Changing Clothes

One hot topic that pops up all the time on caregiver forums has to do with bathing and changing clothes.  It’s one of those things that, no matter what, will become an issue for every person with dementia.  They will get to the point where they don’t bathe and will not change clothes.  They may change into pajamas at night but even so, they will put on the same daytime clothes day after day.

You may think that’s horrible and wonder how they could stand to do that.  The truth is, they forget how to bathe and, if their closet is full of clothes, they can’t make a choice regarding what to wear.  It is easier to stay in the same clothes.

So, you might think that someone needs to help them if they don’t know how to do it.  That brings in another can of worms!  The person doesn’t know that they are having a problem and if you try to call attention to it, you experience a “catastrophic response” (tantrum) caused by not understanding/remembering what they have to do to accomplish a bath and changing clothes. 

I struggled with those tantrums for a couple months but after reading The 36 Hour Day and reading suggestions on the forums, bath time has become fairly easy.  That’s not to say there won’t be an issue here and there but for the most part, every Thursday we accomplish washing her hair and the bath.

It’s interesting that some folks on the forums are quite upset if bathing doesn’t happen on a daily basis.  Others think every other day is a must and some, like me, settle for once a week.  I know this all depends on the person because each person can become “ripe” at different rates.  At 94, Mom does not sweat and, in fact, is usually bundled up even in the summer.  She is not yet incontinent but we use Depends because her habits are not what they used to be and they help also.  So, at this point, once a week is good.

Then there is the question of changing clothes.  Like the bathing, we’ve gotten into a routine.  Every day I change the Depends for her and put lotion and fresh socks on her feet.  That goes like clockwork now and she never balks at it.  Even though she has fresh Depends and socks, Mom would wear the same clothes every day if I let her.  That’s where my decision point comes in.  I won’t let her wear the same clothes all week between baths but how often?  I’ve tossed it around in my mind quite often.

As I asked myself the question again this morning, I finally settled on an answer.  For now, unless she spills something, we’ll stick with changing to clean clothes twice a week and again if there is a special occasion.  In her current condition, I think it works fine and she seems content.

Woo Hoo! Bath is Done!

(Originally written on November 8, 2010)

What a simple phrase, “bath is done”.  But to a caregiver it is cause for celebration, even if it has to be a silent one. 

There are many steps to the bathing process and when dealing with Mom who has dementia, each step is an opportunity for dispute. 

The first, and most crucial, is the notification.  If I can get through that, we can usually get through the bathing without incident.

I’ve learned that a happy but quiet tone of voice when saying, “Mom, this morning we will wash your hair and then do a bath”, is helpful.  It is not a sure thing, however. 

The response may be an easy, “Alright” for which I give an immediate and silent prayer of thanks.  It may be a “What??” meaning she doesn’t comprehend the statement and explanation is needed.  I may get the response, “I just did that yesterday” when, in fact, it has been a week and I will need to convince her of that. 

Once in awhile, the dreaded response, the one no caregiver likes to confront, is the all out war that can ensue.

All out war can involve yelling, cussing and even physical abuse of the caregiver.  Thankfully Mom has never gotten physical but I have dealt with the rest.  None of these were typical behaviors for Mom when I was growing up.  I honestly don’t remember my mom or dad ever yelling other than to call us in from outside.  She has definitely found her voice in dementia!

Although curse words were also seldom heard when I was growing up, ironically the few times I did hear them were from Mom, typically on a Sunday on the way home from church.  She only had two, hell and damn, both very mild in the range of words available but at the time, I had not heard any others. 

Now it seems only one is needed when she goes into battle mode.  She yells at me to “Get away, damn it!” or “I don’t want to, damn it!” 

I’ve learned to do my best to remain calm and quietly remind her that her mother taught her to bathe once a week.  Sometimes I have to pull the doctor into it and tell her he said that she must bathe once a week. 

I bring to battle all my options for persuasion, all the while doing my best to remain calm and speak quietly.

I haven’t always succeeded in my attempt to remain calm in those situations.  A few times I have yelled back.  Even though I have ultimately won each battle, it’s those times that I have lost my composure that have taught me the most.  In this switch of roles I know that Mom, if she were able, would forgive me and be proud that I am learning.

“I’ve Been Doing This All My Life!”

(Originally written on October 20, 2010)

As a caregiver, there are many phrases that you don’t want to hear because you know that what follows won’t be pretty.  I learned very quickly that when Mom says, “You don’t need to tell me what to do.  I’ve been doing this all my life”, I need to watch closely to see if I need to provide help – wanted or not.

There are a lot of things I let pass.  If no one will be hurt including Mom then no harm, no foul.  She likes to cut tissues into squares or strips.  I think in her mind, she’s conserving them.  It means a lot of bits of paper sitting around but that’s not worth worrying about.

Then there are the things that are just a little more of an issue.  Mom has a poinsettia plant that she brought to our home when she moved in.  It is in a pot that sits in a larger plastic bowl.  Every day she waters it with two cups of water.  We realized soon after she moved in that she doesn’t comprehend that the two inches of water that is in the outer bowl actually came from the water she poured into the pot holding the plant. 

Fortunately, we were on hand when she was pouring water happily into the pot, totally oblivious to the water running over the top of the outer bowl!  We were still in the learning phase then and what ensued was quite an uproar.  As we were rushing to clean up the mess, we tried to explain, to no avail, the connection between the water she was pouring and the water overflowing.  Her very loud response was, “You don’t need to tell me how to take care of this!  I’ve been taking care of this for years and never had a problem!  Just leave me alone!” 

After a few attempts at explaining the consequences of her actions at subsequent waterings, I took a different tack.  At night after she has gone to bed, I simply empty the water from the outer bowl.  When she checks her plant in the morning, she can water it as usual with no messy results.

Finally, there are those things that like it or not, have to be handled directly.  They involve safety or sanitary issues.  Steps and reasonable cleanliness are the two biggest issues for us.  Most days Mom knows that she cannot go down the steps by herself because we don’t want her to fall.  She also knows that once a week I will wash her hair and supervise her bath.  Occasionally her need for independence jumps out in those situations and I hear “I’ve been doing this all my life!” 

I’m sure Mom didn’t realize all those years ago that she was preparing me to take care of her now.  She gave me the tools I need to deal with these times:  patience, understanding and most of all, the ability to stand my ground with love.