Refusing to wash

[TheRemainsOfTheDayCream]

My aunt absolutely refuses to wash or get dressed. She moved into a residential home a fortnight ago and has only had one shower in that time (persuaded by a close friend). Her carers have been patiently trying to encourage her daily, but she gets agitated and starts calling them names.

I managed to clean her hair using a no-water shampoo cap on my last visit and have left body wipes for her to use, but I doubt she will use them. And it's an expensive way to wash.

Has anyone else had this issue? Any tips?

Yes my parent with dementia went like this too. I remember the awful frustrating battles I had with them to try to get them to wash or just simply change clothes. Sometimes weeks would go by without them washing at all and they would smell awful of stale urine etc. even carers we employed couldn't convince them to wash.
This seems to be a very common thing with people with dementia.
I learned to just accept it if they refused to wash and not go on at them so much as the more I did the more they dug their heels in and refused. in the end i found they did become more compliant and would occasionally agree to wash by simply not going on and on at them. I found it was very much like dealing with a toddler again just a giant one!

Thanks @whatacroc. It is so frustrating and yes - similar to dealing with a toddler. My aunt just sits in bed in the same nightdress and dressing gown, getting smellier by the day. She won't even let the carers change her bedclothes.

yes my parent was exactly them same with the bedding too, I could have written your post myself. it is extremely frustrating.
Like I said the only advice I can offer is with my parent the less I "nagged" the more cooperative they became. but it was hardwork and I felt awfully neglectful just leaving them unwashed for sometimes weeks when they point blank refused.

It is very common for people with dementia to refuse to wash. They don't like being immersed in or showered with water but will sometimes tolerate a partial flannel wash (depending on who is doing it). It is very early days at the care home, once your aunt gets to know the carers better she may be more cooperative.

My mother had 'favourite' carers and she would let them wash and toilet her. But I don't think she had a bath or shower for the last 5 years or her life, it was all just 'a wash'. She never smelled or looked grubby, although for the last year she refused to have her nails cleaned. But by that time dirty nails were the least of her worries.

Sometimes you just have to let things go, there isn't much you can do.

@whatacroc- I'm sorry you went through this too. I've only had luck once getting my aunt in the shower - and I do think it was a matter of luck rather than skill. She just happened to be in a more compliant mood that day and I'm a very familiar person to her. No luck since!

My DM was like this, insisting she had washed - but she hadn’t. Finally we had a carer who who sit and chat to her and then jolly her along. She would go with her for bath and change her clothes twice a week, she even let her cut her matted hair. When that carer sadly left she was accepting of other carers carrying on bathing her thank goodness. She had always been extremely clean before the dementia kicked in

@catofglory- I would be grateful for a flannel wash at this stage. Agree that it's early days and my aunt has also endured a lot of recent changes in accommodation (home, hospital, respite care). Maybe she will do better once she settles in a permanent care home.

A friend of hers has created a tick chart so that someone (a carer, I suppose - certainly not my aunt) can tick a column every time she washes. She thinks my aunt assumes she has already washed and just needs to have it demonstrated to her that she hasn't. I don't believe it is nearly as simple as this.

@cherrytree12345- I do hope we encounter a carer like that.

I think you’re right, it isn’t that simple. People with dementia get paranoid and think people are lying to them.
My mother believed she washed and was clean, I think she honestly believed that, but she didn’t wash and smelled of urine (there were more serious hygiene problems).
She did eventually consent to having baths in the care home. Sorry you’re going through this, it’s heartbreaking.

@FictionalCharacter- yes, she's definitely getting paranoid. She accuses some of the carers of bullying her when they are simply trying to get her to take her meds. She did the same in hospital.

It sounds as if the washing is a common issue in dementia - and probably the least of our worries. Certainly, my priority today was to calm my aunt down because she didn't know where she was and was distressed. I just hate to see her lying in bed, unwashed and bored and unable to engage in anything. She is a very intelligent, well-read woman and now she keeps books beside her but can't read them. It's heartbreaking.

I think you are right, it is a mix of fear and confusion. It is especially difficult when their familiar environment is disrupted, so after the mix of hospital and care home it will take her a while to settle down.

