How do you tell someone that they stink? UPDATE POST #27 - Mothering Forums

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#1 of 32 Old 03-12-2007, 11:09 AM - Thread Starter
 
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My MIL lives with us and her personal hygiene is lacking. I don't know how to approach the topic with her without terribly upsetting and offending her.

She moved in with us due to her poor health last year. When she moved in I went to the store and bought her all new toiletries- new soap, toothbrush, toothpaste, etc. A year later they're still all barely used.

She hasn't showered in months- she just wipes herself down with a washcloth from time to time and washes her hair in the sink. This is horrible and I don't know how to put it delicately, but she smells like rotten, dirty crotch. I first noticed that after she came out of the bathroom the smell would linger for quite a while. Now it has gotten to the point where I smell crotch just walking past her, or sometimes just being in the same room with her. The few times anyone has said, "MIL, have you taken a shower lately?" she just replies with a cursory "I'm fine."

I do all of the laundry and in the past year I've never washed a single bra or pair of underwear. I think she wears the same Depends for days if not weeks on end- she only asks us to buy her new ones once every few months and there aren't that many in a package. In addition, I never see them in the trash when I empty it- so it all leads me to believe that she's wearing the same smelly adult diaper for long periods of time.

She has teeth that are literally rotting in her head and she REFUSES to go to a dentist- we've made her several appointments and have had to cancel them all. The toothpaste that I bought her a year ago is more or less untouched.

Dh refuses to discuss this with her and says that I have to do it- he freaks out and doesn't want to talk about his mother's rotten crotch smell. Understandably- what son wants to discuss his mom's stinky privates? And since I'm the only other female in the house, it all falls on me.

In addition, she only changes her clothes once or twice a week at most. She even sleeps fully dressed in her clothing. Outwardly, she has a relatively clean appearance (she's careful not to spill food on herself to keep her clothes clean, combs her hair, puts on earrings, etc) but beneath it all she is really dirty.

Physically, MIL is 100% capable of bathing herself. She does not need a home health aide or anything like that- she just lacks the motivation. Yes, she has some serious depression issues, but refuses to get treatment (we've even taken her to the dr. specifically for this and she refuses to discuss it).

The crotch smell has gotten so bad that I can't stand it anymore, but I loathe to say anything to her about it. How do you even begin to broach such a senstive topic with someone who is prone to getting very upset and offended by any mention of her lacking hygiene?

Any suggestions would be greatly appreciated.
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#2 of 32 Old 03-12-2007, 11:14 AM
 
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Could you call and set up an appointment with a doctor (general practioner) for her for whatever reason and then call him/her in advance to voice your concern about her lack of hygiene and ask him/her to raise the issue with MIL?
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#3 of 32 Old 03-12-2007, 11:37 AM
 
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take her swimming

lots of gyms have warm water therapy/excercise classes.

(I'm awful on confrontations )

mom to 14yr dd and 4yr dd
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#4 of 32 Old 03-12-2007, 11:39 AM - Thread Starter
 
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Originally Posted by chel View Post
take her swimming

lots of gyms have warm water therapy/excercise classes.

(I'm awful on confrontations )
Like many people in her generation, MIL never learned how to swim and is PETRIFIED of water. She won't get into anything that is more than shin-deep. Good idea though...
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#5 of 32 Old 03-12-2007, 11:42 AM
 
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I don't know where you are, but if you have some agency that comes in to assess people on their mental health issues and put in place a plan for change, I would call them. We have one here in Canada but the name escapes me for some odd reason. I would think that confronting her, gently or otherwise will be pointless, since it seems her problems run far deeper than just nudging her into the shower.
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#6 of 32 Old 03-12-2007, 11:55 AM
 
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I don't know how old she is, I've worked with elderly who were just like that though. How about each day you could try to lay out her clothes and then say a simple "I've started you're bath, let me know if you need anything". You might have to be sneaky and take her clothes to wash if she ever takes them off. Just laying out clean things with a clean towel and wash cloth for her might encourage her. Otherwise maybe say "I notice you haven't changed clothes/washed/needed any supplies lately, do you need help getting washed up? Is there something you are missing that you're used to having?" Hugs to you, what a tough situation.
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#7 of 32 Old 03-12-2007, 01:24 PM
 
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Wow, your post is so familiar. It really describes what it has been like with my Mom since she had her stroke at the very end of July, 2006.

