Any ideas about mom with late stage dementia in memory care refusing baths, toenails clipped, doctor’s appointments, etc?

If it is a Memory Care facility there is no excuse for her to be left soiled. It's neglect and they can get in trouble with the state for allowing that to happen. It's their specialty and they are supposed to be well trained in this as they are being well paid for it. Either hold them accountable or move her. You can also speak with her doctor about new meds to make her more compliant. My mom has refused baths, getting changed, getting her bedding changed, seeing a doctor, etc. but the facility does not just sit back and let her have her own way. She is bathed, changed and her bedding is kept clean no matter what tantrum she throws. Only once in almost two years have I had to intervene and convince her to take a bath. The rest of the time she has finally given up and allowed them to bathe her. My mom is stubborn as a mule. If they can get her to bathe, they can get anyone to bathe.

First of all there's no reason why her bedding should be dirty. The staff can change her soiled bed while she is out of the room having a meal or walking around. Next, she can be prescribed medications that will keep her calm so she won't get so agitated and angry when it's time to change a diaper or wash up. There's no excuse for what's going on in the memory care. Your mother is in a fully staffed facility. They can get it done if they're willing to do what they need to do.

I did homecare for many years and there would only be me in a house with a demented, combative client. If someone was sitting with a full load onboard in their diaper, they were getting changed whether they wanted to or not. Occasionally an adult child had to get a call to come because mom/dad was sitting in a mess and refusing to be cleaned up. This was rare because I always got it done. Sometimes I had to be harsh and mean to get it done, but it was for their own good. People get over hurt feelings a lot easier than a UTI or skin breakdown because they're left in their own waste.

Start holding the memory care facility responsible for getting your mother changed and cleaned. Give them permission to drug her if necessary. Insist that she is not to be left in her own mess or her bed left in a mess and to get it done however they must. Remember, your mother is not staying there for free. There's big bucks being paid out every month for her to be there. Keeping her clean is part of why they're getting all that big money.

Someone deep in dementia isn't able to make these decisions for themselves. Please meet with administration and let them know that failure to maintain safe cleanliness is negligent care and that you will have to take action first with ombudsman, and then with reporting the facility to their licensing agency if this isn't addressed at once.

This is such a challenging situation, and your exhaustion is completely valid. As someone who specializes in dementia behavioral support, I see this pattern frequently and you're absolutely right that the memory care staff should have better strategies.

Late-stage dementia often brings heightened fear and confusion. Personal care feels invasive and threatening when someone can't understand what's happening or why. The sensory experience of water temperature, being undressed, and strangers touching them can be overwhelming. What looks like stubbornness is actually terror.

The facility should be using specialized approaches, not giving up. Timing is everything - they need to approach during her best time of day, often mid-morning for many. They should never force care when she's agitated. The distraction sandwich technique works well: start with something pleasant like her favorite music or snack, slip in care tasks during that positive moment, then end with something comforting. Breaking tasks down is crucial too. Instead of announcing bath time, they might start with just washing hands and build success gradually. Some days, a thorough bed bath with warm wipes is more achievable than a shower.

Sometimes reframing helps. Saying the doctor ordered this special lotion works better than announcing bath time. If your mom responds better to your voice, they could play a recording of you saying it's okay to let them help, or have you on speaker during care. The key is finding what resonates with her reality.

You need to advocate firmly for better care. Request a care conference immediately to develop a specific behavioral approach plan for your mom. Ask about their staff training in validation therapy and redirection techniques. Have they tried bathing alternatives like bed baths, no-rinse products, or gradual cleaning throughout the day? Document every refusal and request their intervention strategies in writing. If she was previously agreeable to some caregivers, they should be scheduling those specific people for her care.

The urine-soaked sheets and feces situation is a health hazard and dignity issue. This is not acceptable. A quality memory care facility should have specialized approaches beyond giving up when residents refuse. This is literally what families pay them to navigate. They should be trying different approaches with different staff members at different times until they find what works.

If they don't improve their approach within a week, consider filing a care concern with your state's long-term care ombudsman. You might also want to request a medication review with her doctor, not necessarily for sedation, but sometimes addressing underlying pain or anxiety can reduce resistance to care.

Your mom deserves dignity and proper hygiene, and you deserve a facility that doesn't shift their core responsibility onto you. Being out of state makes this even harder, but don't let them make you feel like this is just how it has to be. Push for better. Document everything. And remember that your frustration and exhaustion are completely justified. You're being a wonderful advocate for your mom in an impossible situation.