroom is always "cold." My husband takes a small electric heater and pre-warms the bathroom with the door shut and A/C vent closed. After 15 minutes or so, he pre-warms the water while she undresses. That takes the chill off and keeps the air warm while she dries afterward. While he showers her, I change her sheets (she gets antsy when there aren't sheets on the bed). Unfortunately, my husband won't press the shower issue, so let's just say she gets RIPE. And they both have poor senses of smell, so I suffer most in that regard.

For her hair, she goes to the local Great Clips or a similar place and gets a shampoo done for $5 every week or so.

She, too, won't change her clothes. Generally, I have to step in, hand her some clothes, and tell her to change. She'll argue with my husband, which stresses him. He and I started dating about the time her dementia was first settling in so she doesn't really "know" me (most of the time, she can't remember my name), in that we don't have a long established relationship. So she doesn't know how to say "no" to me when it comes to basic care. Even then, we tend to let her go for 2-3 days unless she has an accident. It's just easier than fighting.

Good luck. We're still figuring things out after 2.5 years of her living with us.


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