What can we do if the Alzheimer's facility that my mom lives in won't bathe her?
We pay $4,000 a month for 24-hour care for Mom in an Alzheimer's facility. Because of the conservative approach Washington state reflects about the patient's civil rights, the facility has not bathed her in nearly 6 months! She doesn't want to bathe--they walk away. What can we do? This is appalling to us! What are the negative health ramifications of this madness? Please help!
I have been working in this field for over 35 years and this astounds me! I know resident rights are important but your mother has been diagnosed with a dementia and symptoms of dementia are that they are unable to process information to make good decisions. An Alzheimer's facility should have been able to take care of this problem. I would have a serious meeting with the person responsible for nursing care and find out why they have not been able to care for your mothers personal needs. Their are many "creative" ways to get a person to take a bath or shower. Getting a person to take a bath who does not want to demands approaches that "fit" the patient. For instance if the person is religious i tell them church is the next day and they of course always bathe before church. If being naked is a problem allow them to wear a gown or bathing suit. Bed baths are wonderful ways to bath someone who is resistant as each part of the body is covered until it is being washed. Then wash as much as they can and stop when the person becomes upset. Eventually, the entire body gets washed! Make sure they approach her with cues that will let her know what they would like her to do like a bar of soap and towels. Hopefully they have a non-institutional bath that is not frightening for her. if they need help in learning different approaches to use the Alzheimer's Association can help.
I recently had a similar problem with my mother not bathing. The difference with your situation is her assisted living home called me for my insight and help. My mother was objecting (cursing the nurses) to bathing and lying about doing it herself. I guess she couldn't process the idea that she had a tell-tale odor because her diminished sense of smell did not allow her to smell the odor. I had to be blunt with her and tell her she wouldn't be allowed to continue living there if she refused to bathe...the only alternative would be a nursing home...an idea she hates with a passion. The ALF director pretty much told her the same thing except he just told her she couldn't continue to live there if she continued to refuse help bathing. I ran into this same problem last year when my mother was hospitalized for atrial fibrillation and a severe UTI. You'd think someone could be forced to bathe if they have an infection directly related to hygiene but no, they couldn't according to the nurse. I had to be blunt with my mother then too...that's the only thing she understands. Apparently, no one can force someone to bathe even if it means their health...crazy!
I suggest you point the Director of your mom's facility to this web site at the University of North Carolina. http://www.bathingwithoutabattle.unc.edu/
They provide excellent training materials for direct caregivers on how to bathe Alzheimer's patients without a battle. I own a home care agency in San Francisco that specializes in Alzheimer's care at home, and we train all our caregivers in these techniques.
Here's a description from their web site.
The Bathing Without a Battle: Creating a Better Bathing Experience for Persons with Alzheimer's Disease and Related Disorders CD and video package teaches person-centered methods for making the bathing experience more enjoyable for both caregivers and the people they are bathing. The package includes an interactive educational CD plus an instructional lecture-demonstration, available in VHS or DVD format. Research has shown that the methods and principles displayed on the CD and video will make a positive difference in bathing for both people with dementia and their caregivers.
well for starters NOT bathing will lead to other health problems! So it is not an option. I agree with the other contributors that something has to be done and there are ways to get it done. What would happen if she develops a skin condition because of not bathing - would the facility accept that it occurred because of their in-action? Best wishes
Three years ago my husband, who has Alzheimer's, broke his arm. I bought him a sleeve to go over the soft cast so he could take a shower without getting that arm wet. I left him alone to take the shower and when I came back the sleeve was off and he said he had showered but the sleeve wasn't wet nor were his towels. The shower was dry, too! So I knew he hadn't taken a shower. About a month later I hired an Aide and was promised by the Agency that she would get him to shower. She was with me 5 days a week from 7AM until I didn't need her. She never got him bathed.
About 10 months later he fell coming out of the bathroom and broke his pinkie in two places. He kept removing the bandage that the doctor at the emergency room put on so I hired a series of 24/7 Aides to help me. Not one of the 20 I had in a period of 11 months ever bathed him or got him to take a shower on his own.
I found most of the Aides unsatisfactory: they didn't do anything they were supposed to do, I had to cook for them; one spent endless time on her cell phone, a no-no, one watched TV all day & smoked; he said he asked my husband if it was OK and my husband said yes. None got him to shower. None cooked for him or cleaned his room. One said she would give him a sponge bath but she didn't.
And so for almost 2 years he never showered or bathed but he also didn't smell or develop skin problems and from an everyday shower-taker he turned into a non-bather!
