Incontinent, living alone, blind and really obstinate!

[milkmoustache]

DM is all these things. The incontinence varies wildly, she does wear the pants but still has awful episodes which leave shit all over the place. She is not really aware of how bad it is because she can't see it, and may also be in denial. Cleaner comes twice a week, is great at dealing with it, but obviously if nobody flags it up, things get missed.
Her carer also comes twice, that kind of cleaning is not her remit, and I think she feels embarrassed mentioning it. Medically DM has had a colonoscopy, seen a specialist, takes Lepicol powder which sometimes helps, but her diet is erratic. I had to take away her stash of prunes, and she is happy eating overripe fruit. When my brother stayed and did all the cooking, things were a lot better, and I think stress doesn't help.
I am at my wit's end. I live elsewhere, and I can't just drop everything.

Social services have done a recent assessment, but I don't think they offer that kind of cleaning, as otherwise she doesn't need any personal care. Hell will freeze over before she would consider a care home, she is resisting any further care sessions, although she likes her carer and can afford more help. And she is very, very obstinate and won't think ahead. I think that covers it... Where do we go from here??

Anyone...?

Difficult. Answering mainly to bump it for you... Would you doing an online shop for her, and therefore food planning, help a bit?

Is the cleaner coming more often an option also?

I think you need to get to the bottom of her faecal incontinence. Would she speak to the GP and following any investigations accept a referral to the continence service?

Would she consider having the cleaner come in more than twice a week?

Have you spoken to her directly about your concerns about her incontinence?

Does the specialist think that the cause of her incontinence is purely related to diet?

Some plain talking. ‘Mum, this is the situation, do you realise how bad it is? you don’t want to end up in a care home, so you must get cleaner in 4 times a week, and sort diet etc, or you will end up in a home’.

Ask her carer to clean the poop? Pay extra

Do you think that one of the issues might be her not being able to get to the toilet in time? Have you been able to establish a pattern to the episodes of incontinence? If she's not able to make it to the loo would provision of a commode help do you think? It would need to be emptied but that might be a opportunity for her to change her mind about having a daily career visit.

Carer

Continence assessment by district nurse?

Chat with district nurse first maybe?

Assessment by sight impairment charities(regional variations so google )

Wiltshire farm foods (frozen meals you can microwave)

Meals on wheels? Would also mean someone would see her once per day?

Would SSD consider a lunch visit to prepare meal/check wellbeing/ make snack for tea? Also will see continence issues

Would of thought if she can’t see to clean herself up then that is something carer can help with. Most my carers wouldn’t think twice and it not something a Cleaner would deal with at all.
Is she able to clean herself up? If it’s that bad that it’s getting everywhere on way bathroom then can’t imagine she can see to sort herself up. It’s a difficult job when you can see what you are doing and with pads. Can you get carer or cleaner to take pictures for SS? Needing help to sort self out in bathroom is personal care, if it’s at any time of day or Night then again more urgent is go carers to be in few times a day.

Some helpful questions here, thanks all.
DM really likes/needs to get out of the house and choose her own food, so meals on wheels is a non-starter. Her carer cooks for her, and she can microwave ready meals, but she sabotages things by eating over ripe fruit and prunes. She gets constipation as well as diarrhoea, the specialist thinks the two are connected. Diet may play a part, but stress too, but because she can't see the mess (weirdly the smell is minimal), she brushes off our concerns. And then there will be weeks when it's fine. She has had several investigations, but no conclusion has been reached, even by the expensive private consultant. District nurse might be a good tactic, it's how on earth we can manage it.
Plain talking is really hard, she is extremely defensive, lashes out verbally, and won't listen to our worries. It's not a subject we avoid, but I think she minimises it, her sight loss is her pressing concern. I will talk to the agency about the cleaning issue, her current carer is really great, but quite new to the job and my impression is that cleaning poo is not what she expects. All more difficult because DM is very defensive, and not wanting to face the future. It was a major struggle getting her to accept the pads, but sometimes even they just can't deal with an urgent episode.

The loose stools might be overflow, she might have impacted constipation.

To get a District Nurse out, it just requires a call to them.

I would ask the carer if she could visit daily, I'd have thought it more her remit than the cleaners . Her skin will need to be checked and she could use a barrier cream. I would ask the g.p. If there is any medical reason for the incontinence and ask for a referral to the community continence service or the dietician if it's food related. Maybe she would benefit from online food ordering or healthy meal delivery service.