cks1646 Asked September 2015
How to address personal hygiene tactfully?
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We have a new problem, but it could have been going on for a while. Dad has his own bathroom so I am not sure when it started but he is not using toilet paper to wipe. How do I know? I finally caught on and marked the roll and left one spare roll. His undies are always bad both ways so that wasn't new. But how do you tactfully approach someone with dementia that they have to wipe their butt? I have a cleaning lady that comes in so I was not noticing the roll being the same until recently... He is also starting to (again) take a shower and put the same underwear back on which in itself is nasty but add in the incontinence issue and it's just bad.
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As for his not wiping well enough, express to him that you're concerned about his cleaning himself properly after using the bathroom. Let him know that you're concerned about his health and that not wiping could cause skin problems in an area where he really doesn't want skin problems.
Since he has dementia what you talk to him about may not sink in but at least you will have tried.
When my dad moved in with me he didn't have dementia but we agreed that going forward we would have to be able to have conversations that were uncomfortable at times and we did have to have some uncomfortable discussions but they were all in the spirit of my taking good care of him. You're taking good care of your dad and this is just a discussion you have to have.
My parents are the children of the Great Depression thus they didn't want to spend the money on new personal care products. And they weren't going through the toilet paper very quickly as it would be months before Mom would place an order with me to buy some next grocery trip.
When I saw the above, I told Dad "don't reuse your Depends, otherwise you will get a bladder infection".... I don't know if that is true or not, but it did get Dad's attention. With Mom not in the house, I got the caregivers back and they are keeping a tighter rein on Dad.
Some days it's a uphill battle, but it could be a lot worse. I just hope that as she gets older she doesn't become too upset with me to change her diaper......we'll see. Good luck cks1646.
The other option would be if he has arm or hand restriction and he cannot clean himself due to that. If that is the case, then insist that he rinse somehow in the shower after BM. There are also hand held devices that help you reach. But, if it's not limited reach, but mental decline, then it may be that you have to start monitoring him more closely. Is there someone there to do that?
With dementia, you have to move past the point of being embarrassed, timid or reserved with your protection. Being subtle, making suggestions, etc. isn't likely to help. Even if you pointblank tell dad what needs to happen, it's not likely to help. The brain doesn't work right and he's not likely to remember your instruction. It's not likely a talk from his doctor will work either. And the logica; reasoning that his normal self would have after a BM, isn't occurring. So, he's not going to have a BM and then recall that his doctor and adult child told him to wipe well. The only other option that I am aware of is to supervise him after each BM. That means always accompanying him to the bathroom each time and insisting that he clean himself. You could stand near and see if he can do it. If not, do it for him. I know of adult daughters who have to change their father's Depends after they get dementia, but they get used to it. I'm not sure I could do it, but I regularly hear of about it. If it is dementia, he will progress and is likely to need depends at some point.
On the wipes, be careful how many are used at one time. My understanding is that they can clog up a toilet system "real fast".
Regarding Depends or another other type of Incontinence product, can you set up a schedule for regular clothes changes? We change from pj's into day clothes then back to pj's at nite. At nite, we do a change of the incontinence product. And I do the change of clothes both times each day.
Leaving the patient to change his/own product is hard for them, because, as mentioned, many times they can't remember.
I know some of you don't live with the person or work; but like one of the first commenters, mark things in your own way to see if the patient is doing things correctly.
Done.
However, because his dementia also has Parkinson like symptoms, he is very stiff and had trouble with the toilet paper at his side. I bought a toilet paper holder that was free standing and put it in front of toilet. That helped for a while, but then he had trouble unrolling. So I tear, roll, and leave paper on the bathroom counter. When I know he is going in for a bowel movement, because I've told him to tell me, I also pull out a couple of the wet wipes and put on the counter.
As for smell, I use a baby diaper pail. They have removable plastic bags that insert and there is a mechanism that twists when you close. So when you open the smell is air tight. Things have changed sense I had babies, which reminds me that I also use a baby monitor. Keep it in the master bathroom, so I know when he is in there. Can move it, if he is napping and I want to work in the yard.
Also--when hubby had his liver transplant--he could not bathe or shower for months..(drain tubes, post op infection...) the hospital sent us home with these huge cloth-like wash & toss things. They were already "wet", I'd throw some in the microwave and get them warm. Hubby cleaned his privates, I got the rest of him--he said it felt great---we did this daily until he could move on to a "bed bath" with a soap/lotion mixture which is made specially for removing dry fecal matter. Works amazingly well. Available at the hospital pharmacy and hospital supply stores. Again--someone with dementia--a whole new dynamic. Hubby was "stoned" as could be, so cooperative with being washed. Of course, in his case, any bacteria could have killed him, so we were super careful about the whole house.
With BMs I kind of watch and sometimes "help" him as he can't see what needs cleaning. Another one of the Not Fun tasks we have to do.
I speak to my clients and tell them that it is very important to be clean. I then explain what I must do. I apologize evrytime because a person with dementia cannot remember from one moment to another what is going on. I am gentle but thorough.
If you have had children it is easier to accept this chore as you probably can remember doing this for your babies.
This is actually the only way to handle this problem. It is one of the biggest expenses; purchasing wet wipes and having gloves at all times.
It is also important to have the individual wash their hands just like a doctor or nurse would. I say this and also monitor the washing.
One of my clients is also blind and has severe Alzheimer's but she is at peace when I perform this task.
Unfortunately, we are so averse to such things as a society it really leaves elders with too many urinary tract infections which can cause more confusion and hospital stays.