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My father is 86 years old and vital in many ways; his primary problem is some urinary incontinence, wearing the same clothes over and over and not showering. He was here recently for 2 weeks and so faras I know, he took one shower, although he said several times that he was going to. He leaks urine pretty bad and does wear a pad, the question is, how often does he change it. I know that he does not not wear it at night when sleeping, nor does he wear underwear (he comes out in the a.m. 1/2 naked to go to the bathroom, He urinate on the bed, in the floor in the bathroom, on the furniture and on himself. He can't smell, so he is not aware that he smells unless someone (me) tells him. It is VERY difficult to talk with my dad about this over and over and over. He knows he has a problem. Just recently he emptied a pee bucket that he keeps in his room and he not only missed the toilet, it felt as though he dumped the whole thing on the floor.This could have been a mistake, but he doesn't clean it up and he does not tell us. He has had fecal problems too, where feces was all over the toilet seat (on the top), which he had to see, but did not clean up, nor did he tell us about it. I love my dad dearly and I know this has to be so hard on him; I am tryinig to be sympathetic, but something has to change.He has been told numerous times to change his clothes, to change his bedding (for when he is at his house, I change it when he is here), and to shower. I say these things as gently as possible to him.. he will do it one time, but then goes back to his old ways. I have read that this type of conversation comes better from an old friend, or from a Dr. than it does from children. I am considering calling his Dr. to see if he will talk with dad. Does anyone have an suggestions on what to do, or how to better handle this? Any suggestions would be appreciated., Thanks so much.

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If he has dementia, which it sounds like he does, he would not be able to do the things you are asking him to do - or do the things he thinks he can do. My husband has stage 6 dementia and I have to follow him into the bathroom when he has a bowel movement because he forgets to wipe most of the time so I help him. Getting him to wear depends all of the time (he is urine incontinent) was a struggle, but he is used to it now and doesn't resist any more. He doesn't know when his depends are full and will go to the bathroom thinking he has to go even when he's already gone. I usually follow him into the bathroom so I can check his depends, which needs to be changed regularly. I learned that I couldn't 'have these conversations' with my husband because dementia precludes him from being able to respond appropriately, so I just did what I knew had to be done regardless. In my opinion, cleanliness is not an area that can be compromised. Believe me, I know its hard, but it's worth it.
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I have to agree with NotHisFault, it definitely sounds as if your father suffers from dementia. My mom suffers as well and has the incontinence/personal hygiene issues you describe. Talking to him will not solve the problem, I talked to mom until I was blue in the face....then I began learning about dementia. It's not that they don't want to be able to take care of themselves, they can't remember how. Too many little steps required to do each task and they can't keep it straight in their head...that's why mom wouldn't take showers unless I got everything prepared and then gave her a shower. She would always complain, but afterwards would admit to feeling so much better. I too, would have to follow her to the bathroom each time and clean her up, check her depends, and clean up after any accidents. I don't believe that your father is leaving messes purposely, he probably just forgets by the time he has readied himself to leave the bathroom. I know this sounds crazy, but I suggest you read all you can on dementia. A friend of mine gave me a book called the 36 Hour Day, its older, but was very helpful in putting me in the proper frame of mind to care for mom. I'll be praying for you and your family.
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My dad did not have dementia when we went through this. He was living with me with his own bathroom. I would see him get the Comet and the papertowels and assume that he was cleaning his bathroom. I would smell the cleaning products. I never thought to check after him. Once I did I needed a Hazmat suit for there was blood, feces, and urine everywhere and it took me hours and hours to clean that up. Also, my dad would be in his bathroom in the mornings for over an hour. I'd hear the water running and I assumed he was taking a shower. It turns out he was rinsing out his soiled clothes in the shower. He wasn't trying to be sneaky, I just misinterpreted what was going on. How the smell never drifted into the hallway is beyond me but my dad WAS cleaning out the sink on a regular basis and I think this masked the smell of the bathroom.

I had to have the shower talk with my dad. It was uncomfortable and embarrassing. The fact that he did not have dementia made it worse. I approached him as gently as I could and instead of asking him what his hygiene habits were (I didn't want to quiz him and make him feel bad) I suggested some hygiene habits. I figured that whatever I suggested he'd do less so I suggested he shower 4 times a week hoping that he'd shower at least 3 times a week. After time went by and this approach proved to be ineffective I hired a bath aide 3 times a week. My dad REALLY didn't like this but he put up with it but then soon decided that he'd rather shower himself than have someone else come to the house to do it. So he got himself into the shower 3 times a week.

I think the older my dad got the harder it became to keep up with hygiene. He was embarrassed about it and didn't want to discuss it with me and I understand that. But we needed to discuss it. Like someone before me posted, skin care, peri care, and overall hygiene habits are vital to someone's health plus I think it makes our parents feel better after having gotten it done. It's an accomplishment.

