Helping mother with dementia getting off the commode. Any suggestions?

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Helping mother with dementia getting off the commode. Any suggestions?

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At times my mother can stand up after getting off of the commode and stay standing, with assistance, while someone else cleans her. Other times, when standing her legs will just give out and she won't/can't stand up long enough for someone else to clean her and pull up her pants. What can we do to make this easier? She is wearing depends but she still needs to stay standing up for a short period of time in order for someone to clean her.

Alzheimer's & Dementia Hygiene Incontinence Toileting

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You can use a bedside commode in the shower. It makes cleaning easy with the shower wand. Shower grab bars are easier to hang onto for dressing because there are two of them. Just make sure the patient and the shower floor are dry before standing up. A pullup diaper and pants can be put on over the feet before the patient stands up to make dressing easier and faster.

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First, I'm assuming that your Mom has grab bars near the toilet. My Mom's bathroom in her MC unit, has a long grab bar next to the toilet. She holds onto that grab bar with both hands while they clean her. I'm assuming that is when your Mom's legs are giving out on her.

I suggest that your Mom go for PT. They have many exercises designed for seniors, however, there is one called sit-to-stand that I believe helps her with toileting. I run my Mom through my own modification of that exercise where I make my Mom lean forward for about 3-5 seconds both on the way up to standing and on the way down, which means that she is on her feet for a minimum of 10 seconds, before continuing and doing the next iteration.

The exercise was taught to us by a PT person who uses it on children who cannot stand (like a 3 year old who cannot stand or walk yet). This exercise was used to get my Mom's legs and abs strong enough while teaching her to be balanced so that she could get back to using the walker and ditch the wheelchair. My modification to the exercise was just to make her hold that "lean forward" pose for 3-5 seconds before continuing which means that she is on her legs for a minimum of 7-10 seconds before she sits down.

The first iteration is always really difficult for my Mom because her body doesn't remember exactly what to do. However, with the second and subsequent iteration, muscle memory takes over. As my Mom's dementia progresses, I'm trying to think of all the kinds of motions that I will need my Mom to automatically do. She lost the ability to walk backwards decades ago. However the ability to move/balance on uneven/moving surfaces, step up and down from a curb, are things that we practice in exercise every day. However, sit-to-stand is the one exercise that no matter how little time I have available, I always do a minimum of 5 iterations. I tell her it is to help her with the toilet.

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Toilet transfer equipment would work. It lifts and holds the patient while the caregiver cleans her up. Even if her legs buckle, the slings hold her in place. This equipment works better with a portable commode for ease of use.

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I agree with cwillies and the floor to ceiling pool. They also can be installed near a bed to give the person something to hold onto as they transfer out of bed. I've seen them my local medical equipment store.

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For my dad we started using the bedside commode. We pull it out into the room for easy access and use what I call a sit to stand (Spyrt) because my dads give out. As he stands I start cleaning his bum. Once stood you can put the bottom pads behind the bottom. Finish pulling up the depends as far as you can. Then lift one bottom pad at a time to finish pulling up depends. This is good to get them in and out of bed to wheelchair etc

The one my dad uses is on Amazon
Lumex Stand Assist Patient Transport Unit

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daughterand3: Perhaps a bidet can be installed on her toilet. Thus, no standing is required by her.

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Be happy she can stand at all. My wife spiral started in a nursing home where they refused to change her now at home she just goes in her diaper. I try to have her tell me so I can keep her clean and dry. After some practice and training it is easier to change her in bed.

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I don’t have any good answers, I just want to say I am in awe of all of you. I also notice it’s almost always the daughter doing the heavy lifting. God bless all of you.

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or wife

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Maybe a physical or occupational therapist might be able to help her or offer some advice to you for assisting her.

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Lealonnie 1 said: “You do the clean up in bed, with wet wipes and disposable chucks underneath her bottom. “

yes.

Roll mom to her side to clean then roll back.

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Easy cleaning can be done with a Luxe Bidet attachment to the toilet.

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Yes, a toilet transfer chair.
something like this (maybe not this exact one, but go on amazon and you'll find plenty)

https://serenelivingco.com/products/the-commode-pro?currency=USD&utm_medium=cpc&utm_source=google&utm_campaign=Google%20Shopping&gclid=Cj0KCQjw852XBhC6ARIsAJsFPN3pMl5rTxGU_FS-lO8ZbVcxv7qRA3mLFxMAhrgmWGtxMS9hQh58euYaAuu3EALw_wcB

It has hydraulics to lift the person up and down on the toilet. Because of the opening, you can use a cleaning wand to clean her up without having to have her stand.

