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My home-bound 95 year old mother with dementia has caregivers come in daily however, they are only allowed to manage meals, housekeeping, etc. I have tried the CNA route to manage personal care and have the appropriate equipment available for showering, etc., however, she refuses a shower or help with cleaning herself and I was paying for an over-priced babysitter!


My biggest issues with her personal care are her hair and her feet. I am looking into bringing a CNA into the mix again to manage this care but the process to set this up with the current agency will be intrusive and not what my mother will put up with. I do not want to change agencies because she has several really good caregivers that I do not want to lose. I thought about having a hairdresser that does home visits come in to wash and set her hair once a week. Also, have worked with a podiatrist in past for foot care. The financial end of this issue is not the big problem, my stubborn, non-complaint mother is the issue. I am trying to uphold her wishes to be at home, not in a NH but feel like this whole process has become a big complicated headache to manage - any suggestions would be greatly appreciated.

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It is frustrating to try to manage care, when the person is resistant to care. So, the only thing that is preventing the care is your mother. I'd consider that those who she is refusing may not have much experience with someone with dementia. If not, I'd try to find someone who is. And, the providers can't force he to allow assistance with her baths. So, if she persists, I'd explore other options. She can't go on indefinitely without baths, hair washing, or personal hygiene after toileting. That would concern me the most. It's not healthy for her to just not be cleaned after bowel movements.

While my LO was rather resistant to care before she arrived in Memory Care, once there, she was fine. I think their staff was especially trained to work with dementia patients and she never had a problem with them.

I wouldn't be too focused on promises that she stay in the home, if you are not able to get her the care she needs there. Her reasoning doesn't seem intact. If it were, she'd realize the need for having her needs met.

Since, funds are available, have you considered hiring a Case care coordinator, who would assess the needs and bring in the help that is needed?
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EM0914 Sep 21, 2018
Thanks for your thoughts. My mother refuses to shower, with or without assistance. All kinds of excuses, too cold, afraid of falling, privacy issues. The problem with showering is more the fact that she is being told to shower, loss of control as well as the big fear of falling. She does “wash” her face, neck, chest but the nether regionsdo not see soap and water. The complaint is she smells sweaty. I have not heard about a case care coordinator but will check into it.
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I also have a stubborn and non-compliant person for who we are giving care. I work with a nurse who goes into retirement homes and does toenail care. You may be able to find someone like that in your area.

With my MIL, we have had to get very frank with her regarding her "behavior," assuming she does have control over it. She recently had brain surgery and was biting nurses and so forth. Therefore, no rehab facility would take her. Now that she is home, she is basically acting right. I had a frank conversation with her letting her know that if she wants to continue living with us, it would require her to be compliant with the caregivers that are coming into our home, including showering and going to all appointments INCLUDING but not limited to a psychiatrist. My husband and I are making back up plans if she refuses to participate in her care which might involve guardianship and/or nursing home. We hope it doesn't come down to that.
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When we went through this problem, the PT and OT stated that elderly people lose depth perception. So even if they have equipment, they still cant gauge where the bottom of the tub is and fear falling. It was suggested to get a bright colored mat for inside the tub or decorate it with those bath decals to help with the depth perception. A CNA cannot do foot care, a podiatrist is your best option.
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EMO914,

This whole process IS a big complicated headache to manage.

Caregivers can help with bathing. You don't need a CNA for that. However, CNAs or caregivers are not allowed to work on feet. That has to be done by a podiatrist. Don't allow anyone to care for your mom's feet except a doctor.

And I think you'd be able to find a hairdresser to come to your house. Many of them will and do make home visits.

Typically a good suggestion would be for you to tell your mother that if you are going to be in charge of her care and deal with all of the headaches then she needs to get her fanny in that shower and quit giving you, the one who is caring for her, such a difficult time. And if she didn't like that, maybe she'd be more comfortable in skilled care. But with her dementia, you can't use this logic with your mom as she doesn't possess those reasoning skills anymore.

Will your mom take a shower for the caregiver? Some elderly folks do better with strangers because they don't want to seem impolite. But I'm thinking if the caregiver was bathing your mom you wouldn't have mentioned your mom's lack of bathing in your post.

What about a bed bath? A caregiver knows how to give a bed bath. And despite what many people think it is not a messy process. There are tips and techniques to it so that your mom will get clean with minimal clean-up time.

As for cleaning herself, I'm assuming you're talking about after using the toilet? Most elderly people with dementia get to that point where they can't clean themselves. Put a box of gloves in the bathroom and resign yourself to doing it for her. Some people use flushable wipes, some people are leery of flushable wipes and throw the wipes in the trash. Wipes are a little more gentle then just toilet tissue especially if you'll be cleaning her and have no sense of how much pressure you're using. The wipes are good for that.
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MargaretMcKen Sep 21, 2018
Where I live, there has been a big ‘thing’ that most so called flushables will flush away but don’t dissolve like toilet paper does. They then form enormous blockages in the sewerage system (eg big as a bus!), with equally enormous infrastructure maintenance costs. Perhaps they should be treated like disposable nappies, in the garbage not the toilet.
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It sounds as though the hairdresser and podiatrist would be a good idea, and wouldn't involve the care agency. If hair and feet are the worst problems, solving them will give you a bit more lee-way with the other issues.
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Regarding the issue with showering, we are also experiencing the same thing. We are working on this and she finally showered this morning with the OT. But mainly, it's been suggested that we make some modifications to help her to feel more safe while showering to avoid falls. Definitely some grab bars in the bathroom and potentially a shower chair. Today she complained of being cold and we talked about how much a nice hot shower would warm her up. :)
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About personal care in the bathroom: after my mother is finished cleaning with regular toilet paper, I do the final step using the larger, nonflushable wipes for cleanup using a generous amount of perineal liquid like Prevon. I keep the Prevon in a giant pump bottle near the sink. I add it to the cloth and rub it together to create a slight foam and I hand it to my mother for .her to get as much as she can manage. I wait and dispose of it, then prepare and use more to get what she could not reach. We finish with a sitz bath.
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Have the caregiver give your mother a sponge bath in the bed...they are used to doing that...in the shower patient more likely to fall.
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