Refuses to engage with carers

[NetZeroZealot]

My father has become very frail and was recently discharged from hospital.

We realised we needed to get a carer in as he cannot wash himself properly any more or have a bath. We were trying to get a bath seat lift installed, but the NHS will no longer provide one as we had to move his bed downstairs.

However the main issue is that he does not want a carer to wash him. All he will allow is for them to shave him. The woman who has been coming is perfectly nice and I don't think it's an issue with her specifically, he just refuses to accept that he needs help. And keeps insisting he wants a proper bath, even though we don't know if he can get upstairs.

He hasn't had a proper wash for weeks now, and although he does not smell, it can't go on for ever like this, it will be bad for his health. Anyone else been in the same situation found a solution? I'm desperately worried.

You cannot force him, maybe she could try with a top half wash first and let him do below waist,, is it a bedbath or is he able to sit out.m. is he still able to walk around, if he is bedbound the bed can go back upstairs. Did he not get bathed or showered in hospital.

He can sit up, and walk very short distances with a stick. But can't get up and down stairs. He walks to the kitchen for meals and the toilet.

In hospital he did not get out of bed for the 3 days he was in. He was offered a choice of the nurse washing him or doing it himself. He said he would do it himself then got in an awful tangle with the sheets. I don't think the nurses realised. I found the disposable toothbrush they gave him (although he had brought one with him, no-one asked) still in its plastic.

The carer seems very gentle and experienced and offered him a footbath, and he wouldn't even consider it.

I would try and get him to do it himself but move sheets/bedding out the way
Sometimes you have to be a bit.. as if they're an awkward toddler so less options and a bit no nonsense with it

"Flannel or sponge?"
"Here, I'll pass you the flannel and you can do your armpits while I get your feet in the bowl to soak"
Then it's distracting chat while you're helping and very matter of fact

It sounds awful written down but when I worked as a carer I could persuade anyone to have a wash! Once it's done, they realise it's not that bad, they feel better and it becomes a routine

I had someone who hadn't showered for a year as they were so self conscious about their body, and we got around it and they had a shower. Agreed on me turning round until they were in and I stood by the curtain handing them soap/flannel/towel etc

He sounds a very proud and independent man, it's hard to ask for help. Can he sink wash in the downstairs loo.

He has choices but they won't be as extensive as he wants. Presumably his bed is now downstairs as he can't manage the stairs. He has a choice to have his bed back upstairs. If he does, he might be eligible for a bath chair/board so he can carry out his own toileting and personal hygiene. The downside to this is he won't be able to access his kitchen. Does he prep his own meals, and do his own laundry?
Another option is he moves. He'd probably be eligible for social housing however if he owns his own property he'll need to sell up and use some of that income for rent and care. Maybe residential care is more suitable. Same consideration re finances.
The last option is he just muddles through till something goes wrong. Whilst as a relative the thought of him falling down the stairs or getting bedsides and infections is distressing, it might be something he considers worth the gamble to keep his independence. He's entitled to make decisions you disagree with. The bar for mental competency is does he understand the choices and potential consequences. Unless you can give him further information or are convinced he doesn't understand then the choices, good or bad, are his to make.

I would be tempted to ask for a male carer and see if that makes a difference.

Thanks all for the advice everyone. I should have mentioned he lives with my Mum who is quite a lot fitter than he is. She does all the cooking etc.

They have savings, so are using private carers. Mum did have a discussion with him at the start about whether he'd prefer male or female and he said female.

However he got on great with one of the male nurses in hospital and wished he could look after him at home. I think it's pride, rather than embarrassment.

He hates showers. He's really quite a difficult man and very set in his ways.

I'll try your method christmaspaws but it won't be a long term solution as I don't live very nearby. But maybe if he accepts it from me, he will come to accept it from a professional.

We struggled to get him to move downstairs - Mum does not want to be bringing meals upstairs 3 times a day - and the bathroom involves steps anyway.

Has he been assessed for a stairlift?

Yeah you definitely need a carer that can keep up with it. People respond to different things and it's just figuring out what works and what they prefer. A good carer can do that and lead someone to thinking it was their own decision

Stairlift not possible. Their staircase has 2 landings with turns on them.

Will maybe suggest trying a different care agency too.

Do they have a downstairs loo that could be turned into a bathroom for him?

You wouldn't need much space, walk-in, upright baths are very short, and much less expensive than installing a shower & pump.

Like this...https://www.jtspas.co.uk/caversham-right-hand-deep-soak-walk-in-bath-1210mm-x-650mm

What about one of those lifts that goes up through the ceiling?

@christmaspaws that is great advice! You are a fantastic carer.

Have you asked a stairlift company? My father’s stairlift had a right-angled bend near the top and a change in gradient near the bottom.

Advice about stairlift was from the council's OT. What company did you use MereDint, and were you pleased with them?

I'm googling lifts and stairlifts now. I had no idea there were so many options!

If he can't manage the stairs would have actually be able to get in and out of the bath safely ?

I was about to suggest a home lift - we're worked out where ours will go when the time comes. There may be a growing second hand market too.

You may find a local bathing service - we have a couple round here where there are accessible baths. One is in a day centre.

Suggestions are:

try another carer - as @christmaspaws says, normally it is possible, its about technique and persuation. for example, if someone is very resistant you can do a bed bath a bit at a time.

try a male carer - sometimes the mere fact of someone bigger and stronger is enough to persuade the patient to play ball.

I think one of the problems for relatives in this situation is that you have no education about what makes a good carer and its only when you've had a few trips to hospital, seen many different health care assistants and nurse in action and tried a few at home that you see the wide range of skillset. The very best are excellent, the worst are no better than an untrained person would be just 'having a crack at it'.

one of the problem with showers can be that the elderly esp those with dementia dont like stuff hitting their head from above that they can't see and cant easily control. so I wouldn't necessarily give up on having a shower attachment downstairs.

regarding lifts, if he is privately paying and can afford it you could try a stilz lift
https://www.stiltz.co.uk/

don't have one here but I know someone who did and was very happy with it.

I used a local firm that also did reconditioned stairlifts. So we had a new, specially fabricated rail (it comes in sections, so bits were specially done, bits were just straight rail) and a reconditioned Stannah seat. Can’t remember the cost, certainly below £3000, may have been below £2000. They got it in place on 23rd Dec, I placed the firm order on 20th.

The average stairlift has a life of not much more than a year, so reconditioned is a sensible choice. Ours lasted 3 months before DH went into a nursing home.

A good stairlift company will nearly always be able to find a compatible stair lift, however remember he will still have to be able to stand up from the actual seat part (these can be low), have good enough cognition to use it safety and if your mum is using 2 rails on the stairs they will likely have to remove one. This along with making the stair case narrower can add to your mums risk. Floor to ceiling lifts are great, but expensive.

How long has your dad been unable to manage the stairs for? Is there anyway that community physio could come in and practice them? Perhaps this way the carer could supervise him going down once in the morning and up in the evening?

Baths aren't the easiest to manage even with bath lifts. Lots of people strip wash.