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My elderly brother lives at home, has had a stroke and has been determined to be competent to make his own decisions. He has a daily caregiver.



Unfortunately he refuses to shower, we have tried everything, and I mean everything to get him to do so. We have remodeled his bathroom, added heat, installed an expensive new ADA toilet with bidet, had home visits from OT and PT to evaluate and make suggestions, which we implemented. We have even offered him cash to shower. His doctor put him on antidepressants.



The problem is that he gets covered with feces. We are at the point of telling him we will not take him anywhere in public or allow his grandkids to visit unless he showers and changes his clothes since he is in fact a health hazard.



We have been turned in to Senior Services for neglect, but it's not our doing. Any additional suggestions?

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The OP's brother has been deemed to be competent to make his own decisions. It doesn't matter whether he's at home or in a facility, no one can make him take a shower.

The OP doesn't say what reasons he is putting forward, but there's nothing for it but to find them out and address them.

What was the outcome of the Senior Services' investigation, RuthGrace? Did they come up with any ideas?
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Beatty Jun 2022
"It doesn't matter whether he's at home or in a facility, no one can make him take a shower". True.

However, the mere presence of 2 caregivers can sometimes cause a change of mind..

My Doctor said "people reserve the right to rot. And some do just that".
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Is the daily caregiver not up to the task of cleaning or showering your brother? That seems like an important part of care.
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Beatty Jun 2022
Even the best caregivers cannot always convince a completely unwilling person.

The Bribe: 'hot cuppa will be waiting after'

Stealth: since you are in the bathroom, let's wash your face & hands. Oops! Your shirt got wet. Better change it. While you are here let's wash under your arms...

Tough Honesty: You smell bad. Let's wash right NOW.

Used ALL these before but then sometimes still failed..

When person had been covered in poop, baby wiped but still refused proper bathing I told their Doctor on next visit. Dr dx Anosognosia & said supported living was required.
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Try wipes for most days and focus on "airplane bath" -under the wings" (armpits) and "under the tail" (bottom areas). Save full baths or showers for "full mess" situations. He may have to be told firmly, "You have poop on your ______ and we need to clean that off in the bath/shower." While cleaning off the poop, get the rest cleaned as well. He may need to have a home health aide come by a few times per week (daily would be better) to actually bathe him since this task may be a bit beyond his abilities.
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Wheel him outside and have the garden hose ready, similar to how the heavyset lady cleaned herself on "My 600 LB Life"
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RuthGrace: He may require managed care facility living. His "living at home" may have to come to an end if he continues to refuse cleanliness. Not to mention the malodor, but also he is at risk for getting skin infections.
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The bigger issue is competence. He may have been declared competent on the past, but a person who refuses to bathe, even when covered in feces does not
appear to be competent. I would suggest having his competency revisited.
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pick the time your dad usually showered. possibly in am. tell him you will make him a cup of hot coffee when he gets out of bathing. My husband will take a shower if the coffee is offered. instead of every day try every other or a few times a week. as they get older people don't bath every day. Sometimes a good bed bath is just as good with something like Irish Spring body wash.
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Have you offered himself showering assistance with a male caregiver? The problem could be as simple as he is modest and doesn't want to be helped with showering by a female.
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What are his reasons for not showering? Can he verbalise them to you or to the caregiver?

Either use a soft or hard approach.

Softer: My relative had answers like Too Cold, Too Slippery. When delving more, a bigger picture emerged. It was #1. Fear, followed by #2. Discomfort. #3. Pride, at not wanting any help.

A combination of an experienced, confident regular caregivers, warmer bathroom, plus compromise worked.
Eg 7 showers vs zero = compromise for 3 x week.

Another however had bigger self-neglect tendencies + lack of insight (Anosognosia).

This required a harder approach. A simple choice: shower at home (with an aide) or in a NH. Your choice. But you DO need to shower.
Refusal of necessary hygiene at home will result in NH placement.

Soft plan A, harder plan B.
Good luck!!
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I'd get brother placed into a Skilled Nursing Facility under Medicaid and they will see to it that he's showered on a regular basis. APS will see to it that he's placed against his will if he continues to refuse to shower and is covered in feces b/c that is definitely a health hazard to everyone who lives in your home. Strokes can cause brain damage that mimics dementia (or IS dementia, at this point) and many folks with dementia refuse to shower.

Let your brother know this is the next step in his living arrangements once APS gets involved, so he may want to take a shower NOW in an effort to ward off what's coming next. I don't know if he'll understand what you're saying, but it's your last ditch effort here!

In the meantime, watch a few Teepa Snow videos on YouTube about bathing dementia elders; she's very good at showing you exactly how to approach the person, what mannerisms to use, words to say, etc. which may help you get him into the shower. Perhaps you and his caregiver can do it together, IDK. You have to assume fear is at the root of his refusal to shower; do you have a hand held shower unit, since many elders are fearful of standing under the sprayer? Are all the safety bars installed to make him feel secure in there? My mother was petrified of the 'slippery' shower floor, so I bought her a pair of water shoes you'd wear at the beach, and that did the trick for her. If you can find out WHY he's refusing to shower, that could prove helpful in your quest to get him in there to begin with! Many elders think they 'just showered' a few minutes ago, so memory issues are the problem for some.

You may want to read this 33 page booklet about dementia which does discuss bathing:

Understanding the Dementia Experience, by Jennifer Ghent-Fuller 
https://www.smashwords.com/books/view/210580


Best of luck with a very difficult situation.
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As long as he's not violent (maybe he's just complaining, mad, says things) - as long as his resistance is just verbal - then force him.

My friend's LO must be forced (he's not violent; just verbally upset). The caregiver forces him, takes him out of the bed, into the wheelchair, and brings him to the shower.

But I guess you must have tried that.

Another point: my friend's LO will not listen to family, but he will listen to a caregiver. He'll be much more cooperative, willing, with a caregiver. But I guess your daily caregiver already tried that with your brother.

How about, the caregiver (it's always easier for a LO to listen to a caregiver), offers your brother his favorite treat (potato chips? candy? a yummy donut?) for every step he cooperates with: step 1 (get out of bed) (donut), step 2 (move towards the shower) (another candy), step 3 (get wet in the shower)...will get candy later, etc. But I guess you already tried that, since you said you tried all sorts of rewards (cash, etc).

Bring a model-looking woman over, and explain to your brother that the model wants him to look/smell good? Or some similar idea: the point is, some incentive where your brother would want to look/smell good, and would himself be embarrassed not to look his best for X person.
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Cover999 Jun 2022
Donut? Not healthy.

He's probably scared of the rushing water coming out of the shower head,
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