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My mom has been at an assisted living facility for about 4 weeks. She is 94 and very old fashioned and modest. She will not let anyone clean her private parts and is not capable of doing it herself.


She insists that she wipes herself with wipes after a bowel movement but I have told her that it is not enough. She is also wearing depends. She has recently developed a UTI. Yesterday, she had diarrhea. She told me she wished I was there. She expects me to clean her butt and her portable potty filled with poop when the assisted living is getting paid for this service. I understand it is hard to let strangers do this but is it my job to do it?


Any suggestions would be appreciated.

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What type shower does Mom have. Full tub or shower with shallow to no ledge. If the later, teach Mom to use the shower to clean herself (assuming there is a shower hose attachment). My wife, prior to Dementia, always kept herself 'fresh' after every trip to the bathroom. However, now, she is beginning to have 'accidents' and also forgets to clean herself. We have a low rise ledge shower. She is responding to my encouragement and assistance to use the shower to clean herself. It is far easier to clean her lower area and clean up afterward!! If it is safe to enter the shower, this approach may work in letting someone assist. I learned this approach after a near-death surgery I had. It is very helpful.
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We had a similar issue..quite frankly I was able to explain to my mom that if she would not cooperate in assisted living she would need to be moved to a nursing home where they had more experience in handling difficult patients. She was upset with me for a couple of days . That cured our issue. She now allows help.
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I worked with a woman whose GrandMother was of the hyper-modest generation. GM had to have an operation ‘down there’, and the surgical unit chose to anesthetise her before shaving her ‘down there’ as required for the procedure. So far as my friend could work out, grandmother had never shown her naked body even to her husband, procreation all happened under the covers.

I think the best suggestion may be to get a long gown, and wash her as well as possible by just lifting up the hem. If she can’t see it, she may be able to pretend that the aide can’t see it either.
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hopeful4646: Perhaps your mother requires a higher level of care.
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"The staff will help you, just a little bit, just for now". Just for today or this week etc.

Wanting a close relative to do a task somehow keeps that feeling of independance alive - family is like me, so therefore *I* am still able to do the task. Faulty thinking. Denial.

I don't know how else to describe it, but have seen YEARS of this with my family. This denial of ability/loss of ability.

Trust in non-family caregivers DOES grow. Even if the words remain, the "I can do it myself" or "I don't need help".. Behaviour starts to change, acceptance & trust grows with repetition.

Experienxed staff will be able to manage fine. Letting someone do what they can for themself eg scrunch up the paper & reach (while staff wipe).

Don't make a big deal about staff 'taking over'. Ignore talk of you coming for potty duty (rediculous). Emphasis the staff will just help *a little bit* instead.

It's embarressing afterall. So aim to minimise that. I'm sure even the Queen needed a little bit of help at 94 right? "Sure it's a bit embarressing Mom. Just say thank you & then forget it".
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Clesslyn4 Jun 2023
My mum is also very private won’t let anyone see even her knees, false teeth etc. I have so much trouble even changing her depends ( pull up pants nappy) she will not allow any help at all. I am now living with her 27/7 due to dementia and a stroke.
You mentioned they ( carers)get accustomed to mum. I mean she gets use to them .

I was wondering how long this takes it is over two months now .

I insisted I have the same three ladies come , not different ones but she still will not have any thing to do with them. They are very skilled and lovely.
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in my dads last weeks with ALZ at home before going into facilities, in home people like RNs, PTs, OTs, etc would come over in addition to bathing help.

My dad did not like being cleaned by a stranger. One time the lady they sent to bathe him was frankly quite a comely young woman. I found myself thinking I wish I was the one she came over to bathe.

She said Richard, you are going to have to take off all your clothes now. He said only if you take yours off first. We all had a howl, including the bath aide, (my mom was mortified but the bath aide says this happens all the time with dementia people and was not offended by it. Anyway, as long as that bath aide came over it was no problem

What if a muscular young stud muffin male bath aide came? Maybe she would relent. Sorry if that sounds sexist but in my dads case it worked.