Her stroke hit the cognitive/memory part of her brain. No paralysis or speech or physical problems. She talks and moves and everything like she used to (memory lapses, though). Anyway, Mom was always a very neat and clean person prior to this happening. She took a bath each evening and, sometimes, each morning, as well!

Since the stroke, nada on the bathing. She has no memory of not bathing. She is in an assisted living residence and they have trouble getting her to bathe as she will not allow anyone in the bathroom with her. She also has some minor incontinence difficulty (some leakage if she doesn't get to the bathroom fast enough, stroke-related).

The great caregivers at the residence now take her daily clothes away and launder them each night and lay-out her fresh clothes each morning (they have to do it this way as she was putting away her soiled clothes everynight. She didn't even realize they were dirty). They really take care to choose nice combinations for her. They also put a mini-pad on top of her underwear each morning (Mom puts it in her panties herself). She dresses herself without difficulty and functions fine other than this problem.

It's not that she doesn't want to address this or talk about it, she simply is unaware of it. So, whenever she visits our home (a couple of times a month), I run her a hot bath twice a day and she soaks, blissfully, for an hour each time. The residence doesn't have bath TUBS, only a shower in her bathroom. Mom has always been a BATH person. She has a really bad back and knees, and the soaking feels so good.

Is your mil a bath person? Could it be she realizes she cannot get in and out of the tub by herself and doesn't want anyone to help her (being naked and having someone else touch you in your private areas is an incredibly vulnerable and unpleasant feeling). She may not like showers and so doesn't bother with them.

And, she always got her hair "done" each week for 50+ years. She never shampooed her own hair. Now I take her to the beauty salon and she gets it done twice a month. At age 86+, her hair can go that long between washings!

Quote:
She does not need a home health aide or anything like that- she just lacks the motivation.
That isn't necessarily true. I would recommend that she be evaluated for a stroke. She may have no idea that she is ignoring her own hygiene. You said she moved-in because of poor health. What was/is wrong?

She (and, you) may need a home health aide to come in and help her with her daily personal care. If she is aware of her difficulties, she may be too embarrassed to discuss them with you! She may not want to admit she needs help. You said she replied in a cursory manner "I'm fine" when you asked when she had last showered. This could be about her feeling a loss of independence ("Crap, she's telling me I smell. Do I now need to have someone help me bathe or wipe myself?!").

A home health aide can bring this up with her in a private conversation. It is always easier coming from someone OTHER than a family member!!!

Oh, is she on any medications? Often, meds will affect the elderly differently than a younger person. If she IS on meds, they may be affecting her cognitive reasoning. Please take her to see a doctor that specializes in geriatrics (a naturopath would be great). Also, if she is on meds, talk to the pharmacist about her behavior. Many times, pharmacists can tell you more than the physicians!
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#8 of 32 Old 03-12-2007, 01:25 PM
 
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As someone else mentioned, it sounds to me like this goes far beyond "telling her she stinks." I don't know that doing so would help much. It seems like this is more a mental or emotional issue. I second the idea of getting her to a medical professional.
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#9 of 32 Old 03-12-2007, 01:39 PM
 
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Wabi Sabi, I remember your other post. Do you have any state or county resources geared toward seniors that you can call for advice and help? The white pages might be a start. I know that in California if you cannot care for yourself, you can be admitted involuntarily to a psych hospital. I'm not advocating that of course, but something REALLY has to be done. NOW. You and DH could even be held as being negligent, which I know you're not, but it could come to that. I'm not trying to scare you or pass judgement, because I know both of you have tried everything under the sun and it has been so hard and it's really affecting everyone negatively in the whole family. I think Graham'smom really had some great ideas.
It may take time to get the resources your MIL/family needs, and you may have to fight through a lot of red tape. Good luck, please keep us updated.

