2 Dec 2007
Dear Mary,
I need help. I have taken in an elderly Aunt who was kicked out of a long-term residential facility in Florida. She is evasive about dates and names of places and has bathed only twice since arriving in May. She has delusions and also lies, although I am not sure if she is really lying or saying something she believes is true. For example, if I tell her she has to stop sleeping in her clothes she get very upset and denies that she does this. The same thing happens with bathing and I do not even dare bring up oral hygiene. When I try to do her laundry she tells me she just called someone to pick it up then tosses it on the porch. You should also know she has a history of alcohol abuse and was a career nurse and Captain in the Navy. Thus, she does not take orders well from me. I try hard to explain things to her, but we end up arguing and get nothing accomplished. I know she needs to be evaluated but how do I do it without arousing her anger? I also need to know how to get her to change and bathe. Can you help me?
Dear Reader,
My suggestion is to call the Veteran’s Administration and make an appointment to have her evaluated as soon as possible. She needs a complete dementia work-up and assessment for level of care. The VA can provide home care, day care, and Assisted Living and Nursing home care for those who qualify. Since she has a long history with the military, she may be more willing to go if you say they called to tell her its time for a check-up.
You have discovered that arguing gets you no where, so do not waste any more energy. Because she is an adult she is insulted when you tell her what to do and because she lacks insight into her deficiencies she thinks she is capable of accomplishing usual activities of daily living.
Your Aunt’s “lying” is really confabulation: making up a story to fit the context of a question or conversation. She can also be drawing on old memories. Take the laundry incident for example. She certainly could have used a picked-up service in the past and mixes up the past with the present. The next time just quietly remove the laundry from her room when she is distracted.
Bathing and changing clothes are common issues with dementia-affected folks. The best approach with bathing is to use the words "cleanup" or "wash-up”. It is also helpful to provide a “reward”. For example, if she likes chocolate, tell her when she's done washing-up there will be brownies and milk waiting for her. Be very careful not to sound like you are talking to a child. Casually follow her into the bathroom and offer to wash the areas she cannot reach. It is fine for her to wash at the sink and sometimes the 7-day bath has to be used: washing one part of the body each day. Try to make every task sound like it was her idea, use casual simple statements, and remember to smile.
Dear Mary,
My husband and I found an assisted living home we are happy with and have done everything required for my mother-in-law to move in. It is a level III licensed facility and we were told she meets that level of care. However, the home now says they will keep her "provisionally" because they want to see if the staff can manage her colostomy. Mary, we assumed colostomy care was something assisted livings could do. Were we wrong?
Dear Reader,
Yes. Resident Aides who provide care in assisted living facilities are not required to have this skill. Colostomy care can be easily taught, but it is a task some people find unpleasant. You might want to call other homes to find one that can meet this need just in case she has to move.
Mary C. Fridley RN, BC
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