Is it elder abuse to allow dementia patient not to bathe?

Care systems are reluctant to take people's choices away from them until and unless they are a clear and present danger to themselves or others. I'll never forget what a social worker told us when that point was reached with my husband's mom and dad, and she was placed in a gero-psych after a few run ins with police over her behavior. The house was a hopeless and dangerous mess, she had threatened to call police on anyone who tried to help, including our brother/brother-in-law. I was still naive enough that I thought is not right that she had no voice in determining her future living arrangements even at that point; I'm sensitized to that sort of thing because I'm a rehab professional, and people with disabilities having choices is a value that is still near and dear to my heart.

She said, "Choices are for healthy people." She also said this sort of thing happened a lot and that home was not even the worst they had ever seen by a long shot. She could tell we felt bad, but no, we probably could not have taken action sooner.

"Healthy" can be pretty relative and subjective...just keep your eyes open for when something develops that crosses the line. I know once we got into that house while Mutti was in the hospital, though BIL did not really want to out of embarrassment at how bad things had gotten, I took pictures so that in case she tried to insist on coming back, we had evidence that she was not capable. The roach swarms, the moldy fridge drawers, the paper and plastic bags stuffed in by the oven...it hurts just to remember that. Back when it just smelled a little funky but they were taking care of thins more or less it was a different matter altogether, unfortunately.

If there is no mental problem such as Dementia/Alz, then I suggest the Medical POA leave it alone. No one wants their independence and freedom of choice taken away. And unless this person's health or safety is in danger, the Medical POA shouldn't be stepping in. This individual should be able to live as they would like and alone as long as they're not a danger to themselves or society. But smelly clothes and body odor is not a reason to take this away. A lot of elders don't like to bathe as often as they should either because they are scared of falling or because they don't want to bother with it. Plus, their sense of smell has diminished - so they don't necessarily "know" they stink. I had this problem with my mother-in-law, so I might suggest home health come once or twice a week to help with bathing. Or just suggest they "try it" and see if it helps keep a regular schedule and alleviate this problem. Good luck!

What you might have here is a UTI (Urinary Tract Infection). That might explain the urine smell. Can you get them to a doctor for a quick urine test? They can give them some antibiotics if necessary and the smell should go away or at least not be so prevalent. It also effects their memory a bit and makes them tired.

Ohhhhh!!! Gotcha! Yeah, that changes things. Sitting around in urine or feces can cause infection but if it's just an odor in the house I'm not sure what can be done regarding placing the elderly parent in another environment. And if the parent was never a real regular bather then this isn't new behavior caused by, for instance, dementia. If the parent isn't a danger to him/herself I'm not sure anything can be done, or should be done. You can hire a bath aide to come in once or twice a week to help with bathing. I personally don't know how to get the smell of urine out of a house but I've seen topics relating to that here somewhere. My dad's bath aide was in and out in about 40 min. at the most. My dad developed an aversion to bathing and he started to smell. First I dropped hints and then I just came out and told him. He still wouldn't shower regularly (shower chair, grab bars all in place) so I hired a bath aide through a local nursing agency and told my dad the same day she was scheduled to come so he couldn't wiggle out of it. I told him that while elderly people don't need to bathe every day, to stay healthy they do need a shower a couple of times a week and it was either going to be by me or a professional. He chose the professional as I knew he would. She came several times before he decided that he'd rather do it himself. ;-)

If the parent just won't shower maybe put some unscented baby wipes in the bathroom so at least the perineal area can be wiped. But that still leaves you with the smell......

Many decisions are difficult to make when they concern someone with dementia. Regarding your elder parent not wanting to bathe: my Dad showered just about every day for years while he was, apparently, in the early stages of dementia. He would be in the shower for 15-20 minutes and as far as my Mom knew he was scrubbing and soaping away. It wasn't until he was diagnosed with dementia and got to the point where he couldn't bathe himself, and she had to begin helping him shower, that she realized that even though he'd been taking showers, he wasn't actually cleaning himself. His skin looked in places like fungus was growing on it, he had eczema, etc. So even if we THINK our elders are taking care of themselves, sometimes they aren't. I'm sure its much worse when we KNOW they're not caring for themselves, such as your parent. Perhaps the easiest thing would be to have someone be there at the home where the elder parent lives at a certain time, at least of couple of days a week, to assist in the person's bathing, or just to be there while the person bathes and to make sure he or she is bathing to the point of cleaning! Even ordinary tasks, such as showering, can become scary when a person has dementia. We just need to find ways to alleviate their fright.