P.S. I found these on the internet. Maybe they can offer better support or ideas.

http://www.caregiverstress.com/

http://www.help4srs.org/

http://www.seniorcitizensbureau.com/
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#10 of 32 Old 03-12-2007, 01:42 PM
 
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How is she physically? Can she get into and out of your shower on her own?

With the Depends, maybe she views incontinence as shameful and doesn't want to acknowledge having accidents as frequently.

The home health care person would be a big help. I'd also, right now, ask her if she has any clothes to be washed, that you haven't seen very many of her clothes and you're worried that she's trying too hard to make things easy for you.

Maybe you could enlist your kid's help "Grandma, brush your teeth with us?" And if she says she already has, you could encourage her to do it twice for the kids' sake.
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#11 of 32 Old 03-12-2007, 01:46 PM
 
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That's a very common sign of depression in the elderly, also. I agree that she needs to be evaluated. Mild previous stroke, mild dementia, medication interactions, and infection (bladder infection in particular) can also cause that.

Shannon, mama to Jack :
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#12 of 32 Old 03-12-2007, 01:56 PM
 
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Quote:
Originally Posted by grahamsmom98 View Post
That isn't necessarily true. I would recommend that she be evaluated for a stroke. She may have no idea that she is ignoring her own hygiene. You said she moved-in because of poor health. What was/is wrong?

She (and, you) may need a home health aide to come in and help her with her daily personal care. If she is aware of her difficulties, she may be too embarrassed to discuss them with you! She may not want to admit she needs help. You said she replied in a cursory manner "I'm fine" when you asked when she had last showered. This could be about her feeling a loss of independence ("Crap, she's telling me I smell. Do I now need to have someone help me bathe or wipe myself?!").

A home health aide can bring this up with her in a private conversation. It is always easier coming from someone OTHER than a family member!!!
: I think she needs to be evaluated.

This must be a very tough situation to deal with.
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#13 of 32 Old 03-12-2007, 02:06 PM - Thread Starter
 
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Originally Posted by grahamsmom98 View Post
That isn't necessarily true. I would recommend that she be evaluated for a stroke. She may have no idea that she is ignoring her own hygiene. You said she moved-in because of poor health. What was/is wrong?
<snip>
Oh, is she on any medications? Often, meds will affect the elderly differently than a younger person. If she IS on meds, they may be affecting her cognitive reasoning. Please take her to see a doctor that specializes in geriatrics (a naturopath would be great). Also, if she is on meds, talk to the pharmacist about her behavior. Many times, pharmacists can tell you more than the physicians!
In a rush right now, can't elaborate all that much but briefly- she moved in with us following two back-to-back strokes. There doesn't appear to be any residual physical affects from the strokes, but some language and cognitive issues...fairly mild though. More than anything they seem to have affected her mood/drive/motivation, understandably so to a certain degree.

And yes- lots of medications (all but once she has taken for years prior to the stroke) for her diabetes, high blood pressure, cholesterol, water retention, cancer, etc.

Also, I asked Dh and he said that he suspects that she never bathed even before her strokes- that she's always prefered to just give wash herself with a washcloth.
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#14 of 32 Old 03-12-2007, 02:23 PM
 
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I know of people who wash with a wash cloth and get clean just fine. So she must be missing a few important parts when she does her washing. Maybe she just washes her face?
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#15 of 32 Old 03-12-2007, 03:37 PM
 
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I don't know where you are, but if you have some agency that comes in to assess people on their mental health issues and put in place a plan for change, I would call them. We have one here in Canada but the name escapes me for some odd reason. I would think that confronting her, gently or otherwise will be pointless, since it seems her problems run far deeper than just nudging her into the shower.
That may or may not fix the problem, though. My MIL's mother had a stroke a couple of years ago, and is suffering from early alzheimers. Her personal hygiene is horrid. My MIL had her assessed after her stroke, and she was quickly moved from her apartment, into a retirement home. The situation has gotten much worse. My MIL often has to sneak her mother's clothes out of the closet to have them cleaned. When the grandmother stays at MIL's house for visits, I can't stand to be near her, the stench is so horrible. MIL has tried to talk to her about the importance of bathing many times, but the woman just gets SO offended and angry.

