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Mom is in AL. The facility passes the smell test but she does not. The facility has her on a toileting schedule. She resists. Mom does not realize that her briefs need to be changed. Her chair, which I regularly recover with mattress protectors, stinks. Mom gets showered twice weekly. It can be more if required. I provide the briefs. How do I convince my mother, with advanced dementia, that her briefs (diapers) need to be changed more frequently? How do I convince her to accepted the necessary help with toileting? And..how can I mitigate the lingering odor in her room? Fabreeze is great but even that has its limits. Is there anything I can place in her room to continuously help to eliminate the odor? She is oblivious to all of this.

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Perhaps you're not aware, but Febreeze contains toxins, the reason why I never have and never will use it.    Many people are unaware of this.

Try baking soda instead; it absorbs odors, as do newspapers and coffee grounds, although I wouldn't normally suggest leaving coffee grounds in an area where someone with dementia is staying.    You could try putting them in a bottle, or large container like those for herbs and seasonings.    Leave the top off but the perforated internal cover so the odors can be absorbed by the coffee grounds.

A scented candle, if not overpoweringly chemical in smell, might help, but consider the danger of leaving it anywhere where your mother might be able to access it.

Lemon is also a possibility.  Some friends who also use organic only treatments use lemon as a cleanser.  It can interact with some metals though.  I cleaned my sink with it and it turned the metal base around the drain to a rusty color, which I haven't been able to eliminate.

I don't have any other suggestions but you might raise this with one of the staff and see if there are other substances that could be used.   Hospitals and nursing homes probably see this often, and I suspect there are some more powerful treatments that they have.   

Don't use bleach though; the odor is overwhelming.
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Riverdale Sep 2019
I doubt an AL facility will allow a candle in the room. It's a great solution for odors but too great a risk in that setting.
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If the smell in her room is overpowering it is likely that more than the chair has become saturated with urine and nothing short of a deep clean with appropriate chemicals is going to remove the smell.

It sounds as though your mother is in an AL that is more appropriate for people who are mostly independent and whose need for assistance is minimal. Bottom line is that she isn't receiving the care she needs, unfortunately administrators will often promise much more than the facility has appropriate staff to handle. Her dementia is only going to get worse and with it will come physical decline, I think now is the time to look for a higher level of care.
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You are indeed a good son.
I do think, though that you may be placing the bar a little too high in terms of your expectations for your mother.
Does she change her own garments? If not, the help staff should have a pretty reasonable schedule for her toileting needs.
You indicate that she “does not realize” that her personal garments “need to be changed”, but that is the absolute fact, SHE DOES NOT REALIZE, and CANNOT realize, and most likely will NEVER REALIZE that she needs fresh underwear, because she has dementia.
You cannot “convince” her, because she has very likely lost the capacity to be convinced. Given her sensory and cognitive limitations, (“She is oblivious to all of this”) she cannot be expected to understand and act on what you are expecting of her.
If the AL care givers are not expecting more of you, try to understand and accept the fact that they are probably focused on preventing skin break down, and not as much focused on your concern about odor.
There are room fragrances and deodorizers that contain only natural ingredients, and they can used to dissipate or conceal the odors that seem objectionable to you.

Hope this helps!
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WVson1, regarding the odor control, I agree with GardenArtist about the Fabreeze. For odor control, check out the organic section of the stores, as those sprays are more user friendly, more plant base. A product called Mrs. Myers makes some nice scents. I use all of her products. I love the Iowa Pine scent but your Mom may or may not like it.

As for her chair, you can check out the pet stores for cleaning products that can be used on furniture. These stores also carry items that you can place in the room to absorb ordors.

As others had mentioned, sadly you can't convince a person with dementia to make changes. Is your Mom in the Memory Care section of the Assisted Living?
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Try a bowls of vinegar. Worked for me.
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Katsmihur Sep 2019
Baking soda absorbs room odors.
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Bed Bath and Beyond sells a product by Yankee Candle that plugs into an outlet and slowly releases scent. Nothing dangerous about it. May not completely solve the issue but might help some.
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worriedinCali Sep 2019
Bath and body works sells those too, there are a variety of plug in diffusers and scents. One bottle of scent (I forget what they are called) lasts a good month. I buy them when they are on sale 5/$23 and use a 20% off or $10 off a $35 purchase coupon.