I would compromise when it came to many areas but I would not compromise when it came to hygiene and basic self-care. I think it made my dad uncomfortable as well, especially when he began needing Depends, but I approached it very matter-of-factly and as kindly as possible. I admitted I was embarrassed at having to have these conversations but we were both adults, we shared the same house, and some things needed discussing. Once I put it out there that way it cleared the air somewhat and allowed us to discuss the issues.

You'll find what works for you. It's an uncomfortable situation for everyone but once you take the bull by the horns and begin to tackle it it will get easier. Good luck!
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My 92-year-old father sounds identical, and I try so hard not to hurt his dignity. Lucky for me and our hired caretakers, he is usually compliant. I see my Dad regressing, and know I must accept this mental degradation road which does not include self-awareness nor sensitivity toward me. He is increasingly somewhere else and I can see how he will probably eventually get meaner to caretakers. I can still invoke the Story of my Mom, and he seems to respond to that quickly and shower.
My 89-year-old mother died quickly from UTI complications. During a visit, I had tried talking with her about her "odor" and she was so overly-proud she glared hatefully at me and told me to mind my own business. She appeared very much in command of herself and ADLs. Assuming she was rational, I did nothing but left. The result? Three days later she was rushed to emergency after spending two days in vomit and green fecal matter on the floor after falling, delirious. My sister and I (who live hundreds of miles away) rushed to the hospital to learn her UTI turned into a blood infection, and the "Failure To Thrive" syndrome set in and killed her. Adult Protective Services and local detectives investigated my Dad for abuse. The entire family was interviewed. They saw that there was no abuse, and Mom in a lucid moment concurred "My family is wonderful and leave us alone." We brought her home with Hospice oversight, and she died a week later. Dad was nearly oblivious. We knew if Dad couldn't call an ambulance for Mom (Mom had to tell him to after a lucid moment throwing up) -- that Dad needed firm care. My sister and I do prompt Dad to shower and change when we visit, and he does. But we could not wipe our father after bowel movements. Some kind of taboo for us there. Watching someone die from a UTI is horrible. Which leads me to say this. The person you are afraid of confronting is not the same person for whom you used to have immense respect and sensitivity toward. They are the same body, but they have gone to another place to live, not consciously. So it seems to protect the vestige of that person you honor, you have to watch out for them like a parent. But a parent who has a very different child that cannot learn nor mirror nor thrive. Letting go of a beloved parent-of-yore does not come easy. All we can do is try to let go with love. Our parents decline and fade, if we want to do best for them, we have to wrestle with our own limits. I have found docs don't deal with this issue beyond "Do you bathe?" Elder's answers in my experience: "Yes." Doc to me privately afterward: "You'll have to deal with it." It is up to you to set your limits, and hopefully reach out to any and all objective help you can find, like Area Agency on Aging, enlisting caregiver help, etc. I feel for you and cry for you, but you are not alone.
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Whether or not your father has dementia, he needs assistance and probably will not ask for it. My father used to tell us that he already showered and that his clothes were clean. His mental capacity was much greater then than now (4 & 5 years ago). Truth was, we knew he might wear the same clothes, morning and night for a week. It was awkward and embarrassing for my brothers and I and often Dad got very irritated. Tough for these self-made men.

Approaches that help him keep his dignity and allow him to believe it's his idea can go a long way in assisting him in getting the self-care happening: May I help you get in the shower? It's laundry day, so let's get your clothes cleaned. Dad, I noticed a stain (or mess), let's get this cleaned up together . . .

You probably can expect much resistance at first because he will probably be embarrassed and not want help. I often took a hard-line approach and insisted. It wasn't pleasant much of the time but sometimes I could turn it into something funny.

Five years later, I'm still learning various ways to approach my dad about things. Plus we get tired of saying what seems obvious to us, so it's easy to weary of finding approaches that work! Just recently I consulted with a nurse practitioner who has expertise in elderly care and she stressed the importance of open communication; that we must address the situation. That means talking with Dad about what is happening and why he needs assistance with toiletry and why he needs to get up from the chair and that no, he is not dressed--one must wear pants around the house, etc.

As for seeking someone else to get the ball rolling, I absolutely agree. Dad can blow me off to some degree because I'm his daughter and he still "knows best" (and maybe he doesn't respect a woman as much as a man). I have found that a doctor's words give authority. Perhaps your husband, a brother, or other relative or friend might mention to your dad that he is fortunate to have you to help him as things get harder for him to do (or something like that).

