They they have tried various behavioral interventions at my suggestion, to no avail. The problem is neither they nor I really understand why he is refusing showers. They tried one milligram of Ativan one hour prior to offering a shower, but that did not work. Now they want to put him on Seroquel, which I have refused. Then they wanted to put him on Depakote. As far as I know neither of these medications help with refusal behavior and have significant side effects. Is there anyone I could consult with or they could consult with about what to do?
DH wouldn't say a word to him, left it to me--the poor DIL....I finally just had to get tough. "Dad, you CANNOT walk around in poopy pants. I won't take you ANYWHERE" (even now my heart sinks a little when I think how I had to speak to this dignified man). He was not a big fan of showering daily, even when he was healthy, so losing the ability to 'hop' in the shower and be totally done in 5 minutes was just not happening. I got him a shower chair and did everything in my power to entice him to shower 3xs a week, more if he had had 'accidents' and needed a full undercarriage wash.
He never did get a decent shower at home. In the hospital, he was much more acquiescent and let the aides scrub him up good. Wish I had been more alert to how they managed to do it.
FWIW--you can bed bathe with that medical 'soap' only for a very few days..eventually you've just got to get in there with warm water and scrub away.
One thing I learned--FIL was raised in very poor circumstances and bathing was something that literally happened once a week. Daily bathing was for 'rich people'. He grew up with no indoor plumbing. I wonder how many elders still have that in their brains. My mom used to yell at me for washing my hair twice a day-- She'd tell me my hair was going to fall out if I washed it more than 2xs a week.
Could be a generational thing, along with what I think is often a fear of slipping. we've ALL had that 'whoopsy daisy' moment in the shower where we almost slip--no matter our age. I am now appreciating the damage I could do if I do fall in the shower. Only 64, but still. After my back surgeries, the shower chair was a godsend!
Talk to your husband and ell him that he needs to take a shower at least once a week so he won't smell and ask him what day he would like it to be and ask him if he prefers a morning or afternoon shower.
If that doesn't work, he'll just have what they call spit baths for clean up.
Maybe he has fallen or nearly fallen in the shower before and is afraid.
Maybe it's cold and uncomfortable when he took one before.
Maybe they were too ruff with him before.
Another piece of this might be the age of the staff they are sending to help him shower. For older men that are modest having young women for intimate care only serves to make their embarrassment worse.
It could also be how they are approaching him. If they are using the standard bullying approach (no matter how politely they may deploy their bullying techniques) of "you don't have anything I haven't seen", "we have no modesty here", "we're all professionals" etc, they are making him more uncomfortable rather than putting him at ease. That bullying usually serves to embarrass men into compliance does not mean it will work with every man. If they instead used some empathy and compassion along the lines of "I know this might be embarrassing for you but please know I will give you as much privacy as I can", the acknowledgement of his basic humanity might serve to garner his comfort in proceeding. Bullying phrases negate his humanity no matter how polite the delivery might be.
I have no doubt the staff feels they have approached him in the correct manner but the extent to which female healthcare staff think modesty, privacy, and dignity don't matter to men, especially older men, is significant. Being polite while saying or doing the wrong things doesn't negate that the wrong things were said or done.
Unless there is a behavioral specialist on staff, both you and the house care giving staff may be missing some unsuspected element of his refusal, and also have a more subtle recommendation for pinpointing potential medication(s) to zero in on helping him past this struggle.
if you ask the staff social worker for recommendations for a psychiatrist/neurologist/psychologist/social worker you may be able to access a professional whom the staff knows and trusts, an added plus in developing mutual confidence in case your husband reveals additional difficult behaviors in the future.
We had VERY good luck overall with this approach when my LO’s depression and anxiety were causing some problems during her early days in her ALF. Hoping that this will be helpful for you too.
For example - if you bring him a basin of water, soap and a towel, is he able to wash his hands?
The more he would be able to do for himself given the right equipment and allowed to go at his own pace, the more it makes sense that he would resist other people trying to force it. Maybe.
Is he changing his clothes?
No.
Hello. Smile. Hold out hand.
Come with me.
You can sit here.
Here's a face cloth to wipe your face. We could do under your arms.
Some days may just be face & a shave but often repetition works & since the hard work of getting to the bathroom is already done, they give in.