I'd suggest definitely having her evaluated, but going into it knowing that an evaluation isn't going to fix the problem. Even if a professional tells her that she needs to take care of herself, she may not be willing (or even care) to do it.
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#16 of 32 Old 03-12-2007, 03:47 PM
 
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I'd suggest definitely having her evaluated, but going into it knowing that an evaluation isn't going to fix the problem. Even if a professional tells her that she needs to take care of herself, she may not be willing (or even care) to do it.
You're right than an evaluation may not fix it, but it may identify the issues at play and if they are serious enough to require intervention such as, but of course not limited to, finding her incapacitated and unable to self-direct her affairs, such as those related to personal hygiene.

I know this because I went to hell and back with my mother when her dementia, later diagnosed as Alzheimer's, nose-dived and I was unable to convince her to do anything. At that time (early 2000) we didn't have an agency that assessed people, or at least they weren't advertised, so it was an absolute nightmare getting services, because she needed them, whether she wanted them or not.
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#17 of 32 Old 03-12-2007, 03:56 PM
 
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Perhaps if you tell her that you'd like to take her shopping on a "pampering spree". Take her to a store where you think she'd enjoy (Body Shop, Aveda, etc) and tell her that she can pick out shampoo; shower gel; deodorant, etc. Make it sound really exciting. Tell her how you love how it feels to use nice smelling products and that you'd love for her to feel pampered too. Then, make sure that she gets to shower first when you both get home.
I've actually had to deal with this in a man. My ex husband. He never bathed. It was so disgusting. I had to do all those tricks and more to get him to bathe.

Good luck!
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#18 of 32 Old 03-12-2007, 03:59 PM
 
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Oh, and maybe have her pick out an inexpensive nightgown or pajama's at Sears or something. She can put those on after her shower and you can gather her laundry while she's in the shower.
And may I suggest that you stock up on Depends and show her that you have plenty for her so she doesn't have to worry about conserving. (maybe, in her mind, she feels badly about you guys buying her disposables.)
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#19 of 32 Old 03-12-2007, 04:00 PM
 
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You are in a tough situation for sure.
I agree that a medical evaluation would be a good first step.
She may be unaware of the issue due to the strokes or possible dementia, as others have mentioned.

Are you willing to help her bathe?
If not, maybe she would agree to having a home health aide come in once a week to help her take a proper bath or shower. She may be embarrassed to have close family doing it.

They sell shower chairs at pharmacies and medical supply stores, the person can sit on it (the seat is like a plastic donut with a hole in the middle) and a hand held shower sprayer can be installed in the tub so the person can wash themselves. This avoids having to stand in the shower which can be very tiring for some people with disabilities. Also they don't have to get down into the tub, and have trouble getting back up.

At the very least (and something you could try now), you could get a sitz bath for the toilet, it fits right in under the toilet seat and is designed to bathe/soak the genita and rectal area after surgery, childbirth, hemmorhoids etc. When you get up you simply dry yourself off with a towel. You could fill it with warm soapy water, leave it there for her, and try to get her to soak in it each day.
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#20 of 32 Old 03-12-2007, 04:30 PM
 
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Quote:
In a rush right now, can't elaborate all that much but briefly- she moved in with us following two back-to-back strokes. There doesn't appear to be any residual physical affects from the strokes, but some language and cognitive issues...fairly mild though. More than anything they seem to have affected her mood/drive/motivation, understandably so to a certain degree.

And yes- lots of medications (all but once she has taken for years prior to the stroke) for her diabetes, high blood pressure, cholesterol, water retention, cancer, etc.
She most certainly needs to be seen by her doctor (it may also be time to see a NEW doctor) as to her condition and the seriousness of this. She may have had additional brain bleeds. DO NOT allow her doctor to blow this off as "to be expected". THIS IS SERIOUS!!

And, the time may have come to re-evaluate those medications and decide which ones she really needs to be taking.

