How do I broach the subject of asking mom to bathe?

My mom is the other extreme. She is in NH. I have an aide for her 4 hours a day. She insists on daily showers, her hair fixed, dressed the way she wants, makeup. She has twice weekly beauty salon visits, twice a month manicures-pedicures. She has been meticulous about her appearance always. It’s okay with me. If she starts to run low on funds she would have to change her routine. Her personal routine gets her out of her room and socializing (she always goes to the dining room and activities after she does her personal care).

A lot of alzheimers patients become afraid of bathing, mabey you could suggest that you will be willing to come sit and help her bathe

My sister and I have had to resort to bribery. If she wants to go out to dinner, she has to shower first because it's been too long. "Want a haircut, mom? Not until you shower." One thing for sure, we cannot approach it late in the day. It will not work if we try after 4:00 in the afternoon. I write on the calendar the days she has a shower, then I point out what day it is and show her when the last one was. It does help. I even said to mom one day, "I hope you don't end up with bugs crawling on you."

If you bought some "bath wipes," would she let you help her wipe down every now and then? They smell good and don't involve water. If private areas need attention, a sink or "helmet bath" with a washcloth will do. She probably does not need a complete daily bath or shower.

My first thought is that, while you perceive she is independent, I am afraid that your mom no longer has the ability to look after her own hygene without support. Coming to that awareness will help you in the long run.

Now that we acknowledge she isn't independent, we can strategies what works for her.

First, ensure you are working with her geriatric physician to assess her overall skill with activities of daily living (ADL), and are giving proper supplemental vitamins and/or TX medications to address the cognitive decline.

Second, be sure the shower is still safe for her. If she has to step over the side of the tub to get in, she needs help in and out of the tub. She might need a shower chair and a moveable spray nozzle that she can control. An inhome assessment might be useful for you to see how your mom is doing with all of her ADLs

A few simple strategies to try might include:
Ideally, you help her keep a calendar. Put bathing, shampooing hair, laundry, etc, on her calendar.

Schedule a weekly event for her to dress (and shower for) that may be Church, a salon appointment, a lunch out. Gentle reminders to bathe before these events might help.

I use Alexa to set routines for my mom and find she will respond to what the Alexa says to do easier than me nagging her.

Finally, if it is an issue for you to assist your mom, hire someone to come in to ensure she is clean. Skin can breakdown very quickly in the elderly and if she is not showering she might not be seeing cuts or ulcers that can become dangerous.

Tell her you know her back or knees hurt and a warm bath will make her bones feel better and stronger . Don’t talk too much… prepare the bath and walk her to it

As long as she is having full wash downs and you have no positive reason to think she is liable to get an infection, ask if she would like some assistance - we are used to having the facility to shower or bath daily, but as long as she avoids infection it isn't necessary. If it becomes a hygiene issue then you have more of a fight, but don't create one before you need to, plenty of fights arise as someone's dementia progresses.

My MIL hasn’t showered or bathed in over a year. She moved in with us at the beginning of August and at first we asked the PSW’s to push, but it quickly ended in screaming from her, and getting all worked up. We knew without a doubt that we were beating a brick wall.

I’m having a behavioral specialist PSW come in next week. Do I think she’ll be able to wave her magic wand and make my MIL cooperate? Hells bells, no. But I’ll keep an open mind and try whatever she tells me to. If I hear anything worthwhile, I’ll pass it onto you.

I am not on the the 'leave her be' side.

What jumps out at me is *Dementia & *not bathed for a month.

Even if physically able, other issues sometimes prevent tasks, especially personal care tasks from being done independently.

Some folk forget how to start - if you start them off they can do it. Some forget the steps (sequencing) & need verbal prompts to do it. Many, as suggested, become fearful. Vision & sensory changes mean they can't see the water, or it hurts etc.

CarylorJean, I would suggest playing detective & work out the problem if you can.

Could try the Ask-Say-Do approach. ASK her, if no action, SAY how to get started, if nothing, try later with DO. Don't discuss, just take her hand & lead her into the bathroom & start the process. See if she is willing..? but stop if she resists.

Once you know HOW much help she needs, then you can plan. Is this going to be a task you help her with, say 3x week? Or is getting a local care assistant affordable?

There is no need to explain to Mom she needs help (it is a step for you to accept though) but if you are her full-time caregiver, it is up to you take the necessary action.

(My Mother detested me helping her bathe but got used to & seems to like the aides that help her now).

CarylorJean: Imho, hire an aide whose sole purpose it is to bathe your mom simply because she won't do it on your direction. Come up with a ruse as to how to get this aide into the residence.

