How can I address hygiene with my mother-in-law?

Yes, there comes a time that you just have to DO IT instead of coerce them to do it themselves. Tell her "doctor said one to two showers a week". Pick a day, have a schedule, hire an aid. Heater and shower bench. If it's "shower day" don't "get dressed" til shower is done; just PJs or robe. Tell her she'll feel better and smell better. Don't make it too big of deal, try to be fast; "after we are done with shower we are going to do _______". Mom didn't resist but was unable to do it herself. I used the type of Body Wash / Shampoo product that they use in Hospitals and Nursing Homes. They are pH balanced and don't require rinsing (we did rinse, but any residual product will not cause any problems). I started with the hair, face, neck and ears; very fast. The aid started with the feet. We worked fast, we worked together, met in "the middle." We did this until she could no longer walk and get to the bathroom. Then it was sponge bath in the bed before getting her up to the wheelchair. Then to Nursing Home was next. Good Luck.

A woman of 97 probably doesn't have a lot going on "down under"---we tend to kind of dry up, sorry if I'm being gross or impolite.

If you can get her to bathe well, and the "intimate odor" continues, you should see a Dr. She could have a yeast infection or some other kind of Ph balance issue. She could have an overgrowth of pubic hair and it needs to be trimmed. (Yes, this happens) That would certainly trap more odor and be pretty rank. I guess I don't really understand what you mean by has "feminine hygiene" smells. I'm a little befuddled by that.

Just getting the old urine smell gone is usually the hardest, as it clings to everything. So potent. Not bathing is simply not an option, so good luck with this. Or rather, to your wife, b/c I cannot see a SIL stepping up to bathe his MIL.

I think re-training mom to use different 'cleansing' methods. The big wipes, the prepackaged washcloths that hospitals use that foam up and then are used to wipe the person down. No rinsing needed. Those can take the place of a bath for a while.
Also, check her hair. My grandmother had very thick hair and when she got very old and could not keep her weekly hair appts, she developed something like cradle cap--the oil in her head built up something fierce--and it smelled awful.

I really feel for you--I went to mother's one day and she was standing stark naked in the bathroom while my brother bathed her. You'd have thought she was Cleopatra--she was positively reveling in the attention. I said "Oops, I'll come back" and she said "Oh, no stay and chat. We're having a lovely time." (Brother looked at me and mouthed the words "ONE of us is having a lovely time". Bless his heart.

Perhaps it's time for a Dr appt to address the feminine
odor issue. I think as caregivers your wife and yourself
need to be much firmer, it isn't going to get any easier.

These are all great tips.
I wanted to mention that my mother in law developed 4 tract infections within one month involving an entire month of hospital stays and rehab.
We finally started washing her bottom and she has not had one tract infection since.
She does not wipe properly.
It is the unthinkable and we try to be matter of fact as to allow her to keep her dignity.
It is necessary.
We even had a home health aide come to the beach house where she was vacationing with my husbands family.
Good luck!
Good luck!

Hi Bestmotherinlaw,

One "tactic" I didn't see mentioned was bringing in an authority figure to broach the topic with your mother-in-law. Set up an appointment with her primary care physician ('just a routine check-up") and ask the doctor to be the bad guy. Generally speaking, older generations respect authority figures and will listen to them when given instructions. Perhaps you could arrange to have one of her doctors tell her that her hygiene is problematic and needs to be addressed? She might be less likely to push back and more likely to follow orders. Even if she receives it poorly, you can continue to blame the doctor when you make efforts to help her stay clean ("I know you're not wild about this, but the doctor said we have to do it."). Your mother-in-law's dementia may thwart the efficacy of this strategy, but it could still be worth a shot.

You could also try to get her doctor to instruct her to use the bathroom modifications you said you've made.

I worked for a Senior Move Manager and was trained as an Aging in Place Specialist (for those who planned to live safely at home as long as possible), and we found the "authority figure" method to be particularly effective. The adult children would come to us months after trying to convince their parents to either move into a Senior community or make modifications to their home for aging in place. Even though we might be saying basically the same things the adult children were telling their parents, we could get their parents on board because we were seen as authorities rather than their "overreacting children."