My Mom was put on a bunch of meds right after the stroke. They put her on cholesterol meds, blood pressure meds, aspirin therapy, anti-depression meds, laxatives, stool softeners, vitamins and antacids. She took NO medications prior to the stroke and they had her on over 21 pills a day within 2 days of being hospitalized!

I did my homework and researched these meds (I'd asked for a complete list of what she was prescribed, you should have seen the confused look on the hospital nurse's face : ).

I found some really scary stuff. Contraindications of drug-to-drugs she was on. Ingredients that could actually add to her problems (aluminum-based antacids + active dementia? No-no-NO! ). Two different laxatives that actually stated they should NOT be used concurrently (yet, she was getting them twice a day!). :

I took her to the follow-up appointment after her release from the stroke rehab clinic and told them that some meds HAD to go and WHY:

Mom was having diarrhea from the laxatives and stool softeners, and developed a terrible rash around her anal area because of the irritation (however, she was too embarrassed to say anything until she told me, in tears, about how bad it hurt "there". (I had to ask her about it!). She'd never taken a laxative in her life. NO MORE laxatives/softeners.

Some of the meds were contraindicated with each other (if I hadn't done the research into what she was getting, it would have been bad). When I brought this to the doctor's attention, he sure looked surprised that someone would know this. Duh, read the inserts and PDR! NO MORE anti-depressants.

She's never had any digestive problems and didn't need antacids. NO MORE Tums and Prevacid.

The cholesterol meds were causing the same muscle pains they had caused when she took them years ago (and quit because of it). NO MORE.

She has never had high blood pressure. NO MORE.

She was experiencing bruising from the lightest touch. NO MORE aspirin.

Most of these were simply preventative and standard procedure for elderly patients on hospital admission. : So often, this begins a terrible spiral that only goes down for the elderly.

She immediately (within a couple of days) began to feel better as soon as "we" discontinued all those pills and her system cleared all that stuff out of her.

The doctor(s) state that these meds might add a year or more onto Mom's life. Her reply: "I am 86. Why is that important? All the women in my family live to 100 or beyond. And, they did it without pills. I intend to do the same. I want off!" That was that! (I love you, Mom!)

My Mom now takes 1 multivitamin a day. That's it. We have talked about it. At age 86, she doesn't want to start meds.

Though your mil may have been on her meds for years, she needs to be re-evaluated on these. The elderly react to meds differently than younger people (this includes those in their 40's, 50's & older!). Has she lost weight in the past year? Then her dosages need to be changed. Too often, the elderly are dosed the same way a younger, heavier person is. You can't expect a 100 lb. 80 year old woman to react the same way as a 200 lb. 30 year old man to the same drug!!

Quote:
Also, I asked Dh and he said that he suspects that she never bathed even before her strokes- that she's always prefered to just give wash herself with a washcloth.
Well, old dogs CAN learn new tricks and, sometimes, need to! But, again, that may be better coming from an alternative care giver, not her daughter-in-law.

This is no longer a personal care issue, but a health issue.

She is at-risk for infections with this lack of cleanliness. Bladder and vaginal infections result from lack of cleanliness. As another poster said, bladder infections can cause dementia. If she is diabetic, it is even more serious. Her lack of this kind of hygiene could cause VERY serious problems.

She needs to see a doctor. NOW.

Keep posting here. YOU need support, too!
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#21 of 32 Old 03-13-2007, 02:05 AM
 
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ooh sticky situation i do agree with having someone evaluate her tho! good luck to u mamma!!!
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#22 of 32 Old 03-13-2007, 02:24 AM
 
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Wabi Sabi- I am nominating you for sainthood-you are truly an Angel!!! What a hero you are in my book!
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#23 of 32 Old 03-13-2007, 03:48 AM
 
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Having her evaluated and telling her doctor your concerns is a good first step.
And I agree that you may have to step in and actually do everything step by step for her. Like lay out her clothes, have set shower times, etc..

Good luck and ((hugs)).

