My mom with dementia won't clean/wipe herself after a BM. Advice?
I'm at my wit's end...They way I figured it out (besides the fact that she is stinky a lot) was that she wasn't wiping post BMs because she never flushes and there is no TP in there. Hoping for some good ideas on how to deal with this. First let me start by telling you what I have already tried: I put those flushable wet wipes next to the toilet....they never get used...even when I put a note near the toilet to USE AFTER BMs. I stand by the door if I hear her go in there and gently remind her to "wipe after you go," to which she gets furious..."why are you hovering over the door...I'm not 2 years old....of COURSE I'm going to wipe!!!" Then I realize that no she did NOT wipe. She will adamantly insist that she did but I see no evidence of that AND I'm starting to find her undies all messy. She will hide them under her bed!!!! I have started making her wear Depends (that was NO easy task) but she finally is resigned to that. I make her take baths more often (which she also hates to do) but it's hard to know if she is really even getting herself clean down there. She will not let me do anything other than run the bath and then she insists I leave (frankly I do not want to stay in there anyway!) She does get in the tub and she does soak for a long time so I'm hoping this is enough to keep her clean. I'm open to any opinions on if you think what I'm doing is fine enough or ??? TIA.
We really don't want to treat our parents as two-year-olds. We want to preserve as much of their independence and dignity as we can. And we also want to keep them safe and healthy. It is a very tough role to play!
Sorry I don't have an answer, but I do feel for you!
So you've got to do something. Now, this is what the brisker kind of HCA or community nurse does, and I copied them: breeze in there, like it was a matter of course, wearing disposable gloves, with a wet wipe, and just do it. The trick is to take it in your stride so that it's done before she knows what's happening. You don't sneak up on her, or try to pretend it isn't happening, and you keep talking in a cheerful, matter of fact way. So it goes something like…
[knock knock at the bathroom door, then] Just popping in to see how you're getting on, mother! Now, where are we, all done? Great job! Let's just check we're all clear here - [whisk wipe around operational area, dispose of wipe in sealed bin] - that's marvellous. Got everything you need? Can you manage with pulling up? I'll just fill the basin so you can wash your hands [you do that, check she actually is all set, then depart].
By treating this situation as normal you are avoiding embarrassment and minimising the intrusion into her privacy. Don't be stressed, don't be embarrassed, don't be ashamed for her. It's a practical matter that needs practical help. If you have a friendly community nurse or OT or similar, could you ask them to give you a quick demonstration?
By the way, if your mother locks the bathroom door, you want to take the lock off anyway. Because sooner or later she will be a falls risk, she will never remember to leave the door unlocked (no matter how sincerely she promises), and an injured senior lying behind a locked bathroom door doesn't bear thinking about - those are hard surfaces to fall on in there.
Currently your mother is already ashamed, that's why she's hiding things. I know the actual butt-wiping phase feels like a massive downward leap, but what you're really doing is restoring her dignity by minimising the problem and reinstating good bathroom habits. She just needs a little help with it.
And if you can't do it, and lots of people can't adjust so go easy on yourself, then ask for help. You'll be amazed at how normal, common, everyday, simple this problem is.
I would be surprised if your mother were able to use a bidet if she can't manage toilet paper - but then again, you never know; and in any case if she can't then whoever is helping her may well find it useful.
They do have automatic ones in Japan, for example, but apart from the expense they might frighten the life out of her - can you imagine, if you weren't expecting it?
Akaheba, you are not ready to physically wipe your mother's butt. She is not ready for that and can't do it herself. Sigh. I guess you continue as things are, perhaps insist on more frequent depends changes, and keep your fingers crossed against sores and infections!
Good luck.
Laying hands on my elderly relative was not a thing I had ever imagined I would need to do and I will never forget the initial panic I felt. Thank God she had the presence of mind to speak up rather than struggle on and fall. Thank God she was a cheerful, laid-back woman who never made dramas out of crises. We should all have someone like her to practise on.
Would you feel clean after a poop soak? I wouldn't. This can infect any open cuts, scrapes, sores on other parts of her body.
I strongly suggest getting an in-home personal attendant to come do showers on her 2-3 times a week. If you have to bathe her, just focus on the really smelly parts: pits, privates, feet. Skin cleanliness is the first step in maintaining skin integrity.
She *will* develop open sores from exposure to urine and feces. And then you really will have a fight on your hands over bathing and changing because it hurts.
This is also one factor in determining if someone needs 24/7 supervision. If they are beyond toileting themselves properly, then in a care center, they will be put in disposables and changed by staff every two-three hours to avoid open sores.
If you are willing to take this on, watch some of the tutorials on youtube for safety precautions when working with someone lying on a bed so you don't strain your back, neck, & shoulders. Especially if they can't roll from side to side for you.
My mom is totally incapacitated and it takes two people to change her, and use of the draw sheet to move her up/down/side to side.
If she won't cooperate for you, she may behave for a "professional" dressed in medical clothes (scrubs). This is really common. My mom thought everybody in scrubs was a nurse.
Good luck out there!
New toileting issues are so difficult not just for the hygiene factor. It's such an obvious indicator things are not right. You can't ignore incontinence or someone of any age who previously did this for themselves but now can't. It's quite a rude event. It's very "real". Nobody gets a video in health class during high school on how to handle this. There is a safe way to do it, and an unsafe way.
Nobody teaches us what the signs are to ask for more help, or to change how things are being done. We wait until it's totally unmanageable and things are a mess (literally) to even contemplate asking for help.
Several years ago - before I had to deal with any of my mom issues - my MIL became gravely ill from multiple myeloma. She had been in the hospital, in another state far away. My husband went down to see about her and the hospital discharged her to his care. We had no idea you can or should refuse that.
He ended up taking her back to her house and discovered he had a 24/7 skilled nursing situation on his hands. His sister was there for a few days - she's a nurse - which really helped. She had run out of time off and had to fly back for work, leaving him all alone.
It took no time for this situation to devolve into a holy nightmare. The woman became 100% incontinent. My husband had to figure out what to do on his own. It was shocking, alarming, awkward, uncomfortable, weird, gross....you name it. Every time she tried to stand up, poop everywhere. Who is prepared for that?
He had only ever changed our babies, not a fully grown woman who was definitely a 2-person assist. Neither one of us knew that she should have been in a nursing home. Those are for old people, right? He fought the good fight around the clock for almost 2 weeks. He ran out of time off too, and out of sheer desperation called his aunts to come down. There was no way this woman could be left alone for a moment she was so ill.
There was nobody there to say "honey, put her in a care facility!", or to explain how you even do that. The discharge people at the hospital never mentioned one thing about that as an option, even when he explained that he lived out of state and she lived alone.
It was heartbreaking and she ended up passing not too long after that. The person taking care of her at the time was completely incapable and refused assistance from hospice or anyone. That story is a whole other soap opera though....
I don't see how a bidet would help, since it would only put water on the situation and wouldn't promise to clean it. She would then have a wet environment that would be ripe for fungus and bacterial growth.
If you can't jump in and take charge, you might contact an outside agency to help, but they would have to be available around the clock or teach you how to do it when they are not at home. You can't allow the patient to refuse to be cleaned when they are not competent to make that decision.
When people are not able to be cared for in their own home, placement should be considered as an option. Most people in Memory Care facilities are incontinent and the staff handle it quite well without much resistance. I wish you the best of luck.
If you do try it (or anything you try, really) let us now the outcome. Yours is a very common problem.
Just started doing this....I hope it works!