My mother in-law was diagnosed with MCI. She had been stable for about 5 years, then some changes were noted. She is now diagnosed with mild dementia. She developed a severe fungal infection under bilateral breasts, inner butocks, buttocks, bilateral groin and abdominal folds. She insist sponge baths are adequate, and it is apparent that it is no longer adequate personal hygiene. The condition was noted by one of her MD's in September 2016. She was ordered an antifungal cream. She also had an outbreak of psoriasis which a steroidal cream was ordered. My sister-in-law is the primary caretaker and my mother-in-law resents her hovering and will not allow her to apply the ointments or check her skin. She went to her Geriatric MD on 12/1/16. The fungal excoriation was severe as well as the psoriasis. Once again the discovery was made by the MD and not the caretaker. I have been a geriatric nurse for 24 years and in this capacity I have been the Wound and Skin Care Nurse for entire facility, ADON, Unit Supervisor and I also was a Charge Med/Tx nurse and often would help the CNA's with showering. After seeing the severity of the rash, the Geriatric MD ordered Shower or Bath with Hair Wash 2x a week by family or outside Home Care Agency. My sister- in -law told MD family would do the bathing, no outside help. She also had a dermatology consult which I attended. Nana's sons have been concerned about her personal hygiene for a while,but she is at that stage of dementia where she still wants control but obviously poor decisions are being made. Family members have approached her about assisting with bathing and shower but she refused. There is alot of family dysfunction between my sister-in-law and her brothers. They want an outside Nursing Agency to come in to take the burden of bathing off their sister. I assisted and gave her a shower with her daughter who is the caretaker and my sister-in-law was very negative, had none of the supplies necessary, made inappropriate comments about the shower etc. I knew it would not be easy and I knew it might take 2-3 weeks to get her acclamated, maybe even a couple months. It was a struggle at first. She didnt believe skin was that bad and forgot the MD ordered showers. Finally we got her to take the shower and it really didn't go that bad at all. in my experience I know this can be difficult. I wanted to sit down with my sister-in-law and Care Plan the process, evaluating what was positive and what was negative so that with second shower it could go smoother by adhering to the postive approaches. I asked my sister-in-law what time I should come to assist with second shower. She said 1p.m. When I got to Nana's house I had a basket of supplies and did I said Hi and went to put the basket down. My sister-in-law said to me while I was taking my coat off, that Nana was refusing to take shower. I said okay, let's talk about it, and see what we could negotiate. Nana was aggitated, angry, mean and I have never seen her that way, and had allowed me to do an initial complete bath with hair washing prior to first shower attempt. That was the first time I saw her skin, and I was very concerned as I was not informed by the famiily of severity. I let Nana vent and express her anger, and told her we would take a shower holiday and reattempt it later.I went into the kitchen and my sister-in-law followed me in, and I said to her, that I didn't realize that she was so aggitated prior to even discussing the shower. AfterI had been there an hour, my sister-in-law said to me that she had arrived at the house an hour before me. She had gotten Nana aggitated but never said a word before Nana had the upsetting episode. I could tell she was very annoyed at her daughter, so I told her to go to the store and I would stay and talk to Nana. By the time Ieft, Nana was okay so I went home. I then got a text from my sister-in-law that said Nana was going to dismiss the services of her Geriatric MD if she made her shower and bath.I have been gently trying to explain to my sister-in-law the regulations because I worked in this field and had similar experiences. I told her that according to Office of Aging and Federal/State regulations that inadequate bathing by an elderly person whether in the Home or Long Term Care setting is not acceptable as it is considered self-inflicted abuse and is a reportable incident by her MD, if the problem can't be dealt with, especially since it is the cause of her skin problems which can lead to serious health concerns. She insist it is not a hygiene issue. The dermatologist verbally ordered to continue shower and bathing. My sister-in-law told me she will not allow Nana to be bathed by outsiders and as long as she can apply the creams to her skin, it will be whatever it will be. I know caretaking is a difficult job,but she is also a nurse. Is the information regarding self-inflicted abuse correct. Due to family dysfunction, I went to see the Social Worker to explain the situation.