When I read this, my blood started to boil. For anyone, no matter who or what or why, etc. not to wash completely and DAILY is to me simply disgusting. If one has a shower, it should be a shower so the water runs off and away. Many people have arthritis and joint problems and it is impossible to wash oneself thoroughly like in a shower. I will be 88 and no matter what is going on or how much pain I am in or sick, I am going to have a daily shower come hell or high water. I am physically unable to wash because I can't stand (disabled) and my joints don't move well. In a case like this, I don't care if she has dementia or is just stubborn, YOU TAKE CONTROL AND MAKE IT CLEARLY UNDERSTOOD SHE WILL BE WASHED DAILY, PREFERABLY IN A SHOWER WHERE SHE CAN SIT, ETC. You need to be in charge - just thinking of this makes me sick. Let her rant and rave - this is the law of the land and so you make it happen. This is one area of life where I have no pity.

When our mother developed dementia, unbeknownst to us, she had developed a fear of shower stalls. It took some time to figure this out but once we did, we knew how to proceed. Your mom may have a fear she hasn't expressed and is afraid to tell you. Gentle investigation may reveal what's really bothering her.

So many things that appear to be tasks our parents can do really aren't. Physically, yes, but mentally, they don't remember or get confused about when they did the task or don't want to admit they don't know how any more. Its easy to overestimate their abilities at this stage. Its probably time to help her, not only with a schedule but also to actually bath her or ask for help to bath her. She may wash but not rinse or fail to wash important body parts.

Using body lotion in between baths and showers helps.

There really is no way to get her to bathe without some type of unpleasant exchange. So be prepared for it. You say she doesn't smell so she's washing up somehow.
Many seniors get an aversion to bathing or showering. Taarna is right in the comments when she says to start a morning routine with her. If she says she'll bathe in the morning, then make the bath up then tell her it will go to waste if she refuses it. If she's water conservative this will probably work.
If she still refuses tell her plainly that she hasn't bathed in over a month and that she's going to have one. No asking. No pleading. Take charge and it's 'you're bathing right now'.

Since she says she'll do it in the morning, start a morning routine. Draw her a nice bath, add fragrance or bath salts if she likes them. Just tell her that her bath is ready for her. She may fuss for awhile until it is part of her routine. Do something similar about her hair. Consistent routines as the key with dementia.

Leave her alone.
If she doesn't smell, she must be cleaning herself.
You don't have to take a bath or shower to clean yourself.
Maybe mom is just doing what is called spit baths where you just clean yourself with a wash cloth like is done to bed ridden people.
Or, maybe mom is afraid she'll fall.
Just in case, put a shower chair/bench in the shower to be used.

Take it in mini steps and negotiate an acceptable routine. Each person is different, but if you focus on the basics first you can build a routine. With my mother I used the lure of an extra warm bathroom, dryer heated towels, bathrobe and Terry cloth turban as a reward for the flight of stairs we had to negotiate to the second floor. I would turn the heat up in the bathroom hours before and transport the towels, bathrobe and turban in a thermal bag. Our daily routine started with an offer of a warm, sudsy disposable washcloth and prompting to “wash your face, neck and ears”. With my MIL in SKN, it was a different routine. I would go daily with hot water in a thermos to boost the heat for the washbasin routine we would use. She would pull off her top and hold it against her chest and I would hand her the washcloth to quickly wash her face, neck and armpits. I would quickly offer her a fresh top to cover up. She would stand and after gave her a towel to hold in front of her, I would hand her the washcloth so she could wash her bottom. There was one aide that was able to shower her on a somewhat regular basis (lol) so my routine was just the basics.

bottom line is to have a quick alternative: “OK, you don’t want a shower, let’s just wash your face with this soft, sudsy cloth to freshen up”. “Here take this warm washcloth and get your armpits, bottom and feet while we are at it”. Reinforced with “Doesn’t that feel good?” As the routine is accepted add in the incidentals: eyelid cleanse, mouthwash, various protective skin creams and moisturizers.

Showering can take a lot of energy for someone who has less than they used to and while you are right it feels great to be clean and refreshed she may only be able to think about the “chore” of it all. Couple that with both her childhood training to limit bathing, her compromised memory/thought process and you are fighting a loosing battle when it becomes a fight. We have had a similar (though not nearly as long) issue with my mom. She has been having a problem with UTI’s and her doctor told her she needed to shower a minimum of 2x a week, she also wanted us to establish a schedule for the days she will shower to make sure it happens. Mom understands the UTI problem and she is typically compliant with doctors orders (with some reminders) so hasn’t fought this but she does tend to need a nap before getting dressed! It takes hours. Perhaps her doctor could be the one insisting on showers once or twice a week or that there be set days so there is no forgetting?

The other thing that occurs to me is the struggle for her between knowing she has always taken care of herself and her children, in the past and should still be able to and that little part of her that knows she needs help. It must be hard, harder for some that others but still hard, to have your child tell you when and how to shower, toilet, get dressed, any of those self care things. I absolutely know from the adult child’s perspective how simple it feels like it should be and frustrating it is when your aging parent won’t cooperate but when I try to put myself in their place and I will be there some day, I’m able to take it less personally. It’s a double edge sword though at least for me because feeling that compassion for her can be very sad for me, as I watch her loose that independence I feel the loss of my mother and I have to be careful not to deny or over impose her needs as a result.

