When a person with Alzheimer's will not wash

That is a long drive for your DH.

It sounds like he is ready for a care or nursing home now.

It's a nightmare and carers can't/won't force him. I think DH is going to have to step up, as I had to with my mum. She had always started her day with a bath using Chanel 5 soap and perfume,, but when she got older, and started smelling like an old sheep, I had to strip to my bra and pants and almost carry her into the shower. She screamed and smacked me repeatedly as I showered her and washed her hair. When I finally got her hair dried, and got her all powdered and perfumed and dressed in fresh clothes, she stroked her hair and said "Oh this is so nice, I don't know how people can bear to be dirty!" Meanwhile I was soaked, bruused and shattered. Did this about once a month until she went into a home, where they mostly used a foam cleaner and wipes to keep her clean, though I went in and washed her hair.

OP, go to your local disability shop, or ask advice from the district nurse, you can get foam cleaners and foam-filled "shampoo hats" which clean well and may be less distressing to him than ordinary washing.

This approach won't work with everyone, but being creative and open to trying different strategies can be very effective.

We had to get carers in twice a week once my mother refused to let me bathe her. The ones who were most successful were experienced, no nonsense women who just got everything ready and kept her chatting. I used the same tactic if there was anything I knew she would refuse to do. Be pleasant, but don't offer an opt out. Before she knew it my mother would be in the bath and out again having her hair dried. I can remember having discussions with care staff who argued that older people have a right to make bad choices, however when dementia is involved I think you have to remember that they also have a right to the best possible healthcare (hygiene is part of that) and to dignity. Those rights need to be balanced against each other. Maintaining skin integrity and avoiding infection is necessary for them to be healthly and comfortable in their final years. I don't agree that it's just part of the dying process. Infected sores and ulcers can have a systemic impact and be very painful.

Caring for a parent or PiL under these circumstances is really tough and your relationship with them changes completely. I'd suggest a chat with the care team's supervisor to see whether they can incorporate some distraction techniques that could get him to agree to be washed.

I know people have mixed opinions about care homes; but some are excellent. Give it some serious thought. I wish I could have carried on caring for my mother until her dying day, but even though I felt it was a last resort and that I'd personally failed after years of struggling, I think she improved a lot once she had settled in.

This is so wise. Our instincts are always to try and get our loved ones back to some kind of normal but with dementia that isn't going to happen. In our experience, it was a question of trying to let the small stuff go, putting our foot down on the big stuff and knowing that would be fairly horrendous, and persevering with trying to find support and solutions even when they were never quite what was needed. I second the advice about the Elderly Parents section, it was a lifeline for me.

We don’t provide his physical care (although there is something going wrong on a daily basis that needs attending too), he has carers that visit but he doesn’t allow them in the majority of the time, he has cleaners and people that bring shopping but again is very hostile to them.

We are not going to get involved in any of the physical care, not that he would let us anyway. I am just wondering how others have managed to get them into a care home as we are told he has enough capacity to choose to stay at home regardless how bad the situation is.

Thank you, no he doesn’t fortunately/unfortunately go missing as he is agoraphobic. He has been in hospital a few times but released back home after a few days.

Carers at home are in a tricky position as they are guests and often in a rush. So they might say, ‘morning John, shall we get you washed now?’ And he’ll say no he’s already done it. As you know your DH was able to get it done probably because he was more forthright and knew how to persuade his DF.

While your FIL is at this stage you’ll probably continue to struggle and I would aim at getting him properly washed and into clean clothes once or twice a week via one method or another. The care staff at home can’t do much more unless you have someone really fantastic.

Its a progressive disease so by the time he needs residential care he may have different challenges altogether.

If there’s any point at which his behaviour becomes unsafe to himself then a capability assessment is needed. If he’s unable to make safe decisions then his liberty to choose can be restricted.

Sorry @Halloweeeeeeeeenforgot to ask of he goes missing at all? Another way is to see if you can get him sectioned?

You need to log every incident of him going missing with the Police.

You also need to email his GP setting out exactly what is happening and say that you want to avoid an unnecessary Hospital admission.

I found my DM’s nursing home brilliant, that do a change face thing where if a carer has no luck getting my DM in the shower they’ll wait a bit and send someone else in. This usually works really well.

So are you doing all of the care? If so, unfortunately the system causes us to make tough choices.