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When I hurt my knee and needed a bit more help getting off the toilet and standing until my knee was stable I turned a walker around and placed it backwards around the toilet. This gave me support to be able to stand up and be able to hold the walker for a bit until I steadied myself. In your mom's case maybe 2 walkers. 1 turned backwards and the other placed in front of her once she stands up.
Make sure the toilet is at the right height for her as well. A riser seat might help if she is taller, or an ADA height toilet.

As her decline progresses a Sit To Stand will help a lot. Just raise her up, pull down pants, remove soiled brief, clean and pull up the pants. The Sit to Stand can be brought into the bathroom so there is privacy.

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My mother had dementia, and gradually her legs weakened until she "forgot" how to stand and walk. She couldn't help it. It went along with her mental and physical decline. At some point, your mother may not be able to stand and may need assistance tranferring from the bed to a wheel chair. This happened to my mother, and she was like a dead weight, it sometimes took 2 people to transfer her, even though she weighed only 90 lbs at that point. Eventually, she was not able to sit unattended in a wheel chair - she'd lean forward reaching for things and fall out of the chair. She had to use a geri chair, which was covered by Hospice. Geri chairs recline and you can't fall out from a reclining position. When my mother got to this point, the aides at her facility cut her out of her Depends and used wipes to clean her in the bed, with a disposable pad below her.

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Geri Chair sounds worse then diapers

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Someone has already mentioned using a portable commode because when you remove the pail you have better access to clean. The first one below is one I have for my husband... the front is open which gives more access for cleaning. Unfortunately, because he is short, it is too tall to place over our commode as I hoped. It also helps because you can put it in front of a bar or counter so they can hold on when they stand. I needed the open front because of my husband's inguinal hernia sometimes made it difficult to use regular toilet, unfortunately it does not have a splash guard so we also use a urinal in front. It is also good because he had gotten where he was not sitting down gently and I was concerned the plumbing may burst if he kept on sitting down so hard. Many open front seats still have a bar across the front and this one does not.

https://www.platinumhealthllc.com/products/ultracommode-voted-1-most-comfortable-bedside-commode-chair-soft-warm-padded-and-foldable-xl-seat-with-100-open-front-padded-pivoting-armrests-adjustable-height-free-commode-pail-blue

If I were buying one today, I would consider this one. I don't know if I knew they had it when I got ours or not.

https://www.platinumhealthllc.com/collections/bedside-commods/products/prevail-commode-shower-seat

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What I do is clean my mother while she is sitting on the toilet. I have her lean forward (and also scoot forward if necessary) and I use baby wipes to clean her up.

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I also need to say that she uses a walker and it's always in front of her when she's on the potty so she can hold on to it while she leans forward.

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Hi daughterand3. I am dealing with the same issue. I’m going to try a commode with bucket that slides out and attempt most/all cleaning while Mom is still seated. The commode faces a horizontal grab bar also but some days legs just give out like you said. We also use a gait belt which has proven to be very valuable. Best of luck!

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I'm not seeing that anyone mentioned using a gait belt. When my husband(who had little to no leg strength)was completely bedridden, I hired an aide to come in the mornings to put him on the bedside commode so he could poop(yes, thankfully he was usually a morning pooper.) When he was done, she would hold him up using the gait belt, and I would wipe him, clean him up and put on a new diaper. The aide would then get my husband back in the bed all the while using the gait belt. It worked great, and made life much easier for my husband and myself as I was his 24/7 caregiver.

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Thank you for the idea. That is also something that we can definitely look into.

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I'll also add that when she was quite weak or ill (like a noodle at one point) and we had to keep her in bed, we developed a system for changing her Depends pull ups after a bowel movement that I learned online and was relatively easy. (Cut the sides, roll them up from the front, roll her onto her side. continue rolling it up for a no mess disposal)
To assist her with standing, we had the counter next to the toilet and would bring her walker, lock the wheels and let her hold on (if she is strong enough).

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My brother installed (very easily) a toilet seat sprayer for my mom...It allowed her to help with her own cleaning and she didn't need to stand long for support. It was something like the Greenco non electric toilet seat sprayer. She didn't have to twist to grab a sprayer because it has a little lever on the side of the toilet seat to activate the spray. If you think this will help, let me know and I'll see if I can find the exact one.

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I do have to say, that after a certain age, like the 90s, legs give out. No rhyme or reason they give out. It happened to my husbands Aunt and she passed at 98. A former friend of my Dads walked all the time after retirement. When he entered his 90s, he shortened the walks till it was just around the block. At 98 he lost the ability to walked and asked his DIL "Do you think its because I am getting old". He lived till he was 102.

My daughter, RN, says our bodies are good for about 80 yrs. After 90, we are passed our expiration date. 😊

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Does your Mother see an OT or PT? Either could advise on the safest way to tranfer & stand.

PT could possibly assess why her legs are giving way - & assess if exercises could help.