It is upsetting seeing things that your relative used to do so easily, but no longer can. During one of my visits the care home chef had made butterfly cakes for the residents. My mother's had been pureed because she could no longer eat solid food. She used to make these cakes for me when I was a child, and now she could no longer even eat them.

I sometimes put a bowl of warm soapy water on the table, and ask Mum to help me wash up. A few cups, a jug and a sponge in the bowl helps to get at least her hands clean. I sometimes top it up with warmer water and she can sit up to half an hour, squeezing the sponge and moving the bubbles. I hand her a flannel and she uses it to wash her face.

For my patients (I’m a ward nurse) who don’t want a shower, I’d often give them a bowl with warm soapy water and suggest a “quick spruce up/freshen up so we are ready for the day”. So face, hands, under arms. I’d give their bottoms/groin area a quick clean when I change pants/dress them (if they’d let me of course!), then I’d let them soak their feet in bowl of warm water (and I’d give feet/lower legs a quick wash). I find the way I word things often means they will allow a “freshen up” but not want a wash or a shower if I ask them if they’d like that. Don’t know if any of that makes sense!!

Would she feel comfortable using wet wipes or baby wipes, if she's getting easily distressed then the staff won't push but I would try and see if she will have fresh sheets and knickers.

No one likes being told what to do. Especially when they’ve lost control over almost everything else.

Ask low demand questions like, I bought a new soap, do you want to try it?
What day is bath day? Do you want a wash after lunch, or in the morning? Shall we have a shower, or just a wash?

It's bloody awful OP, it's a heartbreaking thing to witness. Sometimes acceptance, against your better judgement, is the only way to keep your sanity.

My father found the water from the shower onto his skin painful and was frightened of falling both in and immediately after showering. He much preferred a strip wash.

With regard to clothes and bedding changes, take the dirty clothes away at night when they are in bed and then change the bed during the day when they are otherwise occupied.

However, if your Aunt has only been there two weeks, it will take much longer for her to build trust. She is probably really scared and doesn't know where she is. Everything will be unfamiliar and she won't understand or remember what is going on. She needs time to settle.

@catofglory yes - fear and confusion. In the hospital, my aunt said she was scared to let a nurse take her to the bathroom to shower because she thought they might leave her there and then she wouldn't be able to get back to her bed, where she felt safe. Now she's in a care home, she's scared and confused all over again.

That's so sad about the pureed butterfly cakes.

@Fushia123 that's a thoughtful, gentle way of dealing with this issue - thank you.

@TicTac80 I hope my aunt meets a nurse or carer as sensitive and skilled as you. I've noticed how much words matter to my aunt (e.g. I now use the phrase 'convalescent home' because she gets upset if I say she's in a 'retirement home'), so I'll store up 'freshen up' for future use.

@MissMoneyFairy thank you - and yes, that's exactly what I have suggested to the carers. I've left body wipes in the bathroom - but I suspect my aunt will reject the carer's suggestions to use them. She won't use them herself because she'll have forgotten they're there. I'll suggest she tries them ('freshens up') when I next visit, but I live a long way away so I suppose she will just stay unwashed in the meantime.

Good point @PrizedPickledPopcorn She doesn't know anything is wrong with her so she must feel annoyed at all these strangers suddenly suggesting she needs their help with washing. Low-demand questions and offering choices sounds right - all those skills learned as a parent coming in use again.

This is brilliant - skilled, compassionate, respectful and helpful advice.

@60degreecycle yes, it is. I've been in tears over my aunt's situation several times recently. It's heartbreaking to witness her loss of control and how frightened it's making her. A resident with more advanced dementia stood outside her open bedroom door, swearing, on my last visit and my aunt said 'It must be awful to have dementia. Do you think you know if you've got it?' I said no, I didn't think so.

@unsync my aunt won't change out of her nightie or get out of bed, so there is no chance to wash what she wears or change the bedding. I think you're right about the short length of time she's been there having an impact. At this stage, maybe I should just be grateful she's at least eating and taking her meds (she was refusing when she was at home). Washing can come later, when she's settled in her permanent care home.

I'll remember what you say about your dad finding water painful. Sensory issues seem to become heightened. I know my aunt is very sensitive to noise at the moment so I bought her some ear plugs.