And remember, you probably will have to keep working at setting the pattern of getting assistance; a few times of talking with and helping him will not have him clean up himself or seek your help. You may find that sometimes he takes care of himself okay and the next time is a disaster. Nevertheless, gentle direction on what to do next and offering assistance in a proactive way help. (And believe me, I am still learning! Being patient is not my best characteristic!)

Hope this helps.
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Thank you all for your insightful answers. Dementia had not occurred to me, as dad seems so alert in other areas. For example, we can play rummy and he can easily keep track of cards and scores. After reading everyone's posts, I believe you are all right, he may very well have dementia.The problems listed in my previous post definitely exist and have to be reckoned with. I will be attempting to talk with his Dr. Does anyone know if the Dr. can legally talk with me if I have full power of attorney, which I do? I would just go with dad to his appointments if he lived locally, but he is 5 hours from here. We do have people who look in on him all of the time, so we have a network of help up there, which is awesome. Since my last posting, my brother and I have set up a meeting to discuss these issues. We have to decide about dad coming to live here so we can take care of him. He will resist this completely, that is for sure, but we have to do what is best for him. Again, thanks for the responses and for sharing your stories with me. It is good to have folks who have same or similar situations to share with. ~ Jo
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In addition to what NotHisFault just suggested about emailing or faxing a copy of your dad's HPOA to the doctor, I would at the same time, as briefly and succinctly as possible, write out your dads signs and symptoms and the reason why you will be coming in with your dad to the next appointment. Since you are so far away, you want to organize this ahead of time so it goes off without a hitch. The Dr will most likely not see you alone without your dad. Generally because your dad is his patient and he only gets paid for seeing your dad, not for seeing you in a separate appointment. After you have put your concerns in writing and either emailed or faxed them, you should follow up by speaking with either the doctors nurse or the office manager, depending on the the structure of his practice.

Make sure the doctor will get your letter on his desk before the appointment. That way, the doctor can examine your dad straight away and you and the doctor won't have to have as much of a difficult conversation in front of your father. Sometimes a doctor familiar with a patient can pretty easily diagnose memory loss or dementia, but not the type. If there is a question about whether or not there is memory loss or dementia, you should ask to see a neuro-psychologist, whereas a neurologist would order and study scans and determine the type of dementia. Depending on the size of the community where your dad lives, you may be able to locate a board certified neuro-psychiatrist who could accomplish both tasks.

My aunt was evaluated and diagnosed at a large neuro-psychiatric center at a hospital in Castro Valley CA, part of the San Francisco Bay Area. She & l we're fortunate to have gone there as it saves a lot of time. By contrast, my dad was diagnosed by his cardiologist, confirmed with a brain scan by a non board certified "neurologist" (and I use the term reluctantly in her case), followed by his psychoactive medications being prescribed by a board-certified psychiatrist. We live in a hi desert community with fewer doctors and services of a good hospital are over an hour away. So it was a matter of driving my dad a very long distance 2 or 3 times (which he really couldn't handle) versus having to go in 7 or 8 times for him to get assistance. All doctors appointments confused and upset him, so it was a constant struggle to keep him calm.

BTW, my mom put him in diapers. This was BEFORE pull ups although I'm not sure it would have made a difference. Before his loss, he wore jockey shorts. After, the bathroom toilet scared him, so he used to go into his bedroom to a certain corner, pull away his diaper as if he had opened the pouch of his jockey shorts, and pee on the carpet. When my mother discovered he was doing this, she started following him to the bathroom, kept the lid of the toilet closed, and let him pee into the shower which she then rinsed out each time. No matter how it works out for each individual, the caretaking is usually going to be a lot of work.
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Since when is smelling like urine and feces preserving his dignity? Telling him kindly but firmly what he needs to do does not rob him of his dignity. Dementia and old age rob him of his dignity. Insisting does not rob him of his dignity. But letting the filth continue robs everyone of their right to be in a safe clean enviroment. You may have to be diligent with oversight and clean up, but it will be worth it.
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Hi this is tough but 2 years ago my mums hygiene got so bad I told the nurse and this is the help i got "well its her house and she can do what she wants,if it was your house then you would have something to say"??? Now after googling joining forums etc.. i find that this is a very clear sign of dementia I cant believe the nurse didnt investigate sooner? My mum has a colostomy and throws them out the window into the back garden? realised after several rows about this that now she dosnt know what shes doing so I say nothing have since told a nurse and says this sounds like dementia.
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You're so welcome Jo. We are in the same boat with you, so we understand a lot of what you are going through. If you have medical POA, the doctor can speak with you freely about your Dad's condition - but you should eMail or fax a copy to the doctor's office so there is no confusion going forward. From your post above, it sounds like you are doing all the right things - so hang in there and reach out if you need to vent, ask questions or anything at all. Take care.
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