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Issue: Hygiene for a 70 yr old woman with two strokes and probable undiagnosed Autism or Schizophrenia.

My mother's hygiene is very poor -- if left alone, she will not wipe herself after peeing or pooping. I have recently taken her out of assisted living due to high cost, and plan on returning her back to her house with aides coming to visit twice a day for a couple hours each time.

My biggest concern with placing her back in her own home was her safety, but since she primarily watches TV and naps, I feel confident that she will be safe.

This cleanliness issue is my newest concern placing her back in her home, so my question is, what is acceptable regarding her hygiene? Since she does not wipe herself, and sometime uses her Depend as the toilet (at least with pee, sometimes poop), should I be concerned with this to the point that someone should be with her all the time to make sure she uses the bathroom correctly (so that is is always spotlessly clean)? She does not care at all if she has pee/poop on her as she will sit for hours and hours in this condition. I know this is not ideal, but we do not have the finances to afford an aide 24/7. Considering her care at assisted living, I do not see it as any different from how she lived there -- the staff only checked her diaper once, possibly twice, a day to see if it was clean. Otherwise, she, as well as the other residents, went about their day and relied on the diaper to keep the pee/poop contained until they got around to checking it again.

Is it okay to let her be in a soiled condition for 2-6 hours at a time between cleanings?

All advice is very much appreciated.

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I don't know what is "OK", but I think you are right that unless you are paying extra for it, she is not being monitored on using the bathroom at AL. What you have in mind for her at her home is probably as sanitary/unsanitary as her situation at the AL.

The question is, is that good enough?

She is not unusual in not being aware of/concerned about her dirty hands and general poor hygiene. This is pretty common for impaired elders. This is a health risk for her, and for others in contact with her. Being in a soiled disposable undie for hours risks skin problems and UTIs.

Is it possible that she really needs more supervision than assisted living includes? I don't know what her mental symptoms are that make you think she has something that hasn't been diagnosed yet. Would now be a good time to have a full evaluation and try to determine a diagnosis?

What is her financial status? What is her monthly income? What assets does she have (other than a car and house)? If she might qualify for Medicaid, start looking into that as soon as possible. Even if she doesn't need a nursing home yet, chances are very good she will at some point (and maybe that point is now). Even if she can get by with in-home care, Medicaid can cover that.

My heart really goes out to you, sahk1942. You really want to do what is best for Mother, within the financial constraints you have to deal with, and no "operator's manual" with guidelines for basic necessities. You are doing the best you can. Feel good about that, at least.

I hope others will have more specific hygiene guidelines for you.
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I understand you are doing the best you can, but in my opinion toilletting, mobility (opening the door), and not wandering off, are the acid test for whether a senior can live alone with drop by care. House cleaning, meals, meds, baths can be scheduled.
What you are describing will likely result in rashes, sores and infections. This would not be acceptable in a facility, so I do not think it will work out.
I know you are making tough choices.
Good Luck
L
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Thanks jeannegibbs and ismiami. She is pretty good in most areas except hygiene. Her toileting is very poor. Being that she lived in assisted living for a year, I have a comparison to make in that the staff there only checked her once or twice a day. Does anyone else have experience with a parent who did not maintain self care and what was reasonable in terms of how long their diaper stayed soiled?

I just just discovered an attachable bidet on this website under the Senior Care Products section (I went on Amazon, too, and saw at least 10 other similar models). It has me wondering if that could be the answer to my problem, so that she doesn't have to stretch her arm around to wipe with toilet paper. Anyone have experience with bidets?

Thanks!
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It is normal for the all aging persons to do this. You have to insist that when the aides come to the house not only to check the diaper but make sure she is "clean" Also have to aide help your mom take a shower/bath and make sure its done correctly. My mom for many years never really take showers. After she started to wear pull ups, she's been soiling a lot more. I had the aides to "remind" mom to take a shower at least 2 times a week. (would love to give her more!) At first she pretended to take a shower and had to make her go back in. Then she started to get the towel a little wet to pretend she took a shower! I had to tell the aides to check to make sure the towel is very wet. Now she takes showers regularly and the aides now help clean her. Liked I said, it will be very hard but in the long one, when this is done correctly, there will be less chance of your mom getting infections. Good luck!
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I am a Caregiver and have been fir 25yrs. And her being soiled for a few hours is fine. As long as she's cleaned up well. She should be ok.
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I'm new to the caregiving of an elder, but as a mom of young ones...I would expect the level of cleanliness to be no different. it is custom in child daycares to check on diapers every 2-3 hours. 1-2 times a day is unexceptable, in my book.
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In my MOms home she is toileted about every two hours and in diapers all day. I would not expect anyone to sit in a dirty diaper for the entire day. UTIs have dire consequences for the elderly. I would be very concerned at leaving such a person alone for any lengthy periods of time. Things only go south and with this plan you will probably be picking up the pieces more than necessary. The suggestion to try to sign her up for Medicaid or whatever options are available locally is a good one. Sounds like she needs more care than she will be getting.
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Bidets are great, Home Depot has a toilet attachment, $99. Easy to install.
How much they would help in this situation is questionable. If the poor hygiene is consequence of poor balance or poor flexibility obstructing the reach around, then yes a preemptive bidet squirt helps reach spots that may be missed.
Bidets are also a welcome preemptive strike before a caregiver has to assist clean up.

In the case were someone as described is doing number one and two in diapers and sitting in it, I do not think they would be able or willing to go to the toilet/bidet.
Are they able to get to and enter (walker? Wheelchair?) the bathroom?
If they did, are they capable of changing and tossing the depends on their own?
Will they wash their hands?

This is one of the things insurance companies look to qualify for a ALF claim, because it is critical to quality of life.
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I use a plastic sitz (sp) bath on those days when necessary. Definitely cheaper and probably easier than bidet. Don't you Americans wish we had bidets? I remember having to look it up after reading a novel as a teen. :)
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