You sound like you've been doing a great job, and you're way ahead of where many caregivers are in this kind of situation.

You may have covered all your bases for the bathroom, but I wanted to share a pretty extensive guide I wrote that you may consider sifting through just to double check everything. Just putting down all the things I learned while working in this world - hoping it can be helpful to others: https://thehelpinghome.com/aging-in-place-at-home-definitive-guide-part6/

Part 6, 7, 8, and 9 all have to do with hygiene. Maybe you'll find something in there to be useful.

Best wishes!

Jason

My mom lost her sense of smell and insists she cleans herself, she doesn't. Also showers on older skin is more sensitive. Her care center is very kind and wants her to feel safe. The hygiene is a tough one, she has excuses after excuses not to bath. We are kind still must be firm for her and others around. Not winning but must kind trying. We love our moms ( some days - grrr!) Love you Mom : )

My mom lost her sense of smell and insists she cleans herself, she doesn't. Also showers on older skin is more sensitive. Her care center is very kind and wants her to feel safe. The hygiene is a tough one, she has excuses after excuses not to bath. We are kind still must be firm for her and others around. Not winning but must kind trying. We love our moms !

You have to help her keep her bottom clean! The dementia she has been experienced actually could be caused by urinary tract infections. Older ladies have a real problem keeping that area clean because of all the folds of skin. You should try to help her carefully wash the bottom at least once a day, twice is better. If she sits or lies a lot ultimately she can get bed sores and uncleaned fecal matter can infect the sores causing sepsis which in 97 years old is terminal. Baby wipes can help, but take care to make sure they don't get flushed in the toilet (even if they say flushable on the box) or they may stop up your plumbing! Also make sure she changes her pull ups or diaper at least twice daily. If she is wearing underwear alone, get some of the Tena pads. If you keep her in synthetics (fleece, not cotton), you can wash and then air dry the under-ware or pajama bottoms and they won't smell as badly. We used Tide with Febreze to keep my mother in law smelling fresh. The home health and hospice assistants always commented on how nice she and her clothing smelled.

Dear BestMotherInLaw:

I am exactly where you are now. I am the daughter in law of a bright elegant 96 year old with short term memory issues. She used to take daily baths on her own and get dressed in a nice outfit everyday. Now she only gets dressed when there is somewhere to go and needs to be reminded to bathe. In addition, she has become incapable of wiping herself well after using the bathroom. If she has an accident, she tries to wash out her clothes in our sink and does a poor job.

Since we all use the same bathrooms, this is not acceptable.

We do set up the bath at least once a week and tell her it is a good time to do so now.

We also have taken away her panties and replaced them with disposable pull-ups, the nice ones that fit like underwear. We have those and some wipes in a basket by the toilet, along with a smaller covered trash can. The basket and the trash can are "labeled" with instructions such as "underwear and wipes." I have a brief instruction sheet in the basket to change underwear daily and when necessary.

Whenever she takes a bath, we grab all of the used clothing and do a laundry load. We also have a cover over the sofa wher she sits. This is washed on a regular basis. I also have jars of odor absorbing gel in her room and sitting area.

Occasionally, she does state that she is offended that we think she is "dirty ". We tell her that she is getting forgetful about baths and that we are helping her to remain elegant and pleasant to be around. We also tell her that it is necessary to be clean when living with others. This conversation takes place 1-3 times a month.

The other writers are correct. This lack of awareness of her own hygiene is due to memory (dementia) issues and aging. She does not remember and she does not smell herself. She cannot fully take care of herself.

If we get to the point of too much care and no cooperation, we are considering more in home help or assisted living.

I hope that this is helpful. It sounds like you truly want to be respectful of your MIL.