They are safe BUT you don’t want them to fall out on to a wood surface, it will ruin it. Learned that the hardway!
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Be careful with plug into an outlet item scented item. When the oil runs out, you quickly need to remove the product from the outlet or it could become a fire hazard if left unchecked for months..

Also read the ingredients used in these plug-ins. Some plug-ins the scented smell can cause diarrhea in infants. So I wonder if the same can be said for the elderly? I know these items are not good around pets.
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I think all cushions should be checked. Mattresses too. Your mom bathes, so it isn’t her. The AL facility is supposed to help keep her clean so I would check areas where waste leaked.
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I second FreqFlyer's advice on scented items and plug-ins.   And I think it's easy to conclude that the scents are real and that there are no added ingredients, but that's not always true.  

The only real scented items I buy are from either of two herbal suppliers.  One grows her own herbs, is very particular and once discontinued a wonderful, soothing amber essence body cream b/c her herbal and natural ingredients supplier became unavailable.  The other also grows her own herbs and is still expanding her product line.

I buy my facial and skin creams only from these suppliers.

Another thought is to use essential oils to create natural fragrances.
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People who have dementia often are not able to manage their own hygiene and toileting issues. And, AL staff often have limits to how much they will handle. I'd meet with staff to see if there are any options, because, it sounds like she needs frequent checks on her BM status and more regular and prompt cleanups. It's not likely your mother will cooperate with this, since she has refused so far. I'd explore a higher level of care without delay. Her sitting in dirty diapers is likely to have negative side affects from skin infections, UTIs, etc. I'd also keep in mind that a regular AL may not have the training or experience to work with a person who has dementia, like those in a memory care unit would do. If she's being cleaned properly, there would not be a bad odor.
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Thank you all. My mother's AL also provides memory care. She is gradually evolving in that direction. Like me, or me like her, she does not like to be told. Still needs some sense of control. I get it. My expectations need to be adjusted I think. I will speak to the head nurse regarding my concerns.
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JudinWA Sep 2019
Hi WVson1. I think your best statement is the realization that your "expectations need to be adjusted". That is though one to do. Having worked with families of Seniors in all types of health and care situations for 40+years as an RN that statement really resonates with me. Often it really starts with the primary caregiver, in this case it sounds like you, being willing to adjust their views, expectations and overall ability to address and cope with a parents' changing needs. Then the next step becomes what is it that Mom really needs--to be in control. How does one address the issue and allow Mom to be in control? So many different ways to go about this. For the situation of being incontinent, short of moving her to Memory care, as you do not seem ready, take time to really evaluate all her actions and behaviors related to elimination. Times, awareness or lack there-of, actions or little behaviors that she may do that signify that she is going to eliminate, looking for something. When does she take off clothing, or doesn't she at all? be ready to "sneak in" or substitute clean clothes for soiled at time of eliminating,

How often in a day are you able to come, or can you set aside 2-3 days to be there a lot of the time to learn her behaviors with regards to elimination (not just show up and she is soiled again.) the overall goal would be a little pre-emption to be able to gently replace soiled for clean.

Is she still sing the toilet some of the time? if so what time of the day? When she has her pants down, step and and gently replace with clean. Or if she takes off clothing at night, put new clean clothes out without her really being aware, and replace soiled, including briefs.

But with the goal of getting her to think she is in charge, not you. After all she has been in charge of this activity for most of her life.

Maybe she simply does not like the style of briefs you have chosen, but does not understand that. I have one family that calls their Mother's briefs her "party pants". She has always liked to dress up, and always wore nice underclothing. there are some nice looking briefs available (albeit a little more expensive). but by changing the type of brief and tapping into Mom's love of nice clothing, they're able to address the issue. So maybe there is some way to look at the whole process differently. As you said changing, not lowering, your expectations based on Mom's lifelong habits.