Good Luck

The one thing I learned is not to ask her. If I ask she will fight me. I tell her it is time to shower. With Dimensia Mom has no concept of time, hours, days weeks. But for some reason when I say it is time she cooperates a bit more. If she still gives me a hard time I tell her if she doesn’t let me help her wash they will send in the big male aid, so let’s just get it done before that happens. There is no big male Aid, but saying that gives her a sense of urgency and makes her feel I am her helper rather than forcing her to shower. When she is finished I sit her on the toilet and hand her towels to help her dry herself. I hope this helps you.

Try and make the experience a positive one for her. I make shower time a concert and put on her favourite music. This way she associates her favourite music with shower time. I may also talk about it being a pamper session and do her hair after. The other thing is that I know you say it’s humid but when my mum is showering there’s a portable heater and heating lamps on despite that it might be 25 degrees warm that day. For me it’s suffocatingly hot but for her it’s ideal. I’ve figured the water temp and room temp can’t have much variation or she’ll Yelp that it’s icy or boiling! Last thing,.. compromise. If I know there’s no chance of Mum having full shower I convince her to rinse her bottom half with the hand held shower. I bring it up while she’s changing her pants so that she’s already undressed. Mum gets lots of UTI’s as her bladder doesn’t empty properly so I try reason how it’s doctors orders to rinse below and it’ll feel so fresh after!

Bribe her by offering ice cream or some treat if she bathes or showers.

lealonnie1 has said the exact same thing that I thought as I read your post.
Mom can no longer look after her own hygiene.
If she is not showering are you sure she is properly cleaning herself after toileting? Is she washing her hands?
She does not have to have a bath or shower daily, every other day would be fine.
You will have to start monitoring her in the bathroom.
No way around this and until she gets used to you helping her there will be an unpleasant exchange.
Depending on how cognizant she is you could take a white board and write down a schedule for the week. Mark down shower/bath days so she knows what day she will be getting a shower or bath. Let her help make the schedule so she feels somewhat in control if that will make her feel better.

If you are living with mom do not trust your nose that she does not smell dirty. you get used to odors and you may not realize that she does have a body odor.

Your mother no longer has the ability to look after her hygiene; dementia has robbed her of that ability, as it does all the rest of the poor souls who suffer from it. You'll have to bathe her yourself or hire an aide to come in to do it once a week b/c the elders often argue less with a stranger than they do with a daughter! Watch Teepa Snow videos on how best to bathe an elder with dementia:

https://www.google.com/search?q=teepa+snow+hand+over+hand+bathing&rlz=1C1CHBD_enUS896US896&oq=&sourceid=chrome&ie=UTF-8

Up above is a Google link to those videos along with other good articles on the subject. Teepa Snow has invented a 'hand over hand' bathing technique which soothes elders suffering with dementia & seems to help lots with the issue.

Tell mom she'll need to have a bath once a week *or twice a week which is plenty at this stage of life* and that you will help her with it. The X through the calendar is a good idea, but you can still expect push-back b/c elders with dementia don't like to bathe, period. If you can make the experience pleasant for her, that would be great. Figure out if she has fears and address them, first and foremost. My mother was afraid of falling, so water shoes eliminated that worry for her.

Good luck!

Isthisrealyreal gave good suggestions to you.

You stated,

"Although she has dementia, she still has the ability to look after her hygiene. I don't know if she doesn't realize how long it is since she last bathed but to actually get her to do it causes huge fights."

The new, realistic way to think about it is that she no longer has the ability to look after or care about her hygiene. Dementia is a progressive disease, so now she's permanently lost her ability to do this for herself (remember to bath). She may still have the ability to wash herself but now you may need to use "therapeutic fibs" to coax her into bathing, like "We're expecting visitors this afternoon, so we need to freshen up" or whatever you think would work. Appealing to fears about infections and such will probably not work since that's too complex a thought for her to process.

How many times a week bathing was normal for her? Whatever it was, it may need to be fewer now. Also consider giving her sponge baths in between times.

Is her shower senior safe? Is there a shower chair in it? Is it sufficiently lit? Does she remember how to adjust the water temp? These are all things you can no longer assume about her abilities. Sometimes elders develop a fear or dislike of having water pour over their heads or face. Sometimes having a different person to help bath her works better. We hired a neighbor who is a retired NH employee to give my elderly aunt a shower 2x per week. We started with 1x, then moved to 2x and I don't think it'll ever go to 3 because she doesn't need it. For whatever reason she doesn't put up a fight with Shirley.

I wish you success in solving this challenge du jour!

Perhaps a calendar with bath days on it, then put a green x through the day after the bath is finished.

Do a search on this forum for bath issues. It is a common problem with dementia and there are lots of good ideas about getting baths done.