My father has decided he does not need to wear his diapers. Any suggestions?

How could the ALF staff not realize this is happening? You tell them, please! Don't rely on Father to do it.

Do you think it would help any if he had a bedside commode? Or a plastic urinal bottle? If he has dementia his mind might not get the signal that he has to pee until the last minute, making it difficult to get to the bathroom. What are the chances that he would use something close at hand?

Persons with some kinds of dementia lose their sense of smell. Also the social filters don't work so well. He may not know/care that the room stinks. Does he have any explanation about why he won't wear disposable briefs? Does he just not wear any underwear?

What impairments cause him to need assisted living?

This is a real challenge. The ALF staff should be helping address this.

He is 92, legally blind, has mobility issues and was unable to cook and live on his own. He was fine with using the bathroom until last June when he decided it was too much work to walk so now he is confined to a wheelchair. That was when we originally got the diapers for him because he was having issues making it to the bathroom in time and we were noticing pee on the bathroom floor.

He is like a kid and tries to hide it but when you ask him why his pants are on the floor, he will tell you he peed on them or he will ask me to wash the seat cover because he peed on it. With him trying to hide it, it makes me think he does know what he's doing. For the longest time, he would say they were leaking and I would ask him if he had put on a clean one. He told us yesterday, he doesn't need to wear them because he can get to the bathroom and that he may wear them at night when he sleeps. It confuses me because on one hand it seems to bother him, since he tries to hide it. On the other hand, he has no shame and doesn't seem bothered when he pees on himself and the furniture. He will just move to another chair that is dry and change clothes.

We have told the facility what is going on because we wanted them to remind him to put them on and wanted them to know why the room smelled so bad. They have offered to recarpet it, but he has only been in this room for a year and it is totally trashed.

We have tried the plastic urinal but that didn't work out well between his vision and last minute decision to use it. He refuses to ask for help going to the bathroom or even getting dressed for that matter. I don't know if he is trying to hold on to his independence or if his mind is slipping and that is why he just doesn't care what he pees on or when.

He even stopped sleeping in the bed because he would pee during the night. He would get up and let the sheets dry and not tell staff what had happened. When they noticed and started changing the sheets every day when it happened, he decided he didn't want to sleep in the bed so now he sleeps in a recliner.

You say "his mind is pretty clear". Umm - no, no it isn't. Urinating on yourself, your clothing and your furniture- and not minding it enough to do more than move to a dry spot is not "clear" or rational by any means. Beyond the smell this is unsanitary and a health risk for your father and anyone else who enters his room. It wouldn't surprise me one bit that once the facility pulls up the carpet and really gets the degree to which this is happening - that if it can't be immediately fix - you will be asked to move your father out.

I think this is likely an iceberg of a problem- what you are seeing/smelling is only a small part of a more complex issue. Do you know what his objection to wearing them is? There is no reasoning with dementia - but if you honestly don't feel his judgement isn't faulty due to that - what type of frank discussions are you having with him? Or are you letting him off the hook with giving a lame reply because this is a tough topic - child to parent. If he says he doesn't need them have you been blunt in replying "clearly, yes you do". If he if saying he just can't make it to the bathroom in time - have you told him - that's why you wear the in the first place?

At first the usual easy fixes come to mind. Does your father wear underwear? If so, might it help to remove all the underwear and replace them with Depends? Perhaps finding a Depends product that is more underwear in fit and appearance than diaper might help. Can the facility have someone come to assist him to the bathroom every two hours? It will likely cost you but I'd bet he'd get annoyed enough with that - that diapers might start to seem the lesser of two evils.

But - your best bet may be getting him in to see his doctor or even a neurologist to discuss this situation. A visit to a geriatric psychiatrist would also be an excellent start. A psychiatrist can help identify what's at the root of this problem and very likely prescribe medication that can help fix it.

