WWYD?

[Marylou62]

I'm sorry if this question is cryptic. I'll try and answer as much as I can.
If someone with Alzheimer's and in a specialized Dementia care home, refuses any suggestion of personal care how do you clean them?
They are quite advanced and they noticeably smell.

This is always a hard situation and there is really no right or wrong ( apart from the two extremes of leaving them in urine/faeces because they 'decline care' or performing personal care by using restraint and causing massive distress to person. both of these should be safeguarding referrals)

Middle ground is about what is most compassionate and dignified for the person. For some this might be being slightly more unwashed or unkempt (as long as basic hygiene needs can be met) for other people being more unkempt might by increasing the persons agitation.

It really does depend on what seems in the persons best interests, and this might be different on different days? ie when person with dementia is most relaxed and with a member of staff they trust and at best time of day - full wash, clean clothes, hair wash. On a day when person is more agitated or distressed, toileting care only.

As a general rule things that help

• find the time of day which is best for the person (rather than most convenient for care staff!!!)
• Go slow - show and talk to the person about what is happening - show them the wash cloth, let them feel the water first.
• One step at a time - so they have time to adjust to what is happening. eg open curtains slowly, then gentle remove covers of bed, then gentle sit them up, then show them bowl of water or tooth brush
• help them to be involved as much as they can, even if this is just letting the person hold a tooth brush while someone else brushes teeth, or holding a wet cloth
• lots of reassurance - tone of voice is really important is person has difficulty with understanding they will still be able to recognise tone of voice
• if person is hoisted or hoisted into a bath , imaging how scary this would be if you didn't understand what was happening - is there anything that could make this eaiser
• Is the person in pain? is this causing distress during personal care. Some people need a low dose of pain relief 30mins before care to make rolling or hoisting less painful (chat to nurse or GP if you think this is the case)
• Although it can feel like doing the above takes alot longer it should be easier compared to having to 'battle' through personal care and then person being agitated and distressed for rest of day and staff feeling stressed and upset.

If it gets to stage that its not clear what is the most compassionate and caring thing to do consider support from palliative care / or an understanding GP.

Sailawaygirl...I'm crying reading your thoughtful reply..

I will get back to you...

Its really hard to see the 'bigger picture' and put the person at centre of care because personal care becomes something that has ' to be done' to someone rather than something that should be done 'with someone'. even when people are trying to do the best for someone. Staff are often worried about consequences of not doing (rightly in most cases!)

If you chat to the care leads and the care team about this, they should be understanding and if you can get some strategies down in the persons care plan.

I have found that words like 'kind' ' compassion' ' best time for person' 'when person is most alert' 'reduce distress / agitation' really help to put to focus on the person rather than the task.

its a horrible stage in dementia journey xxx

Every thing you have said makes sense..

I'm sure the care home were trying to be compassionate and caring but I've just left a frightened, shocked and traumatised Mum.. after a shower..

And I was the one who instigated the shower as I mentioned that she smelt...!

Would she still be able to feel like this even if all the steps you mentioned were put in place?

I wasn't there and don't know what happened...

I'm going to phone the home today and chat with the manager...

@Sailawaygirl ?
I rang the home today but the manager is off until Wednesday...(I live 5hrs away)