I really like cwillie's answer who commended windyridge's comment:

I think Windy's suggestion of hiring in help is a good one, hopefully you can spin it as a desire to help her feel more comfortable and alleviate any worry that she may fall. Is her bathroom set up with a bath chair, hand held shower and grab bars? Extra heat is nice too.
As an elderly carer I usually walk in and straight away I am talking, " Okay...shower time..." and if they say: "No, later..." I say..."Thats fine... ..but phew, what"s that smell? Is that pooh in your hair?"  OR: " You have been told that you NEED to have a shower and you are to have on today then you don't have to have one this afternoon." It's difficult though , you must speak empathetically and it can take a couple of days of constantly talking and maybe even getting another carer in who speaks the same as the first carer.

But the most empathetic and goodest response in my mind is Grammyteacher. Check it out.....it's a dialogue with someone who suffers demensia/Alzheimer's...wow, what a caring person.

Thanks again to everyone for the helpful suggestions and ideas.

Best, one of the first behaviors one hears about related to Alzheimer's/demensia is that the person stops wanting to shower. When the demensia becomes "severe" she will be double incontinent and probably be taking bed baths. So this is a demensia related issue, unless you are saying your mother in law has always not bathed and smelled bad. The suggestions made here are sound. These are shared out of experience, not off the cuff. We have been where you are.... are more. 

When my mom was at that stage, I would start the water running, get her shower chair in place, use a space heater to warm the room, get her towels ready, put soap on the wash cloth and says, "time for a shower momma." Then I was there to help her out and put her robe on.

Your MIL's demensia is far enough along that you are saying she won't remember to use a "poise" type pad...so that means someone needs to help her put the pad in her panties, or open it and get it ready and hand it to her to put in her panties. Caregiving quickly gets much more hands on with demensia. Sorry, it is just what happens. One thing not mentioned yet, or at least I didn't see it, is having her checked for a UTI. That can create odor too.

Another thing I did in the early stages was to get a couple of Peri bottles. I would put a mild soap with warm water in one and then one with clear warm water. On mornings mom didn't shower, while she was on the toilet, I would spray her Peri area with the soapy water and then with the clear water. It helped clean her down under a bit.

They make flushable most wipes... Adult disposable wash cloths... No rinse soaps... All can help in these situations. With some demensia patients, it is the running water that they don't like so they do better with a bath. Again, some assistance may be needed.

One thing is for sure when dealing with demensia/Alzheimer's.... This too shall pass...it is progressive and this stage will pass and you will have a whole other set of issues and behaviors.

There is a difference between caring for someone in need of total support with all ADLs and the level of caregiving you are at Best, I was where you are now about 7 years ago and the learning curve seemed very steep. My comment about addressing odour as silly is measured against my need to physically bath, toilet, change diapers, and more for my mother. I've been peed on and pooped on, so yes, the issue of odour seems trivial now.
My mom also relied on sponge baths, when she finally allowed herself to be showered by someone she commented that she "tingled all over", and that was a good thing! Until I began to look I did not know there are so many helpful incontinence supplies, waterproof bed and chair pads etc. There comes a time when the caregiver child has to step in and take the leading roll in the relationship that was once dominated by the parent, even though it is uncomfortable and feels disrespectful and unnatural.

Thanks to all for the multiple replies. One by one here are my responses: "(Use) in home care service(s)" we've considered this and it may be the best option. "Dementia might be a problem" she is very easy going for the most part and her dementia is not severe at this time. "Odors come from the skin because of things that Mother-in-law is eating" I'm confident it is feminine hygiene just can't or don't want to explain why here in this forum. "Buy some prepackage cleaning cloths" trouble is she forgets, short term memory is very very bad. "Morphing into her full time caregiver that little concern (telling her she stinks) seems silly" we've been her 24/7 caregivers for three years now and neither of us can work up the gumption to say this to her. "(Set up the) bathroom with a bath chair, hand held shower and grab bars" did this long ago but she won't use it. "(There are) pads she can use" again she probably won't remember them. Thanks again. I will search the site for more information and will post when we reach a resolve.

