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Family felt she was appropriate for memory care, but she passed the SLUMS test with flying colors. She is in good physical condition, but does not see the need for basic hygiene. She still manages to look presentable and therefore her failure to keep herself clean is not obvious to others.

Had not heard of this SLUMS test, so did some lookup.

"This screening questionnaire consists of 11 brief questions scored on a 30 point scale. It takes approximately seven to 10 minutes to administer."

If this is what the test is, this is minimal. It doesn't sound much more useful that the one used in a doctor office. It *can* identify some early stages of cognitive decline, but these are often used to get a baseline and then used for comparison over time to detect changes.

It might be better to have a full assessment done. Underlying causes of cognitive issues are so different and the symptoms and issues can also vary widely.

As for "qualifying" for MC, I am perplexed by some of the statements. I don't know you aunt, haven't seen the tests done and certainly am not a doctor, but I also think this needs more exploration. I did NOT have a medical DX for my mother when we moved her to MC. It was clear she was in the earlier stages of dementia (once I did some lookup, as I knew nothing about it when this happened!) One thing that was done was an assessment when I was hiring aides, to try to get her used to having someone there. She didn't need any help really, but it wasn't going to get better and I couldn't check on her every day. They sent a nurse who did a much better assessment of mom's needs. Sadly the plan to increase aides time and duties never happened as she refused to let them in after about 2 months.

My YB installed some cameras, mainly to monitor the doors and who was coming/going. It did focus on the kitchen table she sat at a lot, so there were revelations. What started out as a few iterations a few nights became a nightly marathon, checking the door lock, sidelights, and something in the kitchen and LR. The kitchen check was revealed when OB was there for a visit - dishwasher. Never did figure out what she checked in the LR. This became a nightly routine, lasting 1-1.5 hours, over and over! Most likely this was her version of sun-downing. It also revealed she started wearing the same clothes over and over, once for SIX days in a row! This was a woman who had enough clothes to open her own store, a different outfit for every occasion. During that visit, OB pointed out food stains on her clothes and she just laughed it off.

The facility did their own assessment of mom's needs. She was quite mobile, able to feed, dress, eat and more or less get around on her own, but it wasn't safe for her to remain in her own place. They also negated YB's insistence that mom would be better off in AL, not MC. I disagreed, but thankfully they said no and he didn't fight it. She was quite able to get along fine in a safe place for several years. It was likely close to 3 years before she started using a rollator to get around. Over 3.5 years before she refused to stand or walk without assistance, so she ended up in a wheelchair and needing more help with various tasks.

There can be other reasons for her behaviors, so the doctors should be more proactive to get to the reasons. Many issues can be medically related, but treatable. UTIs and other infections can result in odd behavior. Imbalances in the blood can also cause issues. I would certainly pursue more diagnostics to try to determine why she is doing these things (or not doing.) Perhaps she just doesn't want to or doesn't think they are necessary. But, until all potential causes are eliminated, it would be best to try to determine why she is behaving this way. Certainly my mother felt that she was "fine, independent and can cook", when none of the above were true!
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Reply to disgustedtoo
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Assisted Living would be the logical choice for your aunt. A person needs a medical diagnosis of dementia/Alzheimer's in order to be placed in Memory Care. In Assisted Living, the resident can get help with showers and will be required to maintain good hygiene while living there. Has your aunt been seen by her PCP to determine why s/he feels she refuses to maintain good hygiene? Could there be a mental health issue going on like depression which can bring apathy along with it? It's not just dementia that creates a lack of caring about showers and such. Of course, your aunt would have to be agreeable to getting help with showers in order to make AL work for her. If her doctor feels there is depression at play, perhaps an anti-depressant medication can be ordered to see if it helps.

Best of luck!
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Reply to lealonnie1
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grandmamommy May 12, 2021
My disappointing experience with wanting to communicate with a patient's doctor has been that they sometimes seem to think that what they're seeing and hearing at the moment (from the patient) is all there is to treat. When a patient is secretive or manipulative, (or just plain forgetful) the doctor can't make as accurate an assessment as if they would allow for family member input.
Hopefully there is a family member near enough to the Aunt to offer insight to her physicians and practitioners.
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Could be depression rather than dementia? Or other mental illness - bipolar? Does she have cycles of mood at all?

I'm also thinking of sensory issues. Some people (especially if on the autism spectrum) may have strong sensory reactions, hate the feel of water or the smell of soap, taste of toothpaste.

If she is competent there sadly is probably not much you can do. Hygiene is socially required but still a personal choice.