You can carry on until there is a crisis which necessitates a Hospital admission and then insist that he is not discharged to your care but instead assessed for his care needs.

You can call his SW and say that you’ve had enough and after 31st December you will no longer be providing care. Expect some guilt tripping from said SW.

You can see if he will agree to going into a home for a week for respite.

I’m sure though that other MNers will probably have other suggestions

This was also the trigger for my DM, I knew if she could see herself as she was she would want to be clean and smell nice.

Having cared for parent and PIL with dementia I sympathise.

Everyone’s experience is different. But in the end I accepted that dementia is part of the dying process. If someone with dementia gets an infection because they refuse to wash that is also part of the dying process. If they fall down and break a hip because they refuse to go into a care home that is part of the dying process. If they refuse to eat and drink that is also part of the dying process.

We try to preserve and lengthen these lives because we love the person and we are distressed by the changes this disease brings about. But in the end that is futile. We have to accept that the person we knew is fading away and will leave us.

Yes there’s a care team involved plus adult social services etc, he has a care plan at home but rejects them and is aggressive. They say we can’t move him to a home against his wishes.

Would he tolerate a foam cleanser ?
When I was a nurse working in Dementia care we used to often use a cleaning foam called clinisan, to clean our patients.

Have they had a Care Needs assessment @Halloweeeeeeeeenand were one of you present?

I would recommend starting your own thread though in the Elderly Parents section. They are usually a supportive and informative bunch in there

FIL won’t allow the carers in, wont wash, shits and pisses everywhere. How have you PPs managed to get your relatives into a care home?

They might not straight away, which is why a short stay might be a good option at first. But a good care home should have staff who understand this issue and can deploy a range of tactics and equipment. It is certainly something to discuss with them. I will be honest, in my experience this was just the first of many things that got more difficult so you may also want to explore how care home options handle increasing levels of the more challenging aspects of dementia.

Everyone's dementia journey is different, but in our case there aas increasing aggression the more the loved one receieved personal care.

My dad has Alzheimer’s and has been living with me for 18 months now. He will not wash, change his clothes, brush his teeth or do anything for himself unless I am physically there to “make” him - I’ve had to develop a sort of brisk, cheerful but no-nonsense tone which sweeps him along, though he will pout and grumble and make remarks that would upset me if I let them. We’ve had a few horrible soiling incidents which are awful for all of us but I try to keep in mind that it’s much worse for him than it is for me, and I just try to deal with it quickly and as discreetly as possible and move on.

It’s a learning curve living with a dementia patient; for example, we only have one loo, so it’s imperative that Dad has his medication first, then the TV is switched off so he gets the idea that it’s time to go to bed and goes up first. If one of us goes first and the bathroom is occupied when he goes up, he pisses out of his bedroom window all over the doorstep and front door. I am very worried about how things are going to go as this disease progresses, I admit, but we can only take it one day at a time. I use a lot of “signalling” when I need him to do something - tv off and lights down means it’s bedtime, switching the shower on for him and giving him a towel means have a shower. It’s less confronting than just telling him to do stuff, and I always give him a bit of time to get used to the demand and overcome his resistance (he’s also autistic) 😆

One more sorry, I want to see if I can beat my personal best of getting a wash done in x minutes or I bet you I can get your wash done by the time we have finished singing whatever sing.

This may not solve intimate care issues right now but I remember when my Dad was in a care home, you could buy a waterless wash. So if you are desperate, at least you can try to keep him clean without the battle of trying to actually bathe him.
It’s a wicked disease for all involved.

So from my experience I suggest...

Being blunt, you're smelling a bit dad you need the wash, it's not optional when you smell that bad.

Don't forget you are seeing x later, you said you wanted to look and smell your best (obviously just use who he would want to impress most and by the time it is done, he would have forgotten you said he was going to see x).

I know you don't want a wash but this is a new carer, so can you be kind and let her learn on you how hot the water should be, how gentle etc. Just make it out like he is doing a favour by being practiced on.

Get the water, flannels etc ready, then pass him the wet soapy flannel and ask is this a good temperature. If he says yes then try do you want to wash your face or shall I and then if he goes along with that just carry on like he had never refused, asking at each step do you want to wash this bit or shall I.

Good luck!

FIL wouldn't have a bath if there were female carers - it embarassed him. He was happy to let male carers do it