All the best. It is not easy. eliminating odors is another problem, and there are a lot of good suggestions here. I would avoid scents that simply cover up, and go with ones that eliminate. And I agree with the animal lovers, housepet odor eliminators are often the best and the least expensive overall.

Finally, the basic problem may come down to the fact that you are her child. And have never been in charge of personal care for your parent. Often, by having facility staff provide care, your Mom will be more receptive. This removes you fro the loop, and from being the "bad guy". Staff are particularly trained, especially those with Memory Care training, to deal with this and other particular issues arising with Dementia. Adding increased caregiver hours will cost though, and that is another consideration.
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I would plan a day that she can be kept out of her room for most of the day, have someone go into her room and saturate anything cloth or porous plastic/vinyl with straight white vinegar. Vinegar kills the enzymes that cause the odor. Make sure that you get the floor under the places that she sits or sleeps. It will be strong, but it goes away as it dries. I would close her door and put a few fans with the window open.

What does the facility recommend for getting her to change her depends more frequently?

I had to sit face to face with my dad and tell him that I know that he can't help it and I know that he would be embarrassed, so lets deal with this by wearing briefs, changing them when they are wet. He was mad, but once he realized that he was more comfortable it wasn't a problem.

Oh, if her cloths get saturated with urine, a regular wash may not get rid of all the odor. Check her closet, it may be time to take them home and do a vinegar and baking soda soak or replace items.

I don't recommend covering the odor, it doesn't really work, it smells like covered up odor. White vinegar is amazing, it will even get the stains out and it is cheaper than any other options(3.50 a gallon), non toxic, and can be stored in her room. I would keep a gallon and a spray bottle handy to spritz any spots as they occur.

Best of luck, that is a tough one.

You can also use kitty litter under her chair and bed as an odor absorber.
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Im not sure what to call it...

I have this little thing that plugs in and emits a mist from a reservoir containing a mix of water and essential oils. A sort of mini humidifier. It can be set to produce a steady streaming mist or periodic puffs. It does need to be regularly refilled but on the periodic puff setting it does last 24 hours. The mist is not hot even when set on the steady stream so burning ones hands/fingers isn’t really a threat.

Still - I imagine that if mom is sitting around in soiled briefs no amount of scented products will adequately freshen the air. I’d start there.
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Isthisrealyreal Sep 2019
Diffuser rainmom?
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https://advancedtissue.com/2015/06/preventing-pressure-ulcers-in-incontinent-patients/
you might like to view the information there even if no pressure sores at present. It explains why regular changing and washing plus barrier cream are important, 

For the room odour check out
https://www.amazon.co.uk/Purifying-Eliminator-Absorber-Closets-Charcoal/dp/B004BOH6BM

Bicarbonate of soda is also excellent - you can get some talcs with that in it - neat bicarbonate can cause skin irritation but mixed it is great for the skin and odours.
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Memory Care checks them once an hour here....and takes them to the bathroom. Regular assisted living is nowhere near as vigorous. My mother peed in the elevator once in AL......thats when she finally agreed to wear Depends regularly. I was glad nobody else was in there with us to witness her embarrassment. Sigh. You just can't get rid of the odor of urine entirely, I'm afraid. It will help a lot when your mom is on a regular schedule of Depends changes, and when her old clothes are replaced with new ones. I'd also lay down Extrasorbs on her cloth covered seating for protection.
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To all of you suggesting fabreeze, air fresheners and essential oils please be mindful that you are in a facility with other people. For me, being around fabreeze sends me to urgent care. Scented products can trigger her neighbors who have allergies or asthma. Go after the odor, stop trying to cover it up. Work with the facility and make it THEIR responsibility to make sure the odor issue is fixed. After all, they should be the experts at handling these things.
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Odoban removed cat urine odors
from my garage cement floor a few years ago and the smell never returned. Now I use it on furniture, carpet cleaner and car seat for my incontinent Dad. It’s available at big box stores like Home Depot, Lowes, and Walmart. I buy the gallon concentrate eucalyptus scent for fabrics but note there is also a bio stain version with special enzymes for urine and other bodily fluids. I have not tried it because the regular version works for my needs.
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jacobsonbob Sep 2019
FWIW I certainly could have used a product like this some years ago when a tomcat took advantage of a car window I had left open--it took 4 years for the odor to disappear completely! (LOL now, but certainly not when it happened...)
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Odor Elimanator works awesome.

