My mom is 90 yrs old and in Oregon in MC with late stage ALZ since Sept. Her family (my 3 sisters and I) visit 4 times per week. I seem to be the only one concerned because the aides are just now telling us mom has been refusing to take a shower. I told them it's unacceptable and they need to just say we're getting in the shower now and do it. Isn't that why we pay $8,000 a month? They claim the state says they cannot force old people to shower. I say they should. She's not cognitive enough to know what's right or wrong. She's now developed a hardy yeast infection in her groin area. She has a belly flap that we used to keep anti fungal cream on. Aide says she takes a towel and wipes it off. I actually think she's scratching herself with the towel because she's miserable. My sister in charge nor the MC has called the Dr. I suggested perhaps benydryl to rid the itching but what do I know. I guess I'll need to get her in the shower myself because no one seems to be doing much. Meanwhile mom keeps scratching. Does anyone know if Oregon actually has a rule that aides cannot force her to shower, or are they just trying to get out of helping her? The place is very clean and well maintained and aides are always friendly and so helpful. This is the first problem we've had in 6 mo.
Thank you
This may be a safety issue. Slips and falls in shower are not good, and they are common with uncooperative patients.
My question here is what DO THEY DO if they can't shower. Are they staffed to and do they provide bedbath?
This sounds like a serious problem when we are getting into fungal infections and you are correct about not "toweling" the area " which will end you with a RAW MEAT fungal infection.
Time to talk to MD first, administration next about what will be done to prevent this infections. Has Mom been on antibiotics of late? Fungal infection may be severe vaginally or orally if so.
Thery're a lot easier and safer to use; the person doesn't have to disrobe completely and endure the shock of a potentially chilly shower area.
You can buy the no rinse products at drugstores, but comparison shop first b/c I found some of them to be overly priced high.
My daughter worked in NHs for 20 years and says it has to do with how you approach the person. You make them feel they made the decision. Example: "Mrs B, would you not feel better with a nice shower and clean clothes? Then we can put a nice cream on you to help with that itching." Mrs B says "yes", she made the decision. With Dementia its not so easy.
I did find with my Mom, aides would nicely ask. "Mrs E would you like to get a shower." Of course Mom said "no". I asked an aide to just tell her "Mrs E time for a shower". Or just walk them to the shower saying we are going to get clean and all smelly good. You never give someone with Dementia a choice. They no longer have the ability to make that type of decision.
Aides really do not have the time to argue. Some may try others will just take no for an answer and move on to the next resident.
I would wonder if a MC is really for ur Mom. IMO the only difference between them and an AL is that its a lockdown facility for Dementia patients. The ratio of aides to residents maybe a little higher, maybe a little more hands on but there comes a time when a resident needs more care than a MC can give. You may want to check out a nice Longterm care facility. A first question I would ask is how do you get residents to shower?
My Mom suffered from yeast infections under her breasts. She had to wear a cotton bra. No skin on skin. I would find her with no bra on at tge NH. Told my daughter and she asked me where the bras were. In the drawer with her socks. Seems aides dress from the top down, so don't see the bra until they go to put socks on. Person already dressed. I always put Moms clothes in sets so I could keep track if them. Started putting the bra with them and had no problem after that.
I would talk to the DON about getting Mom something orally for the itch. Also seeing about getting her at least sponge baths. Making sure the area where the infection is clean and DRY. Dry is important with a yeast infection. I would also ask if giving her a probiotic would help. Antibiotics usually cause yeast infections so probiotics are used in conjunction to help prevent them. Trying to keep a yeast infection from happening is easier than curing it.
When I showered Mom I always made sure she was dry under her breasts and where that fat flap is. If Mom got red in these areas, I used Desitin diaper cream. Its not water soluble so stays longer.* The redness went right away. An aide I knew recommended Almay deoderant fragrace free. Never use talcom powder. It hardens and causes irritation. Mom used cornstarch.
*some members do not recommend Desitin because its a barrier cream and may keep in the bacteria. IMO, as long as the area is clean and dry, there should be no problem. Used it on my girls and Mom and was the quickest way to get rid of that redness. It must help with the itch too because once on, everyone stopped complaining,
I'll bet they're using other products rather than letting her be unclean. Have you actually asked in a non-hostile manner?
The fungal or yeast infection is a whole other issue. My mom was obese and had that as well, and showering or not wasn't the issue -- it was killing the infection and keeping the area dry. It needs medication.
Be part of the team, not the troublemaker. That's how to get your mom the care she needs.
https://www.verywellhealth.com/tips-for-bathing-someone-with-dementia-97622
Talk to her doctor about a one time -- usually works -- or two time -- if really hard to treat -- dose of Fluconazole. It is by prescription only and has to be carefully monitored in the elderly but is a wonderful way to treat the yeast all at once and minimizes the itching.
https://www.webmd.com/drugs/2/drug-3780-5052/fluconazole-oral/fluconazole-oral/details
First & foremost, though, you have to try to figure out WHY mom is refusing to shower. Is she scared? And if so, of what? My mother with dementia was petrified she'd fall in the shower b/c the floor was slippery, according to her. So I bought her a pair of water shoes & that solved the problem. Some elders need a removable shower head where they can direct the water instead of it pouring on them indiscriminately. The caregivers need to know HOW to deal with an elder who's refusing to shower, also...........there are tips and tricks to the whole game.
Here is a short blurb on the subject of bathing a person with AD or dementia:
"If you send clear signals through your tone of voice, facial expression and relaxed and confident attitude, that you mean them no harm, they may trust you to the point where you are able to help them with their personal care. People with Alzheimer disease become extremely sensitive to the body language of others, as they no longer possess the judgment and insight to understand the situation, so they evaluate the threat posed to themselves by the frown or aggressive stance of the other. It is important to exaggerate your body language communication to let the person with Alzheimer disease know that you intend them no harm. A smile on your face, a relaxed tone of voice and body stance, a sense of calmness and reassurance, perhaps a hug, all communicate that you mean to help, not harm. If you feel like you’re overdoing the positive body language, you are communicating your intent effectively for a person with Alzheimer disease.
Remember that their short-term memory may not permit them to remember what you are doing when the two of you are part way through a task, such as a bath. People have found it effective to keep chatting throughout the task, as the continued connection and reassurance of a soothing tone helps the person with Alzheimer disease stay calm in a situation they would otherwise find threatening."
If your mother has a favorite caregiver, perhaps that person can figure out how to calm her fears & HELP her into the shower once a week (which is enough). But first try to figure out what's scaring her. If you can do that, you may have the problem solved.
Get mom's doctor involved next for a prescription to treat the yeast infection; the nurse on staff at the MC should be responsible for applying the ointment daily and/or dispensing any oral meds needed to clear the problem up. It's vital the nurse stay on top of the situation DAILY until the infection is cleared up; my mother would get all sorts of infections and that was the routine at the MC: first the PCP, then the nurse, and/or home health gets involved from Medicare if necessary. That's important to know: Home Health. They would get involved quite often with mom's issues, esp when she had a toe infection.
Your attitude is important towards the staff at the ALF, too. Make sure you approach them in a non confrontational manner about all this, asking for help as to how best to get mom cleaned up.
Best of luck.