Is this the Aunt I read about recently who was a bit reclusive?
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Reply to Beatty
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I don't have a solution, but I am interested in what people have to say about this. Both my mother (died at 88yrs) and my recently deceased sister (died at 85 yrs) appeared very competent to take care of themselves and lived alone almost to the very end of their lives. The never developed dementia nor memory problems. However, when the family finally had to seek aid for their care at the end of their lives due to physical problems, it was discovered what horrible hygiene they had. Besides the non-bathing, that could only be detected when they undressed, I can't even describe the horror of their feet, both of them. They both went for standard dr. checkups, and I don't understand why their feet, specifically toenails, were horrible to the point of I don't know how they walked. I can't help but think this was some kind of psychological problem combined with the difficulty of clipping their nails and showering. Anyone else encounter this?
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Beatty May 17, 2021
Yep. Very common. Often just can't reach their feet. Hands stiff, can't use the clippers. Hate being cold when washing. Subtle short term memory decline, think they showered yesterday. Afraid of falling. Plus many more.

I wonder if Doctors look at their whole patients, including feet for thorough checkups? A Geriatrician might... should. Certainly family visitors don't. So please don't feel bad you didn't pick it up.
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Can you hire a bath aide?

My mom is like your aunt. She will not shower for days, has stains on her clothes and every 3 days I fight with her to change her clothes at least. She has moderate dementia but we don't have the money to put her in MC/AL. Her primary Dr. says it's upto me to make sure she's clean and has good hygiene...duhhh...I know that. I called a community resource and they said I could hire a bath aide and "this was a phase that'd pass..." ( not sure what they meant...I will have to ask them).
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Reply to wearynow
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Sounds like my Mom when she & I lived together. I took this behavior for stubborness, not dementia. And brought on by years old "who's in charge here" clashes between us. It drove me crazy until we found her a really nice AL facility (in IL). When it came to her being helped to bathe by very pleasant strangers in the AL place that she had no prior relationship with suddenly she stopped being so stubborn. It was all about unfinished business between her and I. It was about my being an adult, and an older one at that, and her wanting me to be a kid and her being in charge.
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Beatty May 17, 2021
Well explained. My Mother would be stubborn for me too. Now she has 'staff' LOL.
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Sounds as though she needs Assisted Living at the least. If this negligence over basic hygiene is new, then it is a sign that there is some failure in the mind, no matter flying through some test. However, if others are not noticing (or smelling) any failure in hygiene you may have differing ideas of what basic hygiene looks like. For years, when I was young and we lived in the South, we didn't have anything but sponge bathing. It sufficed to tell the truth. Wishing you the best. It is certainly something to recognize and follow. Be certain NOW that all paper work is in place for future, DPOA, Will, Advanced Directive, et al.
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Reply to AlvaDeer
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RedVanAnnie May 17, 2021
When recuperating from surgery I have had to rely on "sink baths" and sponging off for extended periods of time, and you can make a pretty good job of that.
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Hiring a bath aide would be an option.
Also transitioning her to AL might be a more lasting solution. She will probably continue to need more help and having her in AL would make the added help easier on her.

When my Husband was in rehab the PT told me that showering can be a problem for some for a variety of reasons.
Fear of slipping, falling.
For a person with dementia not remembering what to do next can be confusing. How to adjust the water, getting wet first, wetting the wash cloth, soaping it, washing your body, getting your hair wet, shampoo, rinse,....there are a lot of steps that for "us" are automatic. When you forget what step is next it can be upsetting and confusing.
She also mentioned that the head and torso are "vulnerable" areas and to have those areas pelted with water can be frightening.
Also there is a lot of noise in the bathroom with the water going, the tiles echo noise.
After hearing that I was a little more understanding with him in the shower. (although he loved taking showers and I did not have this problem)
I gave him control of the hand held shower head, I started at his feet by getting feet and legs wet then his back and let the water gently go over the shoulders. Then I would give him the shower head while I soaped him up.
Hopefully a shower aide would do the same.
Again I think starting a transition to AL would be a good idea.
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Reply to Grandma1954
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A bathing aide would help. This person comes daily to assist with her bath. It would be important to make sure the aide knows that aunt needs help with oral care as well as bathing. Bathing aide can make sure that aunt changes clothes and that dirty items are placed into the laundry.

Laundry service can handle the dirty clothes. OR a housekeeping service can clean her place AND do laundry,
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Reply to Taarna
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Talk to her about getting someone to help with cleaning the house and doing laundry. It will be more difficult getting her to accept help with bathing and teeth, as she is in denial. Do you have POA? Can you talk to her doctor and dentist about the bathing and teeth? Make sure all of her paperwork is in order with POAs for medical and financial affairs, a living will, etc.
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