My mother has dementia, she is in memory care facility. However, she refuses showers and won’t change clothes. Facility can’t make her?

My mom took a bath every single day of her life. Even when it was so cold the bathroom pipes were frozen, she'd heat water on the stove to fill the tub. She switched to showering a year or two ago because she couldn't get up and down easily. Now she only showers every 2-3 days. Which is totally fine as that is all she needs. The change is because she is afraid of falling, but won't consider taking out her tub and installing a walk-in shower. There is no other way to do it, the tub would have to go. There is only one bathroom and there isn't room for both. Well there would be with some renovations, but she isn't willing to pay for any of it. She can afford it. Total cost is less than one month in a nursing home, which is where she will end up if she doesn't make some changes.

My pet peeve with Moms AL and NH was the asked not told.

Ex: Mrs E do you want to go to therapy? Mrs E "no". I told the therapist don't ask tell. Mrs E time for therapy. Mrs E "ok".

I found the aide at AL saying, Do you want to go to the bathroom. Mom of course said no. I told the aide just say "bathroom time" Aide told me they are suppose to ask as a question. I said, then u are going to get a lot of Nos. They finally found that saying "your daughter wants you to..." worked.

My daughter says you have to make them feel they made the decision. Like "Mrs E wouldn't you feel so much better after a nice shower and clean clothes". Then they may say "yes".

Here's my perspective, whether someone is in a facility or at home: If you force them and it cause agitation and upset, to what end is this a good thing? Is it worth it? Sort of a risk vs. benefit. If the person has an odor that is progressively worse, if skin issues are present, then you've got a reason to pursue it. I was appalled originally at my mother who took regular baths and then changed to showers...and then just stopped. I let it go on for a month or so and then decided we had to take action and get help. Called a respected, hospital affiliated home care service. Nurse comes out and observes mom in action, walking, doing steps, dusting and concludes she would not do anything. As shocked as I was, I heard it from other professionals. This first person informed me that the way most older people die is fall related. Sort of a live and let live until they fall and hurt themselves bad enough to die, or wind up ultimately coming home with home care who can then assist them and they are more willing.
This was 3 unbelievable years ago. There have been zero falls. She ambulates well. She's alive. There is no distinct odor. I can't believe it either and am grateful. She shows signs of sporadic minimal incontinence. I have had several aides out before COVID who lacked the right talent to convince her. I have taken all the suggestions. She and I have an antagonistic relationship that has not improved with the dementia. Sometimes she talks under her breath and my appearance will sometimes result in the often laughable, barely audible "Get Lost. That would be good." comment. She is also the same with my father.
I intend to try again with a different agency when things get better, but I am fearful of bringing the COVID into the house where we all live.
All you can do is try, and if it doesn't happen, remember it's not the end of the world. It creates a stressor for us as caregivers, using energy we're short of. Once I got over the shock of what that first nurse told me, it relieved my guilt and I didn't fret as much. I go back and forth and think it's horrible, I should try again/try harder...it just will take the right person...but my mother is difficult and I realize there may not be a right person ever. She may be a match even for Teepa Snow! In the meantime we carry on one day at a time adjusting for her safety and our sanity...

My husband was in a nursing home for 30+ days for rehab, and I insisted on daily showers (most places only do every other day). He was 90 at the time and incontinent, so showering daily was a must to keep him healthy. When I would arrive and he wasn’t showered I was told on several occasions that he didn’t want to and they couldn’t make him. I would the tell Bill, “ it’s time for a shower, and then we will have a snack, come on.” He would get up and walk with me to the nurses station and I would tell them I was happy to shower him myself if no one was available. A CNA would come and say, “Mr. Appleton, are you ready for a shower now? “ He would reply no, not really. The CNA would then look at me and say we are not aloud to make him. I would then repeat what I said to him and he would start walking toward the shower room. This is what worked for him and a year later that is how I trained his morning aide to address the situation. He is showered daily. Hope you can find a method that works for your mom. I wish there was training that explained the difference between “making” someone do something and “getting” someone to do something. Best wishes!

Unfortunately no, they cannot force hygiene. With staff being trained it can still be very difficult to get the resident to be cooperative with this. Ask if they are trying even when it’s not “her shower day”. This should be something they are attempting daily if not a couple times a day. Maybe a change in medication would help. There are mood stabilizing medications that may help her to be more cooperative without causing her to be drowsy. All in all though, care cannot be forced on anyone.

No, the facility can't make her. Was that the question?

What the facility (or more accurately, individual members of staff under pressure, overworked and probably undertrained and underpaid too) mustn't do is use your mother's refusals as an excuse for not keeping up attempts to encourage, motivate and support her (I haven't yet descended to naked bribery unless "- and then I'll get you a lovely cup of tea and your sandwich" counts!).

There could be a couple of dozen different reason for your mother's refusals, from not recognising the clothes she is offered to not feeling confident with individual aides to being too tired to its being the wrong time of day to there being some physical problem she doesn't want anyone to see. Any idea why she might be reluctant?

You can't make someone with dementia do anything. Forcing them to change or shower will cause confrontation. Refusing to bathe or shower is very common and the MC staff should be trained in dealing with such hygiene situations. Have they tried sponge bathing? With the proper techniques you can get a patient to agree to bathe.

They can’t make her, but most facilities have staff that are well experienced in care for patients with dementia and know how to talk them into doing tasks like you name. I’d be asking why they aren’t working with her instead of asking her and then giving up.