It's still a choice on whether someone takes their medicine too, just like a bath. If it's serious health issues that require medicine just to survive or starts having to go to the hospital because of it, that's different and I would step in. But if it's because this person isn't taking their blood pressure and statin medicine regularly and seems to be doing okay - I would leave them be. And just because they eat salty foods and don't maintain a healthy diet isn't another reason to step in either. If that were the case, about 3/4 of the world is in trouble too then. It's their life. Just my thought.

I don't know about the legal aspects of this situation but someone needs to ensure this elderly parent is bathing (several times a week) and can either keep clean hygenically on their own or put someone in the house to make sure the elderly parent is clean. This same someone or another someone should make sure that all medication is taken as well. If the elderly parent lived on their own but is unable to bathe and wash properly I think some action needs to be taken. Hire someone to come in, enlist the help of family or friends, discuss the possibility of an assisted living facility.....It sounds like this elderly parent needs assistance. You didn't mention if the elderly parent has dementia. That changes things if the parent has dementia. They may no longer understand that they have to bathe and keep themselves clean. If there is no dementia and the elderly parent is just choosing to live that way there might be less you can do than if the parent has dementia.

In any case, if you know the elderly parent is sitting around in urine-soaked clothes and can't or won't do laundry someone should step in, not because it's legally required (because I don't know if it is) but because someone shouldn't be sitting around in urine-soaked clothes that never get laundered. I would think some kind of intervention is needed. I guess the next question might be, "How do we force mom/dad into a situation they don't want to be in?" That's a whole other problem.

I appreciate the response. To be clear, though, there are no "urine soaked" clothes; the elder parent does change clothes, but that doesn't eliminate the smell. Also, there is no spoiled food/food poisoning history. There is no spoiling garbage. Its just that they don't want to bathe very often. They don't want help. But if someone chooses to live that way (and has always lived that way, meaning they were never a frequent bather, its just the urine-smell that's become a problem), does that choice of living at home get taken away?

Thank you everyone for your input. Yes, she has mild to moderate dementia. I haven't seen much change in her personal cleanliness though, other than the urine smell. She has been tested for the UTI. The family member she is currently with does not want her to go back to her own home, and the doctor has advised that neither she nor her elder friend drive. The doctor, a couple months ago, didn't feel they should be back at home, because the other family member was willing to take her in, and because of her mild to moderate dementia. She's almost 90. Does an elder with dementia have the right to age at home, or do they give up that right when they do not want home health care?

I have battled my mom in law for about a year on this issue. By 'battle' I mean I have tried everything I can and have come to a conclusion. I was told to keep her meds out of her room because she hid them, didn't take them, etc. She had a fit when the doctor said that (not in front of him, but after we got home) and after exhausting myself mentally for a couple of weeks, I just gave her meds back to her and put everything in a daily morning and evening pill box. She still hid meds, forgot to take them, took too many etc. I have 4 teenagers also and started having major issues with them, and frankly I just gave up trying to deal with the medicine issue with 'gran'. So.......... she 'forgot' many many many pills and then I would get her caught up for a few days, then it would happen again. (My teens were running away and smoking pot--triplets are 16 - and I was VERY preoccupied and ended up in the hospital with my heart issues) . Anyway, long story ....... but basically I learned to NOT take everything so personally and to just DO what I need to do to help 'gran' stay alive optimally. I now go to her and make sure her meds are taken and if she gets mad at me, I just say 'i know it is frustrating......here are your pills and your water... drink up!' or something like that. Then I go about my business and she gets over it. So,, I would say that the elders need to take their meds to be able to function well, so someone should be assigned the 'job' to go over to their house daily to make sure it is taken...whether they get mad or not. Maybe put their meds in the vitamin bottle to make them think they are taking vitamins? But keep it out of their reach. My opinion as I struggle on this road of craziness.............