My FIL was the same. We got him in home care and they sent 18 yo's, who'd say "time for a shower" and then they'd sit on the couch and he'd go run the shower for minute and come out IN THE SAME CLOTHES and say "OK, take me to the coffee shop".

I witnessed this ONCE and let the poor aide have it. I said "You are here to HELP HIM BATHE , so do your dang job!!" We still had issues, but FIL had bowel incontinence and wow--he got really smelly. I'd just gave up trying to be discreet and nice, since I was also the one scrubbing his fouled clothes and underwear (when I could find it, he'd hide it around the house!)

Never a really "clean" type man, he didn't like to shower, it was hard for him, but he had to have his behind cleaned every single day, whether he liked it or not. Sometimes I'd threaten to strip him down and scrub him myself (while hubby cowered on the couch)...that alone would terrify him into washing. (sigh)

As wonderful as it would be to be kind and gentle, sometimes the whispered "you stink" makes the difference. You wouldn't let a baby sit in a soiled diaper, why would you let an 80 yo? Some people can be cajoled and babied along, some require tough love and tough talk.

Best thing for us was dad's frequent hospital stays. The nurses made him shower everyday, no questions.

I know by law aides/nurses have to say "would u like to take a bath". This didn't work with my Mom. You said "time to get a bath". If you "Ask" it would be "no" or "later". I would tell her she needed to do it when tha aide had time. Actually, I told the aides to tell her "your daughter said....". It worked.

I just told my Mom she stunk. I would tell the aide she needed a change. Mom would refuse to go and I would bend over and whisper in her ear "you stink". She would go.

Maybe it is time for pull ups. Or if that doesn't work, sanitary pads. I never asked Mom if she wanted a bath, I just told her it was time for one. Again, I would tell her she stinks. A handheld shower head is great for getting to those areas. I agree that what they eat may be a problem but I also read it has something to do with the skin cells as u age. Using deoderant soap helps. I use Loves baby wipes. They are thick and big. You can use these for a quick wash. For some reason with Dementia, one of the first things is not wanting to bathe. They worry about bowel movements but don't want to bathe.

Oh, I just thought of something else. Maybe Mom-in-law needs to drink more water as that can help to limit some of the odor.... but then again, there are pills that could create a sulfurous odor. AZO also puts out over-the-counter pills that can help with odor, but Mom-in-law would need to check with her doctor.

Back when my own mom was still independent I felt the same as your wife, how could I possibly tell mom that? After morphing into her full time caregiver that little concern seems silly now!
I think Windy's suggestion of hiring in help is a good one, hopefully you can spin it as a desire to help her feel more comfortable and alleviate any worry that she may fall. Is her bathroom set up with a bath chair, hand held shower and grab bars? Extra heat is nice too.
As for the incontinence, many women who are much younger have stress incontinence, there are some pads she can use that are especially designed for this and the smallest are very discrete.

Sometimes odors come from the skin because of things that Mother-in-law is eating, such as lot of onions and garlic. Could be other food items, too.

This is a tough conversation to get started with someone. It's like telling someone they have bad breath. One thing I could think of is to buy some prepackage cleaning cloths for Mom-in-law to try. You can tell her these are easy to use if she needs to freshen up quickly, and here are a variety to try out.

Just go down the grocery aisles, in the baby section are baby wipes [get scented ones as the unscented have a blah smell, scented might make Mom-in-law want to try them]. In the toilet paper aisle are bathroom wipes, but they aren't flushable. And in the personal health sections are feminine hygiene wipes she can use.

62 year old man here. Long story but I had to help my 86 year old mother bathe a few times before I could get home care set up after a surgery. I do not recommend this. I just didn't have a choice at the time.

You should call an in home care service who can have a bath aid visit. It will be $20 per hour or so probably with a 2 to 3 hour minimum.

Her dementia might be a problem. Might take some trickery and fibbing.

And search this sight for a bunch of info on elders and hygiene. Your not the Lone Ranger on this issue by a long shot.