My husband (in memory care) has late-stage Alzheimer’s and is completely bedridden. How can I handle bowel movements?

I understand. Our situation is similar. My DH cannot speak and is in bed or a recliner 24-7. He is urinary incontinent but holds BMs for the commode. I have some suggestions from our experience. First, in our case, my DH does grow weak when constipated - he just doesn’t feel good. So your husband’s weakness maybe situational and not a sign of disease progression (at least not yet). My husband is drained after a BM but sleeps and gains back stamina. I make sure he drinks plenty of liquids and we use stool softener/gentle laxatives daily 2 - 50 mg tabs Sienna Plus twice a day, 5mg doculiquid with a morning drink (green tea and prune juice) and I chop up Sun sweet soft pitted prunes in yogurt once a day. This balance helps keep his stool firm but easy to pass.
We have routine time/s to get him on the commode each day. My husband is a two person transfer assist. So he can only use the commode when an aide is here with me. We help him on the commode twice a day. As the time to use the commode nears, I communicate this to him. He seems to understand and he relaxes somewhat knowing that he’ll be on the commode soon as the aide arrives. We situate the commode as close as possible to him so the transfer is a stand and turn. We use a diabetic commode b/c it is more spacious with a comfortable elongated seat and makes it easier on us to help him sit down. Once seated, I sometimes stand behind him for support to prevent the leaning. The pan on the commode slides front and back so I can do cleaning and apply fresh cream from the rear after a BM while he is seated. I slide the pan back slightly so I have access. I cover what is in the pan with a wipe so I don’t soil my gloves during this cleaning process. I put his new tab underwear on him while he’s seated so all I need do is pull it up once he stands up and adjust the tabs while the aide steadies him from the rear. All of this is done close to a bed in case we need to transfer him to finish any cleaning or adjusting of tab underwear in the safety of his bed. I do use a Hoyer lift but not for commode transfers. I haven’t figured out best process for that yet. I use the Hoyer to transfer him from a recliner chair where he sits during the day back to his bed at night I think getting him up and out of bed each day is beneficial and the Hoyer is indispensable for his safety and ours. We have had great success preventing pressure sores by using an alternating air flow mattress cover on the bed (Amazon for about $100) and an alternating air flow seat cushion for his recliner (Amazon for about $299). The seat cushion works on batteries if in a wheelchair/Gerichair or plugged into house outlet when in his recliner. Finally, I can minimize tab underwear changes by using absorbent booster pads (I like north shore brand also on Amazon). I fold two in half sticky side together and place one between his abdomen and penis and the other over his penis. They absorb urine effectively top and bottom and his disposable rarely gets wet. I check the pads every 3-4 hours and change as needed. I use the tab-style disposables to make this easy whether he is sitting in his chair or lying in bed. I also use incontinence liner pads on the side of the disposables when he is positioned on his side in bed at night. They prevent urine leakage from the side of the disposables where there is no moisture barrier. I realize this may seem a lot but I rarely need to change bed clothes, bed/chair pads or underwear disposables. When DH is seated on the Hoyer sling in his recliner, I put down an under-pad as a buffer for his skin. His shirts are slit in the back for ease of dressing and he wears leg warmers rather than pants to keep his legs warm and make easy access to checking his underwear. The pad also makes it easier to slide the sling out from under him in bed at night and prevents skin chaffing from the friction of pulling out the sling. I hope this post helps you. God bless

Yes, a hoist can still help. The posture of the person sitting in the sling is partly controlled by which straps are used at the top and bottom to attach it to the hoist. It is quite possible to "cradle" a person, so to speak, to support their posture while they're technically seated.

Oh dear, I'm not explaining this very well - if you Google "choosing the correct sling for hoisting" you should get plenty of results from suppliers and manufacturers who (if they're worth their salt) are usually generous with advice to customers. There's no need to be cynical about sales, it's in their interests to ensure that they're not providing people with equipment that's useless at best, and therefore they need their customers to understand what to look for.

Example taken from my quick experimental search (and anonymised in line with forum rules):

"There are a few things to consider when we look at specifying slings, let’s take a look at some of the criteria on our checklist.
Jump straight to…
Hoisting Sling Size
Style
Material
Optional Extras

1. Hoisting Sling Size
The size of the sling is particularly important, as it can affect the individual’s comfort and safety during transfers. If the hoisting sling is too small, then it could be tight in certain areas, and if the sling is too big, then the person could quite simply slide out of it.

