Is there an easier way to clean my mother and ensure she is cleaned properly while standing?

A fellow caregiver asked...

My mother 85 yrs old lives with my father 86 yrs. He cares for her but will not hire a caregiver. My mother wears diapers, but cannot clean her self, remove the diaper or put a clean one on due to walking difficulties. When I go there to help my dad, I'm concerned that when my mother soils her diaper, she may not be cleaned up properly and can get a bladder infection. Usually when my father cleans her up with wipies as he stands in front or to the side of her, while she stands with her walker against a potty chair. Cleaning up a soiled elderly person is similar to a baby elephant's skin; folds go on for ever. I read that the soiled person should be laid down on a absorbent disposable bed pad, turned to their side while the care giver rinses and cleans the person before putting on a clean diaper. Is there an easier way to clean her and ensure she is cleaned properly while standing? My mother also likes to wear pants, and we have been using scissors to cut the soiled diaper off, since the ones with the side attachments are harder to put on. Also, how many times a day should her diaper be changed or checked? Is every two hours correct?

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

I have read through your letter. You bring up many questions, so I will try to address each one individually.

1) How should someone be cleaned when they are incontinent? If your mother is incontinent of urine only, it is fine for your father to remove the adult brief, cleanse her with wipes (make sure they are hypoallergenic) and then place a new clean brief on her. He may also want to put some protective ointment on her backside, like vasoline or A&D ointment, especially if she gets irritated skin.

If she is also incontinent of bowel, then he can also clean her while she is standing up, but he needs to make sure he is really spreading her buttocks apart and really cleaning well in all of the crevices that a person can have. He should wipe her using a front to back motion ONLY, making sure he uses a fresh side of the wipe with each stroke. Again, once she is really clean, he can apply a protective ointment, like vasoline. Having someone lie down in bed to clean is not really better, unless your mother is too weak and cannot stand long enough for your father to clean her properly.

My other thought is that he can try to clean her somewhat while she is sitting on the commode chair, by having her wipe herself (if she is able) using toilet paper or the wipes. Again, he/she should use the front to back motion. Then, she can stand up, and he can finish cleaning her backside.

2) Removing the brief using scissors? Regular scissors may be too dangerous. You can buy bandage scissors at medical supply stores that have blunted edges, so there is no danger of your mother getting cut or injured. Some of the briefs can also be torn at the side to get them off easily.

3) How many times a day should she be checked for incontinence? I do agree that every two hours is a good rule. If that is not possible, then I would suggest he check her on arising in the morning, before and after meals, before bed, and twice through the night.

4) Is your father able to take care for your mother? Only you know if he is taking good care of her or not. You sound concerned about it from your letter, so I am thinking you might be right about him not doing it well. I am also wondering how he is bathing her and getting her dressed/undressed during the day. Many seniors do not like having to hire help, as they feel like they have failed somehow, or only they should take care of her, as it is their "duty". Please reassure him that this kind of caretaking is very stressful, and that having a caregiver even a couple times a week may help him reduce his stress. Unfortunately, caregivers will often work until they either cannot take it anymore, or get sick themselves. If your dad gets sick or injured taking care of your mother, how will she get the care she needs?

If your dad refuses to hire help, have you asked him why he is so resistant. Is he afraid to have strangers in the house? Does he worry about the money it would cost? Have you offered to help him find someone and/or pay for help? I would really sit down and talk with him about it before something happens.

5) UTI prevention Your mother should be changed as soon as possible when she is soiled. She also needs to be cleansed using a front to back motion, so that bacteria from her rectal area is not spread around. She should drink fluids and stay well hydrated.

Good luck!