Hygiene and Dementia

Not an easy caregiving task to accomplish. Doable. Just not easy.

For whatever reason dementia individuals are terrified of water. I know my own mom-in-law doesn't particularly like to even wash her hands.

And taking a shower? Ohmigosh.

And taking her teeth out to let them be cleaned? What she remembers is going to the dentist and coming out with no teeth.

Randy, my husband, usually has to catch her before she gets out of bed in the morning and can finagle her into the shower. He is not always 100% on getting her dentures out. Sometimes the best he can do is get her to brush her teeth and rinse her mouth out with mouthwash.

I remember meeting Randy at the hospital when she was released after her surgery. I got there just in time for her shower. He figured it would be easier to shower her there as they are equipped and there is more room in a hospital shower. For whatever reason, they had a male nurse in and out; this I do not understand. Even though a dementia patient usually loses all sense of modesty, this just seemed wrong to me. He, the nurse, also seemed less than effective. My mom-in-law was sitting there saying things like, "You know I don't have any clothes on." "Don't do this to me." "Why are you doing this to me?" Anyway, I got there in time to hear her screaming. While I do not relish the thought of seeing her naked, between Randy and I, and the absence of the male nurse presence, we got her showered and dressed, ready to go home. 

The fear of water to a dementia patient is very real. Something we do not understand and I suspect we never really will.

My sister-in-law recently took Faye (my mom-in-law) to the doctor within the last month as we have tried two caregivers to no avail and we needed to have her officially diagnosed with end-stage Alzheimer's. We have to work through the system. Fortunately, Faye was "misbehaving" so her new doctor could see her behavior. I say fortunately because it is important to note that sometimes a dementia patient acts just fine when they are out of their own home. Apparently, Faye called the assistant who took her blood pressure a "fucking bitch," which I totally believe. She absolutely HATES having that done. (My question has always been why do they pump the cuff so high to begin with?) Faye also seriously dislikes going into the small exam rooms and having the door closed. Her old doctor, who moved, was able to get her to cooperate for her blood pressure and took the fastest readings on planet earth. She would also let the door stay open. One time, she even examined her in the hallway! Anywho, not knowing the "rules" of how to get Faye to "behave" at the doctor ... she, Faye, has been diagnosed with end-stage Alzheimer's (which is good and bad) and supposedly has been referred to a caseworker.

The problem with that is the Kaiser system only does medical home care and not hygiene. Ummmm, hello? Hygiene is medically necessary. Why? If a dementia patient is not cleaned properly, or at least the best you can, they can get all sorts of infections, like urinary tract infections which can then lead to worse behavior which can then lead to trips to the emergency room leading to a hospital admission. Why, oh why does the "system" not see hygiene as medically necessary? I just do not understand this at all. What is the point of having a caseworker if they are not going to assist with hygiene, which is a HUGE, I mean HUGE, issue in the dementia world?

So far, though, our third attempt at a caregiver is working out. Granted, this is only week two, but she seems to be a good fit for both Faye and Les (her husband of almost 50 years). I know Les has been resistant to having someone in their home, but so far so good ... granted, it is only week two and she has only been able to get a shower accomplished once, but in those two weeks she has taken Faye to get a pedicure (which she seriously needed) and to get a haircut (which looks great!). Faye also had an accident at the restaurant today and Melanie apparently didn't make a big deal out of it, just took her home and got her cleaned up. A+ in my book.

The best way to deal with difficult behaviors, I think, is to STOP, I mean absolutely STOP, telling the dementia individual NO or don't do that or telling him/her he/she is wrong all the time.

Good example. Faye had her shirt on inside out the other day. So what?? She was up, dressed, and covered. Who cares? Les was telling her she needed to fix her shirt. First thing Randy told her was that her shirt was wrong. I'm like, "It's not a big deal. She's covered." Some things just do not matter.

An inside out shirt is so minor in comparison to what your loved one could be doing. Just go with it.