I think he thought he was a young man again.
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You are paying good money for the help of those aides. Just tell the stubborn old gal it’s them or nobody to do that gross job. This should not even be a topic of conversation between you,
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GrannyinVA May 2023
Emma, you might not want to do that. Older people tend to dig their heels in if forced to do anything. Maybe mom does not like the caregivers?
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Do not do it.
You may have to consider reducing your visits for a while . This may be challenging but especially when someone is new in a facility it helps them learn to build trust with the staff and, if she knows you are not coming, it may make her ( mad, upset etc) for a bit, but she will ultimately let the staff do the tasks. You can explain to her perhaps that you have to be away for a week for example and, have the staff assigned to her in the room when you tell her, and emphasize that you will be away and that you trust the staff to take care of these needs.
Ultimately you are helping her to adjust to others helping her, by staying away a bit.. Also should anything happen that you were ill etc, you would know that she is getting the help. If you continue going and doing the tasks, it is an intentional way of enabling her behavior to refuse help.
Do not allow her to continue to control you and the situation as it is not healthy for her nor you.
This is not unusual behavior that you are experiencing with your mother. Also speak with the staff about how they have dealt with this before. The supervising staff should have professional suggestions for you also.
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Of course she wants you there.
This is natural and understandable.

It is an adjustment for her ... and at 94.
Many of us have a really hard time adjusting to change when we are 20 or 71.

You ask if it is your job? I do not understand why you are asking us this question.
This is a question to ask yourself on how you want to proceed?

I believe what you are asking us here is HOW to handle the situation / your mom's reaction / insistence.
- Talk to her with loving kindness.
- Tell her you understand her wants, needs, concerns. Let her know you hear her ' loud and clear.'
* Even so, with feelings of embarrassment, she will continue to feel the same way UNTIL she feels more comfortable with staff - and she may not ever feel comfortable with staff, although she WILL resign to 'what is' being in facility where others need to manage her hygiene / bathing needs.

I think the only avenue is to give her time to adjust.
Be kind and compassionate. Although do not give in to her demands/requests of you doing ... what staff needs to do.
* If you give in to her and clean her once ... she will continue to expect it. And, she will (has?) learn that by asking or telling you to clean her that you will eventually do it.

While it may or likely MAY NOT matter if you try to use this LOGIC. Mom, if you do not allow staff to clean you, you may end up in the hospital and then hospital staff will need to clean you - on top of whatever medical issues develop (as a result of not being clean(ed up) in the first place. I would phrase this as succinctly as possible - so she understands ... that medical issues may develop (or have) and that others MORE STRANGERS in a hospital will end up cleaning her 'anyway.'

Give her a hug and tell her that PROFESSIONAL staff needs to ensure that she is healthy and safe. These are your priorities for her. She will adjust as she does to the care / facility services you are paying for, although I understand it hurts you to see your mom like this, embarrassed and wanting you to care for her.

Gena / Touch Matters
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CaringinVA May 2023
Well said Gena. "Be kind and compassionate. Although do not give in to her demands/requests of you doing ... what staff needs to do." So true. "Give her a hug and tell her that PROFESSIONAL staff needs to ensure that she is healthy and safe." Yes indeed.
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There are bidets and bidet attachments that could assist with modesty issues. Put "bidet attachments" in your search window and ask the facility if they might be open to investing in a real Bidet.
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TouchMatters May 2023
A very nice thought / idea. I hope that the facility will allow this attachment. (I'd think the family would have to pay for this, not the facility.)

It could certainly help although wouldn't deal with the entire issue / need. Thank you for suggesting. Gena
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-demonstrate for caregivers how you have done it in the past & how you expect/want things done; tips are always appreciated
-tell caregivers abt mom; previous career, children, hobbies so that they can distract & chat with her while they provide care. Will give her mind something to focus on other than feelings of embarrassment.
-let her participate, give wash cloth, spray/squirt bottle if able to use so that she can simultaneously help
-tell her, we’re
placing this sheet/towel over you so you don’t feel so exposed & you’re covered up; only expose area of body being washed
-ensure washcloth is folded enough so that only the cloth is felt, no fingers.
-“I hope someone does this for me
when I need it”, “We’re all
gonna need help at some point in our lives”, “we gotta wash well so you don’t get an infection”
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Not your job. Can your mom get in and out of the tub herself? Wash herself?
the aide may need training in how to make this happen - there are videos but you can’t be the solution.
this week we had success by putting the water on, letting her realize it was bath time and then monitoring her - but this is def a challenge we
all find.
if she doesn’t allow professional help she will need a IL.
it’s a slippery slope if you do it.
unless you are trained you can hurt her and yourself.
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TouchMatters May 2023
The mother can not clean herself as she needs.
Although the mother will ALWAYS say she can.
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We are going through the same thing with my mother. She has some cognitive issues due to a stroke, it seems to have stripped away her judgment and compassion.. She can’t move easily, is obese and in pain due to arthritis and spinal stenosis. She is also a former nurse practitioner who has always “known better” than everybody else. I understand the frustration at not being able to care for herself, but to try to have my frail 92 year old father help her instead of a young aide is beyond me. She is unable to see past her own needs (kind of always been like that). She will sit in her wheel chair and won’t allow staff to help her to the toilet but will “go” right in her chair right in front of them. She can be very logical in her own world without reference to reality sometimes. She got referred to geriatric psychiatric ward, they found she had a severe UTI (again-we will be asking for weekly UTI tests or prophylactic antibiotics if that is possible), but this behavior predates the UTI and has been a constant since she has been at the SNF. This SNF let’s her have visits from her cat and is close to where my father lives, I’ve noticed that the level of care is better the more compliant the resident, but in this day and age, it will be hard to find a place where young underpaid aides will be compassionate to someone who calls them fat, lazy, not smart, etc. My sister (who mother is not particularly nice to) tried to tell her her living options would change drastically if her behavior didn’t change, and I’m now on my way down there to try to do the same. She often listens to me more than my sister, but if she can’t retain the information, not sure it will do any good. Just have to plug along and take it day by day. My sister, who lives with my father, has had the laboring oar for the last 8 months, desperately needs a break, and my own personal situation has now resolved enough for me to give her one.
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AliOJ58 May 2023
This all sounds too familiar - brains wired to be in change want to remain in charge!!
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I don't want anybody looking at me. Get her a bathing suit. Then everything will be just fine.
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PureEnergy May 2023
To reply to myself, make that bathing suit real big so that she can wash her own private parts.
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Of course your mother wishes that you were with her - you probably would too if you were in her shoes.

