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We have a new problem, but it could have been going on for a while. Dad has his own bathroom so I am not sure when it started but he is not using toilet paper to wipe. How do I know? I finally caught on and marked the roll and left one spare roll. His undies are always bad both ways so that wasn't new. But how do you tactfully approach someone with dementia that they have to wipe their butt? I have a cleaning lady that comes in so I was not noticing the roll being the same until recently... He is also starting to (again) take a shower and put the same underwear back on which in itself is nasty but add in the incontinence issue and it's just bad.

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Since my parents [90's] still live under their own roof with no caregivers [Mom refused], and me under my own roof, I didn't really know what was going on until my Mom had to be hospitalized for some time. Then I was able to snoop around their house. That is when I noticed that both parents were reusing their Depends and Poise pads.... oops.

My parents are the children of the Great Depression thus they didn't want to spend the money on new personal care products. And they weren't going through the toilet paper very quickly as it would be months before Mom would place an order with me to buy some next grocery trip.

When I saw the above, I told Dad "don't reuse your Depends, otherwise you will get a bladder infection".... I don't know if that is true or not, but it did get Dad's attention. With Mom not in the house, I got the caregivers back and they are keeping a tighter rein on Dad.
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SouthPecan, we are not being "cruel" when we help her shower. We are right there with her, the water temp is perfect. We cannot reason with her any more but a sponge bath does NOT do the job after she has been out in the yard sweating and/or had a bowel/bladder accident(which she probably then stepped in) and/or sweated all night in bed because of her leukemia. We do sit her on the shower seat and fill the tub with enough water that she can reach and bathe herself with...she is always supervised so that she does not fall and when she is at my home and has an accident, the safest thing is to put her in my walk in shower (with my help) for a quick scrub down. Please watch your wording...I know you meant no offense but after several years, though we are sympathetic to our loved ones with dementia, it's exhausting to have to keep handling these issues every day. "Cruel" is an awfully strong word and no one is being "cruel" trying to keep her, or anyone else with dementia, clean and healthy in the safest way possible with the facilities at hand.
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As a professional caregiver my experience requires me to actually do the wiping with wet wipes and gloves.

I speak to my clients and tell them that it is very important to be clean. I then explain what I must do. I apologize evrytime because a person with dementia cannot remember from one moment to another what is going on. I am gentle but thorough.

If you have had children it is easier to accept this chore as you probably can remember doing this for your babies.

This is actually the only way to handle this problem. It is one of the biggest expenses; purchasing wet wipes and having gloves at all times.

It is also important to have the individual wash their hands just like a doctor or nurse would. I say this and also monitor the washing.

One of my clients is also blind and has severe Alzheimer's but she is at peace when I perform this task.

Unfortunately, we are so averse to such things as a society it really leaves elders with too many urinary tract infections which can cause more confusion and hospital stays.
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Since your dad lives with you would it be possible, when he gets in the shower, to put his soiled underwear in the hamper and put out a fresh pair for him?

As for his not wiping well enough, express to him that you're concerned about his cleaning himself properly after using the bathroom. Let him know that you're concerned about his health and that not wiping could cause skin problems in an area where he really doesn't want skin problems.

Since he has dementia what you talk to him about may not sink in but at least you will have tried.

When my dad moved in with me he didn't have dementia but we agreed that going forward we would have to be able to have conversations that were uncomfortable at times and we did have to have some uncomfortable discussions but they were all in the spirit of my taking good care of him. You're taking good care of your dad and this is just a discussion you have to have.
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Kashi60
My husband became angry when I noticed something he didn't. He was unaware of his errors, mistakes, challenges, whatever you want to call them. But he could not acknowledge that he had done anything incorrrectly. Consequently eveything wrong wih him had to be my fault. It was a most difficult early stage of Alzheimer's disease.It was a time when the balance in our relationship shifted. I finally became the nagging wife he was accusing me of being.
If I had it to do over, I would not argue with him or tell him to change, merely hold his hand, lead him to the bathroom, hand him clean clothing and help him remove the soiled. No words, done as if nothing had transpired.
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I know this problem and long explanations are for naught . simply say his physician wants to make sure he is keeping himself especially clean in this area simply for his health and the rest of the family. if things don't improve have a talk with his Dr, and ask he to speak firmly and directly to your dad about the importance of doing a good job maintaining cleanliness. we found dad paid more attention to his advice than ours. Also at shower time confiscate all dirty unders , wash or trash immediately, good luck!!
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CKS1646, it can be very challenging to convince someone with dementia to change a behavior. Your profile doesn't say that he has dementia, but that's what his behavior sounds like.