"I suppose you're going to hose me now". Yes. But it will be WARM & quick & then I'll get you DRY again 😁
And then my mom had a ruptured diverticula and was in the hospital and skilled nursing for 6 months. He declined rapidly during that period, I finally realized he no longer showered and had to tell him if he didn’t shower on Fridays, I wouldn’t take him to spend the weekend with my mom. At first he complied but when he started telling me he showered although the bathroom was bone dry. I just thought the effort to get in the shower was so difficult he didn’t want to do it. I realize now he probably thought he had showered.
I was in the process of activating his VA benefits so I could get someone to come help him shower when he died. I believe he was suffering from vascular dementia due to an under-performing heart and very poor circulation. I’m surprised his nursing home doesn’t have a procedure in place to deal with this, since, as another poster commented, decline in personal hygiene is a sign of dementia.
I agree you should let them try different medications to help with his reticence and see if he has a logical reason why he doesn’t want to shower. But don’t be surprised if he can’t tell you why.
Have they tried bed baths?
Have they tried getting him in a shower chair?
Is he afraid he is going to slip?
Is he uncomfortable with female aides helping him in the shower?
I would try the other medication and see if it helps. You can always ask that the medication be discontinued if there are undesirable side effects.
My Husband was on Seraquel with no apparent side effects.
I don't think they have tried bed baths. My guess is he would be resistant to that as he doesn't like them to do anything to him such as trimming his nails, etc. But it's worth suggesting it to them.
I don't think he's afraid of falling. He's quite ambulatory, probably more than almost any other resident there.
I've wondered about the female aides myself. But I've also had male aides call me and ask me to help get him to cooperate in changing his clothes and he's not cooperative with them either.
Thank you so much for responding!
Read up about dementia; it's very, very common for a person with dementia/Alzheimer's NOT to want to bathe. They get very alarmed at the thought of it for a variety of reasons since their brains are no longer functioning properly. Watch Teepa Snow videos on YouTube, this one in particular:
https://www.youtube.com/watch?v=iKT9YIVPREE
Teepa also uses a technique called 'hand under hand' which offers a dementia patient comfort and assurance that he'll be in good hands and safe while being cared for.
https://www.youtube.com/watch?v=Wn1OEfQt0ow
The above link demonstrates the hand-under-hand method being used for dressing a dementia patient who's resistant.
We have a poster here who relayed a story about her loved one who refused to bathe. The answer turned out to be using a hand held water sprayer; the woman hated having water in her face/hair and was very afraid of it. Being able to direct the water only where the elder wanted it was the answer! For my mother, water shoes allowed her to feel SAFE in the shower; she kept saying it was 'slippery' in there and nothing would convince her otherwise. One day I think God spoke to me, literally, and said Water Shoes. I was like Okay Thanks! Went to Amazon.com and ordered them, and we've had NO issues since.
https://www.amazon.com/VIFUUR-Water-Sports-Unisex-Shoes/dp/B07499GRR7/ref=sr_1_2_sspa?dchild=1&keywords=water+shoes+for+men&qid=1608345354&sr=8-2-spons&psc=1&spLa=ZW5jcnlwdGVkUXVhbGlmaWVyPUExNEZVQ0JHNDYxQ1ZRJmVuY3J5cHRlZElkPUEwNjA4MDk0M0E2S1VMUEQwSzZSNSZlbmNyeXB0ZWRBZElkPUEwMzgwNDc2R1JFNklaWUtYVkdLJndpZGdldE5hbWU9c3BfYXRmJmFjdGlvbj1jbGlja1JlZGlyZWN0JmRvTm90TG9nQ2xpY2s9dHJ1ZQ==
The staff at his SNF need to be trained in DEMENTIA care; it's very important. Because if they aren't, they will be lost as to how to handle him entirely. Memory Care Assisted Living homes do train their staff with Teepa Snow videos and other training materials on this very subject. Ask the Director of Nursing *DON* at DH's place HOW they go about training?
If you have to medicate him to accomplish what's necessary, then so be it. The quality of life is SO dramatically reduced with dementia/Alzheimer's anyway, that sometimes adding medication can really help. You won't know until you try. My mother is 94 and lives in Memory Care. I never say 'no' to trying a new medication; I only say 'no' if she winds up having an adverse reaction TO it. Then we call it quits. Some things work, some things do not. But we never stop trying to relieve her pain (in her case, it's chronic neuropathy pain).
Wishing you the best of luck finding a solution to a difficult issue.