It doesnt try to cover up the Odor but actually eliminates it. Comes in both a solid or gel.

Just tell your mom that her panties (diapers) have pee and need to be changed.

Sone people don't like to hear diapers and they might not remember the word soiled.

Have your mom's potty chair wiped down daily with fabuloso
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How often do the staff at your mom’s facility chk on her? She should not be sitting in her filth.

Alternatively, hire a caregiver for this need. Expensive but it takes away your worries.
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It sounds like the staff at the AL facility is not doing their job.
Or it is possible that your mom needs Memory Care not AL.
She should be checked every 2 hours and changed when necessary.

As far as eliminating the odors.
Odor Ban, I purchased it the gallon size at Sam's Club. It does not mask the odors but eliminates them It is also good in the wash.
Clorox has a product called Urine Remover works on hard and soft surfaces.

Again I think this calls for a discussion at the facility where you mom lives.
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Does she have any rash issues? Her bottom must be sore..... I always keep a can of lysol by my mom's bed & a renuzit air freshener.... Not just for toilet smells, but general odors....

Not up to mom, if she has dementia, the NH needs to address it more frequently. Mention to staff & when you have a care meeting. I had issues as well, also, they do not allow powder....
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We had the exact same scenario with my mom. I was hesitant to move her to Memory Care as I thought she would be very resistant to the schedule. She has thrived there since and she is CLEAN!!! I wish we had made the move sooner.
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On Amazon we bought charcoal pads that go around the toilet if she is missing the toilet. Also chlorax sells a spray for the floor that eliminates the pre smell. If she won't change her underwear sounds like more frequent showers or dependd
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First I would see if she has a uti. Then I would talk to the staff pronto. This needs to be addressed immediately. You mean to tell me the staff doesnt notice the smell? Why are they ignoring it? They should have addressed this with with their boss immediately. She needs consistent changing. Sounds like she sitting in a soiled brief all day. I would be highly upset with this. Urine can burn skin. Then she will get skin breakdown and horrible rashes/sores. Why are they ok with this?
So I would talk to the person in charge. Either the staff addresses this issue immediately, or she needs to be moved to personal care, or something needs to change. If she has dementia she is not the right fit for assisted living.

The focus needs to be on the real issue of her sitting in soiled briefs too long. Are they adult diapers or underwear? Urine doesnt smell bad right away. It smells horrible after hours. Or can smell like ammonia if the person is dehydrated. They need to be changed mult times a day. Not 1x a day.

As far as I know assisted living is for people that need a bit of help but are still quite independent. Not dementia pts! Just forgetful, or need to be watched for falls, but still able to take care of themselves. So staff only provides light support.

She needs a higher level of care now. So either the staff doesnt care, or you are in denial. I know assisted living is much cheaper than a nursing home. I dont blame you there. But this should be addressed asap. The urine/soiling herself is the main problem. The smell is the least of your worries. Your chasing your tail by not addressing the main cause. You need to discuss asap. You might have to hire a cna to come in and change her briefs. Might be cheaper than memory care. But I think with dementia she is not safe in assisted living. They have stoves and micros in their room. Staff only checks on them. They dont watch 24/7. Good luck.
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Isthisrealyreal Sep 2019
Jasmina, facilities are calling memory care, assisted living. As if all of this wasn't confusing enough now you need a questionnaire to figure out what the facility actually is.