The other option would be if he has arm or hand restriction and he cannot clean himself due to that. If that is the case, then insist that he rinse somehow in the shower after BM. There are also hand held devices that help you reach. But, if it's not limited reach, but mental decline, then it may be that you have to start monitoring him more closely. Is there someone there to do that?

With dementia, you have to move past the point of being embarrassed, timid or reserved with your protection. Being subtle, making suggestions, etc. isn't likely to help. Even if you pointblank tell dad what needs to happen, it's not likely to help. The brain doesn't work right and he's not likely to remember your instruction. It's not likely a talk from his doctor will work either. And the logica; reasoning that his normal self would have after a BM, isn't occurring. So, he's not going to have a BM and then recall that his doctor and adult child told him to wipe well. The only other option that I am aware of is to supervise him after each BM. That means always accompanying him to the bathroom each time and insisting that he clean himself. You could stand near and see if he can do it. If not, do it for him. I know of adult daughters who have to change their father's Depends after they get dementia, but they get used to it. I'm not sure I could do it, but I regularly hear of about it. If it is dementia, he will progress and is likely to need depends at some point.
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One option we've had good success with is a toilet seat bidet. Although if someone is forgetting to wipe, they could/would just as easily forget to push the wash button too. But, in cases of decreased mobility, wiping can be difficult or painful so the bidet seat is super helpful. And for caregivers, having the remote function allows you to "do the washing" for them by just pressing the buttons and reminding them to wiggle around a little on the seat while washing.
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My Elder Care client became incontinent towards the end of my "stay" with her. She had Parkinson's and was developing dementia the last 6 months I was with her. She withheld fluids from her diet on purpose and also took a drug that helped with bladder control. Consequently, she was always dehydrated and constipated. I pushed fluids as much as possible--but she fought everyone on that. Going to the bathroom was a huge challenge and at least a 20 minute operation. But when she had to go, she had to go NOW. After many, many days spent cleaning her pure white bedroom carpet from "accidents' her family stepped in and she began to wear pads. But she held it in so long that the pads were useless and we'd be out somewhere and she's urinate all over everywhere. Even with the dementia, she knew she's just made a huge mess....and she was mortified. I'd come in on Mondays and smell her laundry from the back door. So she moved to full depends. Things were better, but she hated the way she looked in Depends--felt like they "showed"...which they didn't. She also had to be forceably told to change those. It was hard. I never had to "watch" over her bathroom habits, b/c even tho I worked and 8 hr shift, she rarely used the bathroom in that time. (I'd say to her--"hey, before we both go the store, let's take a potty break" and she always said "No, I don't need to go". This is a huge reason she ended up in a NH. She lived with her daughter and the house ALWAYS smelled of old urine. I know her daughters and granddaughters took turns literally getting in the shower with her and washing her about 3 times a week. I'm very grateful my mother is fastidious about showering.....for now. I agree with above posters---a person with dementia--you have no idea how their brain is wired now and how terrifying something as simple and daily as a shower or bath can be. Daddy got bed baths the last 6 months of his life. A sweet caregiver came in just to do that. He never smelled bad at all. You can accomplish good hygiene w/o showering, it just takes a lot more creativity and work. I don't know if "tactfully" is even an option at some point....
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I agree with Sunnygirl. This is an all day every day behavioral challenge which will need supervision in the bathroom. Some parents are very private about personal toileting issues. You may need to pretend you are washing out something in the sink or tub and excuse yourself for being there, but you both will eventually get used to it and he will comply. If this is the only behavioral challenge you have, it is usually not the reason for seeking outside care. But when others threaten safety, it may become necessary to have an aide with him.
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