How to address personal hygiene tactfully?

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.

We had similar issues with my mom. I did help to buy the moist cleaning wipes and to talk about why she was not cleaning. Part of the problem has also been lots of weight gain and difficulty doing the job well.

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!!

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.

Oh this resonates with me! Mom has just started to finally accept wearing depends. Unfortunately she wears the same on over and over. I have told her to just throw the damned thing in the trash, but she won't listen to me. Also I have questions about her personal hygiene. She won't let anyone in the bathroom with her, so really do not know just what she does. I do know she hasn't taken a shower in several years! She simply uses a washcloth in the sink to wash herself.

The comment about supplying wet wipes was a good one. I put out a box of these on the bathroom sink, and it appears she has been using them. Also I mentioned she wears depends, she also uses a bladder leakage pad with it.

Dont get me started! I dont understand why the bath or shower has become the enemy! Mom always has someone to help her so there is no falling risk but she acts like the water coming out of the shower is acid rain instead of water...she fights it. It is so bizarre. She thinks a sponge bath is enough but its not, as she still smells like pee and old sweat. Then she gets her feelings hurt or her back up if we broach the subject. An ongoing battle....

Hello TSM1013. You are not alone, this is a common behavior in dementia. Reasoning only goes so far. You may have to go with thorough sponge baths while she stands in the tub or sits in a shower seat. Imagine if you had dementia and someone tried to put you in a shower you thought was going to scorch you. It would be cruel. Maybe she will agree to put her feet under the shower and gradually more of her body. Or, maybe not.

Boy this subject is very very familiar to me!!! Every day, sometimes twice a day or more, I have to remind Momma to change her Depends diaper. I tried to explain to her that adult diapers aren't much different than babies diapers, outside of their size of course, they still aren't made to hold urine all day long into the next day, because they fall apart. Just like a babies diaper needing changed often during the day, so does adult diapers. Some days are better than most, while there is still days where she either refuses to change them because she too was a child of the Great Depression and didn't want to waste anything or she is stubborn or because she forgot. I often find a variety of pieces of her diaper soaking wet with urine and stuck to the kitchen floor or bathroom floor or on the carpet in her bedroom. I try my level best to ask her nicely if she changed her diaper that morning without sounding like I'm scolding her. Some days she will say "she thought she did" and will go check, other days she will put it off. It's mostly Momma and I here, but when we get company, I have to discreetly tell her to go change her diaper.

Some days it's a uphill battle, but it could be a lot worse. I just hope that as she gets older she doesn't become too upset with me to change her diaper......we'll see. Good luck cks1646.

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.

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....

My 2¢ worth.
On the wipes, be careful how many are used at one time. My understanding is that they can clog up a toilet system "real fast".
Regarding Depends or another other type of Incontinence product, can you set up a schedule for regular clothes changes? We change from pj's into day clothes then back to pj's at nite. At nite, we do a change of the incontinence product. And I do the change of clothes both times each day.
Leaving the patient to change his/own product is hard for them, because, as mentioned, many times they can't remember.
I know some of you don't live with the person or work; but like one of the first commenters, mark things in your own way to see if the patient is doing things correctly.
Done.

I had a VA subcontractor install a lift pole, and he told me about a toilet attachment that washes and dries the bottom. He said they work great. A physical therapist told me about them too. I can't imagine how that would work with someone with dementia learning something new, but I find my husband, with Lewy Body Dementia, does well with things he learns before he needs them. So probably too late for him now.

However, because his dementia also has Parkinson like symptoms, he is very stiff and had trouble with the toilet paper at his side. I bought a toilet paper holder that was free standing and put it in front of toilet. That helped for a while, but then he had trouble unrolling. So I tear, roll, and leave paper on the bathroom counter. When I know he is going in for a bowel movement, because I've told him to tell me, I also pull out a couple of the wet wipes and put on the counter.

As for smell, I use a baby diaper pail. They have removable plastic bags that insert and there is a mechanism that twists when you close. So when you open the smell is air tight. Things have changed sense I had babies, which reminds me that I also use a baby monitor. Keep it in the master bathroom, so I know when he is in there. Can move it, if he is napping and I want to work in the yard.

Oh yes--those wipes are NOT to be flushed, esp if you have a septic system!! That adds another whole level of "retraining". The idea of the diaper genie would work well...altho it would fill up very quickly with adult depends. Better that than wet depends being left out. Mother would just bag hers up and toss them in the hall for "whomever" to take out to the trash. I had a little chat with her about that being a little gross to walk in and see, first thing--so we got scented baby diaper bags which she now uses. They can sit in her trash for a day or so until someone takes out her trash. The toilet remediation to make it like a bidet might work--it also might be terrifying to someone who doesn't even want to shower--but it's worth a try!
Also--when hubby had his liver transplant--he could not bathe or shower for months..(drain tubes, post op infection...) the hospital sent us home with these huge cloth-like wash & toss things. They were already "wet", I'd throw some in the microwave and get them warm. Hubby cleaned his privates, I got the rest of him--he said it felt great---we did this daily until he could move on to a "bed bath" with a soap/lotion mixture which is made specially for removing dry fecal matter. Works amazingly well. Available at the hospital pharmacy and hospital supply stores. Again--someone with dementia--a whole new dynamic. Hubby was "stoned" as could be, so cooperative with being washed. Of course, in his case, any bacteria could have killed him, so we were super careful about the whole house.