I imagine that they have found that most seniors are less resistant to the term "Assisted Living" and will seek help sooner or not fight their families so hard.

I am of the age that I get mailings every other day and I see this memory care, assisted living term consistently.
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Time to have a talk with the staff and management. You all need to be onboard with a toileting schedule with Mom. Usually, the deal is to offer/take her to the toilet every 3-4 hours. Staff should be kind but firm that Mom sticks to the schedule.

If she has a UTI, that needs to be treated by a doctor. If she has many UTI's she can end up not having her kidneys work well and the waste products get deposited in her skin, Then, she will always smell of ammonia/urine. In that case, she'll need more frequent bathing with a very mild soap and lots of lotion since the skin will be itchy.

For odor, washing machine scent crystals to cover some of her personal odor since her clothes will be scented.. There are room fresheners that cycle on and off over a period of time. You'll have to see if the facility allows the room fresheners.
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You may not believe this but we used Barbasol shaving cream to help with odors. She will continue to be oblivious but you have to learn how to talk and do at the same time. Including her in conversation like it is or her idea. It is very time consuming and wears on your patience but you do what you can. The main thing is always to remember to take care of yourself.
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Isthisrealyreal Sep 2019
How do you use the barbasol?
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She may need more assistance that you get in assisted living - like a higher level of care facility. Assisted living, as I understand, is for people who can still pretty much care for themselves and require a little 'assistance' from time to time. She needs more hands on as in taking her to toilet, changing her briefs throughout the day, and bathing like every other day. In Assisted Living, much like home health care, the staff member may show up to give a bath, but if you say no it could be a while in between bathing. If she doesn't already have a UTI, what you describe is one in the making.
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Everyone, thank you for your suggestions and concerns. To clarify. My mother is in an appropriate professional AL facility that does graduate to memory care. This is not independent living. BM accidents are addressed immediately as they are known. She is on a toileting schedule. She may not realize when she is leaking but I think she does realize when the diaper(I never use that term) is wet. But...it is just too much effort for her to change them herself. Question: is there an interchangeable pad that she can slip in and out of her diaper to make it easier to change when wet. I think she would do it if easier. The diaper must stay on but maybe there is an insert that can be removed and replaced. when wet. Without having to remove the main diaper. I bet this problem has already been solved a thousand ways but I am not yet aware of a good solution.
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MamaLlama Sep 2019
My mom wears the pull up diapers and, at night, she uses a large maxi-pad that I get at Walmart (WM brand called "Options Pads"). I get the extra long, max absorbency. They seem to work pretty well for her. This might be a possible solution. They aren't too awfully expensive so, if they don't work for your mom, at least a bunch of money hasn't been wasted. Good luck to you.
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There are products that are used in public toilets that are on a timer that spray deodorizer in the room to reduce the smell in the bathroom.  You could probably order some of these for your mother's room and install them, or have maintenance install them for you.  As far as the change out of the pull-ups--tell her that she needs this done more frequently and why and if the staff is willing to shower her for you more than twice a week, then they may be willing to "remind her" that she needs her pull-up changed out and help her with that as well if nothing more than handing her a replacement while she does the change out herself.  My mom is on a 3 x a week shower schedule and gets showered twice a week because I do the showering myself.  You are lucky to have help.  I am the caregiver--and the checkwriter.  I pay for services that don't happen unless I do them myself.
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Isthisrealyreal Sep 2019
Debbiesdaz, the problem with anything that sprays is it has been proven to cause and/or irritate lung issues. Breathing those chemicals all the time is really dangerous.
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If it is to difficult, which I get, shoes and socks off, drawers off, depends off, wipe down, depends on, drawers back on, shoes and socks on, whew, I am worn out just thinking about that every time I pee.

Have you modified her wardrobe and shoes to make this process less burdensome? I would find some nice slip on shoes (when you find ones that work, get a few pairs so she is covered for a year) and put her in a skirt (elastic waist, mid calf to provide leg warmth, presto). That would simplify the entire process to a few seconds instead of a long project.
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