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#24 of 32 Old 03-13-2007, 09:37 AM
 
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i am a nurse in a nursing home and we have several patients who resist bathing and having their depends changed. (one who sounds ALOT like your MIL, always looks nice, keeps her clothes clean) what works for most of them is to say, first thing in the morning, at 2 we are going to do your bath, then remind then every hour or 2. once they get their clothes off, whisk them away and lay out clean ones. its worth a try.
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#25 of 32 Old 03-13-2007, 09:52 AM
 
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Does she go to the doctor? If so take it up with him.

Then look into social services. Does she get out an socialize? If not find her a social circle it might motivate her to bath.
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#26 of 32 Old 03-13-2007, 11:41 AM
 
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When I worked as a nursing assistant, I saw this situation a lot. What I would do is not ask questions or give open options. For example, I would say "I'll come and get you for your bath at 9:00. Does that conflict with your schedule?"
If it was a problem at 9:00, then I'd give the option of 10:00 or 11:00. I would NOT give the option of no bath. If the person smelled, I just kept everything matter-of-fact "We need to make sure your bottom gets clean to prevent infection".

My Nana was living at home alone and reusing her Depends. She hung them to dry and reused them. Now she has an infection so bad that she has to be on antibiotics for the rest of her life.
Definitely get outside help if you don't think you can handle it alone.

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#27 of 32 Old 03-14-2007, 06:44 PM - Thread Starter
 
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I made MIL an appointment with the family doc for today- and she refused to go. Said that she (the doctor) "don't know anything."

So, I went to the appointment myself and spoke to the doctor who said that because of MIL's issues (history of cancer, diabetes, strokes, high blood pressure, 5 heart bypasses and more) she really needs to be seen at least once every 3 months for monitering. The doctor also acknowledged that MIL won't speak to her during her appointments and therefore the doctor can't really do much.

After discussing some of her issues (lack of hygiene, lack of motivation, incredibly poor diet in spite of her diabetes, very sedentary, refusal to participate in any social activities, etc) the doctor said that we really need to get her in for an evaluation with either a psychiatrist or neurologist for an assessment to see if we're dealing with depression or possibly early stage dementia.

Since MIL refuses to even see the family doctor, we agreed that there's no hope in trying to get her to a psychiatrist. I am going to try to get her in to see a neurologist and just tell her it is follow-up for her strokes.

In the meantime, I'm also going to call her old family doctor (who she saw for several decades before moving in with us) to see about taking her in to see him. He is in a different town and driving there on a regular basis would be impractical, but maybe if we go back to see him just this once she'll be able to talk to him since she already has a long-established relationship with him. I called today, but the office is closed so I'll have to call back tomorrow. I'm really hoping that I can still get in to see him sometime this week while I'm still on spring break- it will be hard to drive her to the other town once classes start back into full-gear next week.

I have got to make *something* happen- both for her health and for my sanity.
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#28 of 32 Old 03-14-2007, 06:57 PM
 
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That sounds like a difficult balance. I hope she agrees to see the other doctor.

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#29 of 32 Old 03-14-2007, 07:14 PM
 
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You are a great DIL! I hope your husband appreciates all the trouble you are going to to help his mother. I would be inclined to tell him he needs to talk to his mom and tell her she has to go to the doctors appointment. I know no one likes to treat their parent like a child but sometimes it has to be done, for their benefit.
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#30 of 32 Old 03-14-2007, 07:38 PM
 
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Wabi~If you're going to be this woman's health care person - your family because you can't afford professional care, you personally because your husband "won't discuss mommy's crotch" (grow up! you were borned outta there!) YOU need to STEP up and do a good job of it. I know it's not what you want, but it's your job.

My suggestion is to join a support group for caregivers - to get support and ideas.

Also, at this point, her health is at serious risk. She could die from the rash and subsequent infection. I have cared for a demented person. I know about the "seems like himself/but totally off" decline of someone with brain damage. But you are *almost* abusing this woman. Imagine it from an outside perspective. Think of the sores on her genitals and explaining to someone that you let her wear the same diaper for weeks at a time, and unwashed clothing - because she wanted to...

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