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But the bottom line is that he is unable to toilet himself independently and take care of his personal hygiene. In the past two days he has soiled himself and the floor around him despite wearing a brief. We have a bath aide who can assist but it not always immediately available. He does not seem to understand that an ability to toilet himself independently is required for him to be able to live home alone. When discussing this with him he said "I'm not leaving my home and I don't care if there is sh*t on the ceiling." Very unreasonable and he refuses to acknowledge his self care deficits.

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There comes a time when his opinion does not count so much anymore. Just like you can ask a child what he would like, but you are not bound to that because the child cannot make good decisions, you will have to make good decisions for him now. He may not like it, but just like with a child, you must be firm and do what is best for him, not what is most comfortable for either of you. I know it's hard, and you will have to be strong and use good boundaries. It's time to take action.
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Once somebody looses the ability to toilet they need 24 hour care whether at home or In a facility. All other daily living activities can be scheduled for drop by help: bathe, meal prep, house cleaning, groceries. But, when you gotta go you gotta go.
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I feel your frustration, Challenged1. My mother is in a similar situation - she refuses to believe/admit she pees and poops herself daily, and fights (screams at) anyone who tries to get her to change her depends, sleep on a waterproof pad, take off her jeans before bed (she's been sleeping in her full clothes for 2 years, but the incontinence is new in the last 6-8 months), etc.... My friends are telling me to put her in a nursing home, but I feel guilty. It's true, though - when they're not able to handle this basic activity unassisted, it must mean they're rather far "gone" and as Surprise said, at some point it's not up to them. It's hard to make that decision, though.
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