My brother refuses to shower or bathe. He has had paranoid schizophrenia all his life and now at 63 has dementia but is not aware of it. Any suggestions?

Your brother has been hit with a double whammy of schizophrenia and dementia. He makes sense most of the time yet he refuses to bathe to the point where he has developed sores on his skin.

You love your brother and you're concerned about him otherwise you wouldn't have shared with us the struggle you are experiencing as his caregiver. I understand your desire to keep him at home as opposed to a nursing home but, through absolutely NO fault of your own or your mom's, your brother is unable to receive the care he needs at home.

You don't need to threaten him with a nursing home if he doesn't bathe. You can be respectful toward him and try to discuss this with him. Do you know why he doesn't want to bathe? Does he feel unsafe getting in and out of the shower? Does he dislike being cold once he gets out? See if you can discover a reason for his not wanting to bathe. Walking around with sores on his skin is no longer an option and you might want to share this with him as well. If he doesn't want to go to a nursing home and he continues to not bathe let him know that you'll have to bring a shower aide into the home and he/she can help him with his showering. So your brother's options are showering himself or you hire a shower aide (via his Dr.'s office) to come to the house twice a week.

If he continues to refuse all assistance then it's time to discuss a nursing home because he won't be getting the care he needs living at home. Again, this is not an indictment of you and your mom and the care you give him. I know you take good care of him or else you wouldn't be concerned about his not showering.

As caregivers we can let go of a lot of things but basic daily hygiene isn't one of them. And as you suggested in your post someone who continues to not bathe and gets skin sores as a result is at a higher risk for other infections and with his medical and psychiatric problems your brother's at risk under the best of circumstances.

Have an earnest discussion with him about his hygiene and allow him every opportunity to make the decision for himself before you look to outside assistance. 

This is so sad. So he is seen at the VA. Do they say anything about his not being washed? Could any psychiatrist, psychologist, psychiatric nurse, etc., that he is seen by have any ideas about this issue? I hope other people have some suggestions for you. Thinking of your family.

Hang on. Some one with knowledge should chime in.