Then a year and a half ago I moved him into a secure floor at an Assisted Living facility and from time to time someone gets him into the shower but not on a daily or weekly basis and he is just fine. Still doesn't smell! He is 82 by the way.
I have always been told that Americans bathe too often. Not my American husband!
Alzheimer's Patients are afraid of water. You might have to pay to let the hairdresser wash their hair once a week. The CNA's can give them a bed bath at the sink while distracting them. Where I last worked we had to give Ativan prior to the shower so the patient would not bite/scratch or hit. Until we were able to get my Mom into a routine we were happy if we could get her in the shower once every two weeks. This is a discussion for a care conference. Call your Social Worker and let her know you have an issue you need to address with the Director of Nursing and the Unit Manager. Your Doctor will need to be involved at some point. The policies of the facility will be reviewed. The outcome should be how they can deal with this problem and to keep in mind what would be in the best interest of the patient. Good luck!!
we had this problem with my dad too when we moved him to an assisted living facility last fall. Mom had been bathing him while he was at home. He refused to let anyone else do so when he was living at home. After entering the facility he refused a bath for a week. We told him he MUST let them shower him; we did not want him to smell bad. Mom even went so far as to tell him if he didn't bathe she would not come visit him. That seemed to do the trick for us. But it's different for everyone. I understood from the ALF he was in at the time that yes, he could refuse a bath, but if/when it became a hygiene issue they would make him bathe.
Boy, does this sound like my Mom. She can't afford to pay the price the assisted living charges, but she has a friend that comes to see her faithfully once a week, and I pay her to do it. She did it for 4 1/2 years, then suddenly, Mom refused everyone-the home health nurse that came to do it at one time, her friend and even the caregiver that was going to do it once even though it's not on her plan because of the smell. They called me in, which will only teach Mom to refuse all help, and they will get me to come in. She thinks I should be her caregiver, and I am unable to do it. But I went in, and she was angry and insisting that she had showed many times that day, and wasn't going to do it again (sound familiar?). After about 30 minutes of trying everything, the caregiver was able to get one with me there, but it took two of us. Afterward, we discovered the smell was not from just body smell and urine, but she had a massive (blistering red) yeast infection under her belly flap. I reminded her over and over that she had had those before, and they are too painful to leave untreated, and that we needed to clean and treat them regularly. It was so painful for her. Next I took time off of work to be there on the day her friend came (she had refused to let her friend do it for over a year--she claimed she never showered her before) and we tag teamed. We told her we'd help her clean up and take her out for ice cream. She still refused (I don't think she knew what ice cream was), but we got her in the bathroom, asked what color of puff she wanted us to use... She told us she had already showered 3 times that morning (you don't argue with a dementia patient), so I told her that may be, but I know you can't lift your belly flap by yourself, so we're going to help you--I refuse to let you get that painful infection back. We managed to just keep distracting her and chattering back and forth until her objections got lost in our chatter, and we got it done. I blew dried her hair, treated the underside of her belly, and got her dressed. Then we took her for ice cream, and came back and played a game. She really seemed to enjoy that. This week when I showed up, her friend had already showered her, and they were playing. I brought some snacks and joined them. I'm trying to replace her negative thoughts on showering with more positive ones. I don't know how long it will last, but I will continue this for a month or so and see how it goes. I just watched some of the video Jim had mentioned, and one of the tips they give is not to call it bathing or showering. Try something like: clean up, or wash up or some catchy name that they might not associate with whatever their mind thinks of when "shower or bath" is mentioned. Many things happen to the skin (besides smell). The skin will break down if not kept clean, they can get yeast (candida) infections where moisture and heat are present and not cleaned and dried regularly. They also need cleaning on a regular basis to inspect the skin for break downs, pressure sores, cellulitis, yeast, abcess's, or other sores that need treatment. If an infection gets into the blood stream, it can lead to septis which can take hold quickly and be fatal. It's blood poisoning from bacteria... I have seen first hand how violent they can be when refusing, and you can't force it, just have to find a way to work around it. Maybe start by telling them you'll make a deal--no shower today if you wash your face and hands, and hand them a warm wet wash cloth, then add to it... It may take awhile, but be creative and see what seems to break down their resistance. Do they like back massages? If so, wrap a warm towel around their shoulder and give a little massage. Massage lotion in afterwards and remind them how good it feels. If they don't like the sound of the water, start with warm water in a wash cloth, then squeeze it so some runs down them a bit, then wipe it off. Let them pick out the wash cloth or soap or ??? They want control It's tough, VERY tough, but hang in there. You are very right--their health is at stake. Good luck, and God Bless.