[etc etc down to...]


4. Optional Extras
Slings also come with a number of optional extras that we consider when specifying as well. Here are a few of our most popular ones:
Hip tapes: We recommend using these when the client has fragile hips, brittle bones, or low muscle tone. The tapes give extra support and adjustment to the hip area.
Chest strap: This is a partially padded strap that gives extra support, and can be situated at waist height if needed.

Head support: We offer arched head support, square roll don head support, or dress sling head support, which all boast different qualities.
Removable bones: Not quite as strange as they sound, removable bones are extra supports that can be slid into the sling around the back area.
Neck roll: A soft towelling neck roll for extra comfort and support to the neck area.

Although there are lots of options when it comes to slings, they’re not too difficult to navigate. Just remember these key features when looking at hoisting slings and you should be fine. If you’re still unsure or want some more advice, please get in touch with us. We can also make completely customised made-to-measure slings for individuals with specific needs."

There is one thing over which (unless they're so far-sighted as to offer training courses too) the manufacturers have no control, and that's the skill of the user. A bad experience can put a patient/client off being hoisted for good - step forward our lovely client who has not been out of bed for nine months because of fat-headed ham-fisted clumsiness - so make absolutely sure that anyone using a hoist near your husband is better than competent. You can make this fun by insisting that they hoist you (or each other) first to demonstrate their skills! - no one should ever criticise you for wanting to make sure.

Talk to the hospice nurse. In your situation, this may be a short lived problem.Your observation about him trying to avoid soiling the diaper are right, this happens a lot. As he continues to get weaker, his ability to control the muscles involved in retaining stool will get weaker as well. This really is the end stage of his illness. Such a hard road. Take good care of yourself, too.

He should be put on a toileting schedule. Aides and caregiver should offer him a urinal, bedpan or bedside commode every 2 hours while he is awake. If he is tends to constipation, please consider putting him on a daily dose of Colace or SennaKot or prune juice. Please also consider giving him more water and foods with more fiber to help with his bowels. Lastly, movement helps the bowels to move faster. Try putting on some music and having him "dance" in his wheelchair or bed.

I am sure that the place he lives will put a toileting schedule in place and give the meds, if you ask.

It's amazing to me how many people respond to posts withOUT reading it first!

Call your DH's doctor and get advice about how to proceed. Then get the Memory Care nurse on board with a course of treatment with laxatives to keep him regular. If he is too weak to use the commode, he WILL have a BM in his Depends or adult brief when the urge is strong enough.

I see no mention of hospice care for DH; so it's also a good idea to ask his PCP about an evaluation for him. You'd be surprised at how many services are available to him with hospice.

While it's difficult to move a person in this condition into a SNF from Memory Care, be sure the MC is equipped to handle his needs properly before you make the decision. You should only be present to sit with your husband and not expected to do caregiver duties while with him or figure out his care plan! A SNF will have a Hoyer Lift to enable DH to move around more easily than he's able to now, so that's something to consider as well.

Wishing you the best of luck with a difficult situation. Bless you for all you do for your DH; I'm with bundleofjoy on her comment to you!

You can use a hoist (with the correct style and fit of sling) for commode, or even toilet, transfers. The facility should be on top of this, are they not being helpful?

I suggest you move him to skilled nursing. Memory care is not equipped to do the kind of care he needs now. You should not be doing any of his care.

You may want to get him evaluated for Hospice.

I read this that he is in a facility, memory care and on hospice.

A nursing home would be a better fit for him, I would think.

It is possible that the facility where your husband is can not use "equipment" to help transfer a resident. If this is the case then I would seek to have him moved to a Skilled Nursing Facility where they can use equipment to help safely transfer him to a commode or the toilet.
(Some states changed regulations as to the use of equipment you can ask if this is the case where you are. Or it could be a facility rule that they do not permit the use of equipment.)
Using a Hoyer Lift would be safer and more secure for him. Since he does not have the trunk support any more a Sit-to-Stand could not be used.

Talk to the Hospice Nurse or the Hospice Social Worker to see if a transfer to a Skilled Nursing facility could be arranged. It is very possible that you could keep the same Hospice Team so he would not have to get used to a lot of new people.

You probably need to start Hospice services if you intend to keep him at home or at least Palliative Care.

Call his primary care for advice and ask his social worker.
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With this help you need caregivers everyday. You cannot handle this situation alone. Its far too much.

God bless and the best of luck.