Honestly- I don't want to be an alarmist- but I think if you don't get this fixed your father may be looking at a nursing home placement sooner rather than later or even ever. I always hated it when well meaning people use to say to me - regarding my very difficult mother "you need to have her...". However, you need to get militant on this situation if you're not getting anywhere with your father. It is unacceptable from a human dignity aspect as well as an ethical, moral and sanitation standpoint to allow anyone to wallow in their own excrement.

I'm sorry if I sound like a big b!tch. I am not blaming you, honestly! Aging parents with declining health - mental and/or physical- don't come with instructions booklets. I don't know about you, but I was completely unprepared for my six year joy ride through dementia. But if I learned anything- it's that there comes a time when the roles reverse and you become your parents parent. That, and you just do the best you can. Good luck to you!

When I said his mind was pretty clear, what I meant by that was he is showing no signs of dementia. He doesn’t say the same things over and over, he remembers conversations to the point where he will ask you about something you talked about the next time you see him, he discusses shows he has listened to with us, discusses news topics, doesn’t have issues using the correct words in sentences, he doesn’t forget where he put things, he remembers names/people, and remembers how to get places. No one in the family has ever raised any concerns about his mental health as far as this is concerned. The sad thing, the rest of the family doesn’t seem concerned with him wetting himself and everything in the apartment. They see it as him having accidents and don’t want to embarrass him. They also think he is just being stubborn and doesn’t want to admit that he is at the point where he can no longer make it to the bathroom and needs help.

I will agree the whole peeing on himself, the furniture and the carpet is not rational or clear minded by any means. I do not understand and think it is nasty. We have tried to approach it the best we could without hurting his feelings, which is our mistake. We are trying the tough approach tonight and will have another conversation with him and tell him if he doesn’t start wearing them 24/7 we will have to esculate his level of care (which freaks him out) because he is not able to manage that. He refuses to let the staff help him dress or bath and the thought of them doing that upsets him. We have also decided to take him to the doctor to talk about it with him and see if he has any recommendations and thinks he needs to be tested for dementia or how we can handle it.

We have talked to the facility where he lives and have alerted them to what is going on and have asked them to make sure he is wearing his diaper. With him being able to dress and bath himself, they cannot make it wear it or keep one on all day. They did not realize that is what he is doing and have said they would do what they can to help us help him. He currently is under the lowest form of care at the facility. Maybe we take him to the next level. We do have the room professionally cleaned often to cut down on the smell and wash the carpets often. The facility has offered to re-carpet his room too.

His objection to wearing them 24/7 is that he says he does not need them during the day because he is able to get to the bathroom. He just needs them at night because he may not wake up. When we moved him into the ALF, we took all of his underwear and left him with nothing but these pullups. These fit nicely and are easy for him to wear and aren’t that noticeable. I do know we need to be responsible and be tough. I guess we have had problems reversing rolls and he hasn’t been that easy to do that.

I don’t think you’re a bitch and appreciate your bluntness. It is so hard dealing with all of the every day to day issues with aging parents and I think it is hard because we haven’t gotten to the place where we are tough enough and it is hurting him. This is our first time dealing with this and it would be nice if they came with instruction booklets. ha‼

Rainmom,
Since your dad is in a place where he's being cared for, you may or may not need to track down, exactly what is going on with him regarding his toileting issues. Have they done MRI and neuropsychological evaluation? It's very involved, but, could provide some answers.

When, I saw your description of his toileting issues, it brought to mind, what I encountered with my LO. She was running her own household, paying bills, driving, discussing daily events, etc., when she fractured her foot. No head injury involved. She was able to get in an out of bed, but, for some unknown reason INSISTED on wearing adult disposal underwear for MONTHS! Even after her foot healed. She resisted using the bedside commode too! It was very bizarre behavior, as she had never been that way. Healthcare professionals told me that she was lazy and spoiled, because she resisted physical therapy too. About a year later, she was diagnosed with significant dementia. I have no doubt that this was an early sign.

