My foster mother has some form of dementia, but currently remains unofficially diagnosed.
For the past 3 months, her cognitive skills and level of understanding have declined.
She no longer wipes properly, doesn't want me to do it, doesn't want me in the restroom with her anymore monitoring her, tells me she can't go with anyone watching her, often tells me she knows what she is doing in regards to toileting.
When she urinates, she'll wipe her front using the same piece of toilet paper twice, just folded over ...also she refuses to wipe her back end as well when finished urinating.
When she has a bowel movement, she wipes back to front and often uses her wet body rag too frequently and on both parts.
I tell her it's important to wipe both parts, with separate paper even when urinating. She tells me there isn't any point in her wiping her back end after urinating as she didn't have a bowel movement.
When she has a bowel movement alone, or sometimes with urination. she'll wipe her back end going towards her front. She'll wipe both parts together.
Sometimes she leaves reside and doesn't get it all.I showed and told her multiple times how to properly wipe, but it's useless because she doesn't understand.
What is there to do or improve things, as she is leaving residue in her pants when she doesn't wipe it all?
She has been smelling awful and since I can't get her to bathe nor change into clean clothes often. What do I do?
Like she'll sneak and "wash" when I'm asleep and refuses to call me for assistance. She'll put back on her dirty clothes that she may have been wearing a week to two and refuses to wash again and put on clean clothes.
She gets cold often and doesn't really like undressing to bathe..
What do I do about both problems? I have told her if she can't do either properly anymore, someone else may have to come in and help her. A stranger. I have also told her that she will get infections and may wind up in the hospital in which she hates. If she doesn't at least let me help her.
She tells me to stop hovering around the bathroom door, and won't let me accompany her anymore. She tells me that she's not a child and knows how to properly wipe.
She also told me that she isn't going to cooperate if someone else were to do it.
I am unsure if I should be using these approaches and feel terribly for her. I really don't intentionally try to shame her, nor argue with her ...
Just get frustrated and saddened by her arguing with me and refusing to believe nor cooperate only with me.
She's always been verbally abusive towards only me.. and always argued, picked fights, refuses to believe only me about anything, pre-dementia.
Dementia only makes it worse
As you know wiping back to front is risky for women and can cause UTI's.
Since she is gonna do what she is gonna do, having her take cranberry pills will help prevent the UTI's.
As to any leftover residue left in underwear noted when doing the laundry, there's so much more in the elder's body than simply "correct wiping" that prevents good results. 1. The sphincter becomes a bit lax.
2. The bowel doesn't have good strong peristalisis. I hate to get too graphic here but stools may be less correct consistency, and are eliminated in a matter that leaves more of a "mess" to clean. The sphincter fails to shut completely.
3. Unfortunately all of THIS happens just when the mind is failing in understanding how to cleanse (likely a lifelong habit of doing it wrong--said habit now engrained).
4, At the time the urethra is less a solid gate against bacteria.
ALL OF THIS can lead to frequent UTIs and when they are on board there can be a lot of worsening of the dementia.
I'm afraid, and I say this given your other message to us on Forum today, that you may be closing in on a time when mom needs more than your care. You are the level LAST one she wants to listen to about anything. She is close now to needing the care of several shifts of folks to walk her through her day in terms of getting into the shower, getting clean, getting toileted and cleansed and so on. Other than to tell you that the difference is matter of just rote "getting it done" I can't explain to you how different care is in a good facility. But then you have the counter-problem that not all facilities care or are good ones. And then cleanliness is even MORE an issue for mom.
I think you will have to make it clear now to your mom that she can get infections if she isn't properly clean, and that sadly for you BOTH you now have to monitor cleanliness for her OR SHE MUST GO TO CARE where they will do this FOR HER without DISCUSSION.
That is to say, you are going to have to toughen up your stance and get this done daily with lots of changes of underwear, lots of wipes, and a very matter-of-fact attitude. DO NOT THROW those wipes in your plumbing. Even when they say they can be flushed. They CAN'T. So into the garbage pail and frequent emptying.
Sadly, for caregivers, there is not always a fix.
There is not always an answer.
You already know what has to be done and you are unable to far to force the issue. But at the point you are looking at bladder infections you may need to.
I am sorry. You're not alone.
From the behaviors you are describing, she is probably already in moderate stage dementia. Elderly women are much more susceptible to UTIs, and not even due to hygiene but to hormone and physiological changes in their aging bodies. Often UTIs in seniors produce behavior changes, like confusion, delusions, hallucinations, agitation, and the senior cannot tell you there is something wrong.
Please call APS and report her as a vulnerable adult. The more you insert yourself, the longer it takes for her to get the appropriate care she needs. You must step 100% away for this to happen. Or, you take her to the ER and tell them she is confused and needs to be tested for a UTI (even if this isn't true because they won't admit her for dementia since that isn't treatabel). Once there you can tell them she is an "unsafe discharge" and refuses help at home and that you are NOT and will NOT be her caregiver. Then you ask to speak to a hospital social worker to discuss her needing to go directly into a facility. She will get a court-assigned legal guardian who will manage all her affairs and make decisions in her best interests.
County help is the only long-term solution for her progressive disease. You are the one that needs to accept it.
Bless you for trying to help her to this point. Now others needs to step in going forward.
Many elders with dementia at some point can not be taken care of by a child they raised. This woman views you as a child and will continue to try to be in charge . She will not allow you to provide the care she needs , nor is this your responsibility .
She needs to be taken care of by professionals ( Non family) in memory care .
Move out , and call APS ( Adult Protective Services) to take over this woman .
And now she has dementia, which you are ill equipped to handle.
You need to move out and call APS and report this woman as a vulnerable adult with dementia living by herself and they will take things from there and make sure that she receives the proper care.
She is NOT your responsibility, so move out and get on with living your life away from the abuse.