Poor hygiene and resistance to bathing or shower—presents a different kind of 'domestic' challenge. "My brother and I are at our wits end with this problem", writes an enquirer.
On New Year's Eve 2009 my mother, aged 79, had been found dehydrated and disorientated in the retirement village unit where she and my dad stayed together for 16 years until he passed away four years ago. She 'surrendered' her independence and moved into a room in a Home for the Elderly, with communal bathrooms. She has taken to washing at the basin in her room, arguing that her mother believed one can clean herself just as well with a small bowl of water than a big bath full. She added that at her unit she let the water run into a watering can until warm and watered the plants the next day. She further remarked that her wall mounted shower seat at home had been better. It came out at her eightieth birthday party that she is not bathing per se and I've been commanded to speak to the caretaking staff. The sister in charge was not in the least surprised. She remarked that they've not observed anything and that my mother's appears clean on her person—usually dirty hair or smell is the first giveaway if a resident does not bathe/shower.
Mother-in-law complained recently that her sister, of almost 90, lately smells when she visits. This prompted me to do a Google search, with 'elderly not bathing' appearing as a search suggestion when I typed in 'elderly not' and more than 1.5 million results.
One of the first results listed is a question "Why do so many elderly stop bathing and cleaning?" including the remark "but I have known many who, despite the usual aches and pains associated with aging, are able to bathe, but don't. I see this as a recurring theme with so many seniors, and I am wondering; Is it a matter of just not caring anymore, or is it a matter of being more trouble than the person thinks it is worth to hop in a shower for 5 minutes?"
On Aging Care.com—a virtual community for caregivers—one of 74 responses to "How do you get an elderly parent to take a bath or shower, when they refuse to do so?" (emphasis added) reads:
I am having to deal with my parents in the assisted living facility not bathing. For my dad its an issue of the dementia. I found that he responds to notes, so he is getting easier to deal with when it comes to showering.
However, the real problem becomes mom. For her it is an issue of control. First I dealt with her starving herself (she went down to 74 lbs at 5' 2") and now that issue is done (meds are great). Now she won't shower, which absolutely floors me. She has been immaculate all her life and bathed all the time. Now its definitely out of spite she won't do it.
My mother in the past 6 months was admitted twice to geriatric psych and was diagnosed with "extreme severe depression". It was not because she was lacking, I had an attorney around, doctors, etc who diagnosed her as competent.... it was on purpose (not the depression). Every decision she made she was coherent to a certain level, but I had to give the "okay" she could make those decisions. Its weird. Mom still cannot admit that dad has Alzheimer's and it has made her daily life extremely difficult, and one that has left her totally out of control.... so now the control is down to bathing.
I went to go have a talk with mom because the assisted living kept calling me to talk to her and mom doesn't listen to me. Actually if I say anything, she digs her feet in harder not to do it. So I went to talk to mom and basically told her that the facility was getting an audit from the health department checking records and that she was marked down as not having one for months. Mom got ticked off with me, said a few nasty things and threw me out of her apartment.
I don't know what I'm supposed to do. According to the geriatric psychiatrist, I'm supposed to give mom consequences for her behavior (one's I can live with), and now I'm having to play hard ball. I don't like it one iota.... but she's backed me into a corner. Anyone else have this kind of issue? As of this posting the nursing administrators believe she has taken a shower, but we're not sure how frequently they will happen. They want her to take one a week. Am I the only one that is ready to scream?
Tips for caregivers of the elderly contains a post in this regard, which states (emphasis added):
As individuals begin to age and their health starts to deteriorate family members may see a dramatic change in hygiene habits. Things like changing their clothes on a regular basis, bathing, combing or fixing their hair, lack of make up for the ladies who always fixed themselves up may start to show up in little ways. It starts with the notice that grandmom or mom didn't put her lipstick on today or her hair is not fixed well. When you ask about it, the answer you may receive is oh I just didn't feel like it today. If that answer seems odd to you, it should, there may be something going on that the person is not sharing.
Things like eye sight worsening, arthritis acting up, a physical pain in the body or possibly the beginning stages of memory impairment may be occurring. Often what happens is the person starts to rationalize their behavior or lack there of by making excuses that are in general terms such as just didn't feel like, didn't have enough time, etc.
Like anyone who would say that to you, you want to give the person the benefit of the doubt but you should keep an eye to see if it happens again, the frequency of how often and if there is a pattern to it. Maybe it is only on rainy days when the person's arthiritis is acting up and causing the person much pain. The person may not tell you how bad the pain is. The key to identifying if patterns of behavior are changing is to watch, listen and document. Keep a little note on your calendar at home or in your wallet, this date, saw mom and hair not done, said didn't feel like it. This documentation may come in hand later to show a doctor the patterns or to determine how and when possible memory impairments began.
Reference is made to the start of memory impairments because often people who begin to suffer from dementia can lose the sequencing or patterning of how to do a certain behavior. He or she may not remember the steps of how to put lipsticks on, throw a possible eye sight problem on top of that and the person will just stop putting the lipstick on completely. It is much easier to just generalize and say oh I don't feel like it than to verbalize they are scared that something is wrong and they can't remember the steps of how to do it or see it.
Bathing is often a behavior that memory impaired individuals will not do. They resist the bathing or showering completely, often becoming angry or aggressive if you bring it up. This can be a combination of many reasons why. Again they can forget how to do it, be ashamed to let anyone see them without clothes, not be able to see the depth of the water in the tub, as a clear water against a white tub bottom and poor eye sight is a dangerous combo, if you can't see how deep, you won't get in, thinking you might drown, putting a color on the white bottom like dark blue mat sometimes helps if it is an eyesight problem, getting in and out of the tub physically can be a major problem for people so they stop doing it because it hurts too much and causes them pain. There are many reasons why people will not bathe. Sometimes we want people to bathe on our schedule in the morning when in fact they bathe all their life in the afternoon or evening and for memory impaired individuals who are actively reliving the past, they know they bathe in the evening. If you force them to do it at another time, they will resist. Sometimes sponge bathing is your best answer and showering with a shower chair, safety bars and a hand held shower piece can be done once a week.
Changing clothes often becomes an overwhelming experience for people as well. They will wear the same clothes for several days or wear only like 3 outfits when they have tons of clothes to choose from. We need to remember the goal is to keep people clean and healthy. If we can get a sponge bath and clean clothes whether it is one of the 3 outfits they always wear, they are bathed and clean. Keep your expectations low. They don't have to wear all the clothes in their closet, they just need to be clean and healthy. Let them wear what they want as long as it is clean.
When you find yourself getting overwhelmed and frustrated, it may be time to bring in outside help. Often people respond to the aide who comes in to bathe them and they will do it for the aide because she is coming specifically to do it and leave. Sometimes the person sees the aide as an authority figure and will comply with the request of the aide to bathe. It is worth a try to see if it works. We need to be creative with our elderly folks not manipulative. Try different things to help them stay healthy and clean. Keep your goal and expectations for them low. They do not live their lives like younger people. Poor eyesight, aging, pain, physical disablity can make anyone feel like why bother putting the lipstick on. It is easy to rationalize it away. Aging is a process and we need to go through the process with them on their terms not ours. For more information, go to www.comfortkeepers.com
It is evident that resistance to bathing or showering a common phenomenon among elderly persons.