When my husband, who has vascular dementia, "outgrew" Depends I found awesome products ar North Shore Supply. They have daytime and night time ones and nearly no overflow or odor. And they have large wipes and special bags that tie easily. I have to help him change as he can no longer figure it out.
With BMs I kind of watch and sometimes "help" him as he can't see what needs cleaning. Another one of the Not Fun tasks we have to do.

cks: OMG, I just went through this with my mother!! I had to leave my Maryland home and move into her home with her in Massachusetts. She wouldn't budge. Right away I noticed her odor and pulled her aside and said "mom you've got to wash better." But that didn't work b/c every morning for 6 months, I was wiping up the bathroom floor and toilet BEFORE I could even use it....not of urine, but poop!!! She had a shower seat that she used in her shower stall and one time she even used that as a toilet! Disgusting! So you should approach him with the truth.

I agree with all. My husband's stroke left him with no ability to smell. He didn't know that he was "offending"....mostly me. So I "approached him with the truth". Good idea. I found he was unable to wipe clean even with the wipes, so I insisted on bathing and I helped. Now he is bed bound and is in diapers. With hospice help and family, we keep him clean. My father was another story, he just didn't like to bathe, so again, I was truthful. He didn't live with us, but if we were going to go someplace, I just told him he needed to take a shower and put on clean clothes. He never seemed offended and enjoyed going out.

That's right, Nancy, he lost his olfactory sense. So DID MY MOM.

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.

unfortunately...these seniors don't even know that they have poop in their pants. my father tries to clean up...but it's difficult for them. I just tell him ... you have poop in your pajamas, I could see they are dirty and you smell! I care for them...nothing is embarrassing anymore.

Thats so true, lifeexperiences. Mom has huge accidents then cannot see well enough to clean it up so steps in it, tracks it all over the house and is completely unaware of the mess. When we gently call her attention to it, she blames the poor dog and either gets her feelings hurt or mad at us. She hates wearing Depends but it is to the point that she has no choice when she goes out of the house....vanity takes a back seat. Nowadays, we have to do what we have to in order to keep her safe, clean and healthy/hygienic and issues such as the shower scaring her are a secondary concern. We would never put her in danger or deliberately cause her distress but she no longer has the ability to reason so we have to take control. An unpleasant reality....

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.

I experienced the same situation with my Papa before, and now with my Mama. Your Dad is already showing signs that he could not take care of himself anymore. He needs a caregiver, who will assist him in this activity. Giving him all the tools that he needs, like wipes, soap, water, and his fresh undies may work if he still remembers how to use these. There'll come a time when he couldn't be independent anymore if his dementia is progressing. Therefore having a caregiver will solve this problem.

Dear TSM13...it's a process. At first it's uncomfortable for everyone...then slowly, you just take over and they will follow. These older seniors are very tired...but of course, no one wants to lose control of their life...later, they will be soooooo grateful that you are helping them. Just move in...and keep going...things will turn around for you...but you will be working more. take care...

lifeexperiences: You are right on point! I said to my mother "wouldn't you rather have me, your daughter, tell you that you smell instead of your friend? "

Children become Adults and Adults become Children. I took care of my Mother and Wife, I was very frank about what needed to be done and did it. Fortunately, they were mentally alert, but physically not able to do the toilet thing. I would supply a warm soapy cloth and rinsing towel. They were bed ridden and not able to visit the bathroom. You do what you do for people you love.

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.

I read somewhere that when water hits an older persons skin it is uncomfortable. remember as we age our skin gets thinner and more fragile, so it might actually sting when the water hits their skin. And I know that smell and taste also diminish as we age so if they don't smell anything bad they don't know they have an odor. hope things get better for you.

I have this problem with my husband...and I don't even think he has dementia!! Although he just had an MRI so maybe we will find out. But he is incontinent and still tries to use regular underwear..I bought depends and just put them in his bathroom...very subtle at first ..he has finally started wearing them but not all the time so he wets himself and just walks around like it's nothing!! I have to tell him that he needs to change his pants and he gets offended! What the heck is up with that!! So it's been a constant battle to keep after him....and he keeps getting upset everything I mention it...gee if he doesn't have dementia now..what will happen when he does! Lord help me!!

hi kashi60.... i buy really long pads on ebay...and have them in my dads drawer...he puts them in his underwear...and changes them when wet. then of course if he wets to much, clean underwear too. he does not have dementia. this might help? but yah...it's tough!