OT could advise re equipment. For hygiene, maybe a squirt bottle & long handled wiper (sponge on a stick)?

There are standing machines that can be hired or bought ($$). There is a simple one without mechanics they use in aged care homes - with a grab bar, knee guard (to stop knees fully bending) & paddles to semi sit/lean on. A person needs to have leg strength to stand up to use it, but it can be safer for those who can't stand for long.

I'll try to put a link just to see what I mean. Definately need professional to advise with that sort of gear though as not suitable for everyone's needs.

https://www.arjo.com/int/products/patient-handling/standing-and-raising-aid/sara-stedy/

Without standing ability, it's hoist transfer to bed (or recliner that flattens) to change pads lying rolling side to side.

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You might consider a hoist/standing machine to support her in a semistanding position (harness around the back/waist carries the weight) to allow easy access for clean up. I also find it allows for easier placement on low toilets which would otherwise be unsuitable.
Going further down that path, a bidet could do most of the cleaning in situ, leaving just a quick wipe to finish.

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Seems some sort of sitz bath would be needed too.
Impossible for an older wrinkly person to be sanitary with just a wipe.

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Seems like she should be in a facility where a team of professionals takes care of her. Sometimes you have to accept that the caregiving has turned a corner and you can no longer handle it. Keeping her safe is the first priority now.

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When u mean commode do you mean a regular toilet or do you mean a portable one?

If you are talking about a toilet, get a portable commode like this one pictured. Medicare will pay for one.

https://www.homedepot.com/p/Drive-Medical-Folding-Steel-Bedside-Commode-11148-1/203269798?g_store=&source=shoppingads&locale=en-US&pla&mtc=SHOPPING-BF-CDP-GGL-D29B-029_009_BATH_ACC-NA-Multi-NA-PLA-NA-NA-NA-NA-NBR-NA-NA-NA-NA&cm_mmc=SHOPPING-BF-CDP-GGL-D29B-029_009_BATH_ACC-NA-Multi-NA-PLA-NA-NA-NA-NA-NBR-NA-NA-NA-NA-71700000032919342-58700003861054714-92700071923334214&gclid=Cj0KCQjwof6WBhD4ARIsAOi65ahrLRlQAb9G2Tlb7AgTkuYwyEC5eBjLlNWM_GFcudmfwH1PXcgTk3saApydEALw_wcB&gclsrc=aw.ds

The bar on the back should be removable, take it off. A new commode should come with a bucket and splash guard. Place the commode over the toilet. (You can remove the toilet seat because the commode has one) Place the splash guard where the bucket goes and make sure the bottom goes down inside the toilet bowl a couple of inches. The legs can be adjusted. Now Mom has arms she can lift herself up with and hold herself up with.

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My mom wore pull-ups 24/7 the last year of her life. I always cleaned and changed her while she sat on the toilet. To clean, I used a squirt bottle with long tip (for postpartum use) to clean her front and back, and dried her with toilet paper. Then I slipped on a new pull-up AND pants over her feet while she was still on the toilet, then helped her up and pulled both the pull-up and pants in place.

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Thank you for the reply. That is definitely something we could try.

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If you don't have anywhere to put a grab bar you can get poles that go from floor to ceiling, like this

https://www.agingcare.com/products/tension-mounted-transfer-pole-grab-bar-445149.htm

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Does she have something to hold onto? My mother had a bar on the wall to hold onto while she was being cleaned, but if that's not possible, put a chair backward in front of her, so she can hold onto the back.

(Sorry -- I responded before reading all the other responses that said the same thing.)

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Thank you for replying. All and any responses and ideas are appreciated.

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If the commode faces a wall, you can install horizontal grab bar for your mom to hold onto while she's being cleaned.

Fair warning, my mother, with Dementia, was still being taken to the toilet several times a day (for dignity, I suppose; she wore pull-ups). There was a grab bar and the aide would say, "now grab the bar Mrs. A". The aide was supposed to check that she had done so.

One day, the aide did not glance up to see if mom had grabbed; she hadn't. Mom fell, hit her head, broke her wrist and died about a week later.

If you install a bar, you HAVE to check that she has grabbed EVERY SINGLE TIME.

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A very sad way to go Barb.
Sorry for your loss of Mom. 🌹

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Nothing you can do; if your mother is incapable of standing up, even for short periods of time, then you'll have to ditch the commode entirely and relegate her to using Depends exclusively. It's too dangerous to risk having her fall down while trying to clean her up after using the commode or the toilet, so it should be avoided in the name of safety.

Best of luck.

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I understand but even if we don't use the commode she will still need to be cleaned up when we have her depends changed, especially when she has a bowel movement, so how would we do that?

Helping mother with dementia getting off the commode. Any suggestions?

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