Your mother needs assistance cleaning herself and it's your responsibility to see that she gets it - whether it's you or someone else.
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You’re unlikely to convince mom of anything at this stage. It’s up to the professionals to figure out how to care for her. That’s their job.

If she’s beyond their capabilities, she needs a higher stage of care.
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In my experience intakes about 1hr personal care (daily) to prepare for day as well as cleanup properly after toileting. The routine requires knowing the person’s bowel movement routine as well as managing bowel issues: diarrhea, constipation, UTI. Once the routine/issues have been determined, scheduling that 1 hour care will be the goal. Trial, error and MANY adjustments will give some relief. 120% effort, about 3% success ? But that success, although temporary, will be what you will remember.
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Have you spoken with the people at the assisted living about this? Why they don't just clean her potty when needed and not just wait for you. It they are kind without attitude she your mom might be more responsive to them. Remind them this is what they are being paid for they caring for your mom. If they are good caregivers they can win her over.
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In my experience intakes about 1hr personal care (daily) to prepare for day as well as cleanup properly after toileting. The routine requires knowing the person’s bowel movement routine as well as managing bowel issues: diarrhea, constipation, UTI. Once the routine/issues have been determined, scheduling that 1 hour care will be the goal. Trial, error and MANY adjustments will give some relief. 120% effort, about 3% success ? But that success, although temporary, will be what you will remember.
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Some ALs offer more services than others, although there may be a higher fee. If your mother needs someone to "check" on her periodically and empty the commode or assist in her toileting some ALs offer "extra" care to provide this; others do not with some only offering medication management.

Your mother sounds like she is borderline between what a full service AL can offer and needing more attentive nursing care. You may need to find someone to attend your mother in her current AL or start looking for a facility that is a better match for her needs.
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If your mom is handed a soapy wash cloth, can she clean her private parts?

If not, then she is beyond what any AL can provide.
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JoAnn29 May 2023
Really, you should not use soap in that area. The soap gets into the urethra and causes urinary infections.
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Your mother requires a higher level of care than what she's currently getting in AL. You don't mention dementia so Idk if memory care AL is an option, but my mother was thoroughly cleaned up and bathed by aides who were experienced so utis weren't an issue, and neither was hygiene as she had showers 2x a week. Properly trained caregivers know how to handle shy residents and help them past their issues so they can stay healthy and clean at all times. If not, mom needs a higher level of care in a SNF or AL with more experienced staff.

Let mom know that she must accept help with her bathing and toileting needs, or else you'll need to make arrangements to move her to a nursing home in short order. We often reach a point in life where we don't get a choice in certain matters.

Good luck!
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I’m sorry that your mom is struggling with this. My mom was extremely modest too. She eventually got over her modesty. I hope that your mom will too.

She may not be trying to make you feel guilty. She is struggling with having a stranger care for her so intimately. Others don’t want family members to do these things and would prefer a caregiver.

I think the best way to handle this situation is to tell your mom that you would be uncomfortable washing her private parts and that the caregivers have experience with it and will be able to do the best job.

It is not your place to do this. This is what the staff is for.

Best wishes to you and your mom.
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