I'd discuss it with his doctor. Regardless of how normal he may appear in some areas, it's very abnormal and I wouldn't worry about insulting him, embarrassing, etc. If he was vulnerable to that, then he wouldn't be exhibiting that behavior. He's not recognizing how bizarre it is, apparently.

And maybe we are missing obvious signs since we are not with him 24/7. Well, the obvious sign is something is wrong because of the peeing and not caring to do something to prevent it from happening. We had talked to the doctor about 6 months ago about him having accidents at night. The doctor put him on medication for overly active bladder (I think that is what it was for). At that time, we thought the peeing on the floor was only happening during the night because he wasn't changing his diaper. It was last week we figured out the problem was also occurring during the day and was a bigger problem than originally thought.

First, I wouldn't refer to incontinence supplies for an adult as "diapers." Changing what you call it isn't going to fix his problems, but it does honor his dignity and might make it slightly more palatable to him to use them.

What I told both my husband and my mother (each had dementia) was that the disposable undies were to "catch leaks" and deal with accidents. Of course you can still go to the bathroom, honey! And you do a good job. But sometimes your illness/age stops you from getting there in time. So the disposables are "just in case." If you don't have any leaking you can just pull them back up after using the toilet. If you've leaked a little, you can put on a fresh pair.

Both my husband and my mother were still aware enough to not want to appear with their pants wet, and both were very willing to have some protection against that. It seems your father is in a different state of mind. But it MIGHT help a little, as you are having frank talks with him, to refer to "disposable undies" as "protection, in case you leak or have an accident." He thinks he can still get to the bathroom. Don't deprive him of the dignity of believing that. But he just needs a little protection, to deal with accidents.

I agree that he isn't showing what you expect to see first with dementia. But clearly he is having cognitive issues. An evaluation seems in order to me.

This is so tough, isn't it? Sounds like you are truly doing your best. Hang in there!

I agree and disagree a bit with some of the advise given - but of course I'm not the advice police. I just know I went through something similar with my mom.

Mom wasn't to the point she was just sitting there urinating - although that did start later - but she was having accidents everyday. Urine was staining all the furniture and even her car seats. It was tragically comical that my sister-in-laws and I would never sit down when visiting her. It was a bit tougher with my mom than my dad - having the conversation- and it took a couple attempts. Finally, I got her to admit it embarrassed her to wear them. I asked how she felt about walking around with a huge wet spot on her backside. That pretty much did the trick - but it took being very honest and very blunt. 

Okay - so back to my original point. I totally agree about not calling them diapers. Even though Rainman doesn't understand any difference - at home we call them pull-ups, probably a throw back to his toddlerhood. My friend that owns several group homes for adults with disabilities has her staff refer to the merely as "briefs". Yes, it's very important to allow the person to maintain as much dignity as possible - hard enough with old age striping it away left and right.

However, I stand by my original advice that it's time for a frank, blunt conversation - without downplaying the situation. You can be honest and to the point without humiliating them. Soft peddling what's happening, as you have seen - and as you said - has gotten you no where. Maybe it's because my adult son has been in "pull ups" for 24 years it's just not a topic we tippy toe around in my family - and when it came time to have the "adult protection" talk with both my parents it was done respectfully and honestly.

I believe if you approach the topic with love, concern, respect and honesty- you can't go wrong.

Let your dad know that it is now time to wear the Depends. Ask him how badly he wants to move to a place where there is a higher level of care and he will have even less control over his daily life. It might give him something to think about. If he doesn't want to move, he must start wearing Depends. Tell him that you understand that it sucks to get old and that there is no shame in having somebody help you with going to the bathroom and showering, that is what you pay for in assisted living. I would also look into what it would take to clean up his furniture, I'm sure the couch, mattress, and whatever has a cushion stinks to high heaven. Say that guests that come over would like to have a clean place to sit, not a place to sit that is soaked with pee. Sometimes being frank but gentle can be helpful.