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Posted August 19, 2007

Ask An Expert

Elderly Care: When Dad Refuses Adult Diapers

Q. How do you get someone to use Depends when they keep wetting themselves? My father-in-law keeps urinating in his clothes, and my mother-in-law cleans him up -- but he refuses to consider wearing Depends?

Anna T., West Palm Beach, Florida.

A. You don't say why your father-in-law is having incontinence problems. If you haven't already tipped off his doctor it would be a good idea for your mother-in-law to do so. There is always the possibility of a medical condition causing or contributing to the problem.

Talking to the doctor won't solve your immediate moisture problem, however. It sounds like your mother-in-law is committed to avoiding placing him outside the home as long as possible. The inability to manage incontinence at home is one of the biggest reasons many caregivers ultimately turn to facility care, so this problem needs to be resolved for his sake, as well as for your mother-in-law and the furniture. It will take some patience and some determination on her part.

If your father-in-law has a progressive dementing illness, like Alzheimer's disease or Parkinson's disease (or several other possibilities), it is likely that his reasoning powers are declining. So, the decision to use incontinence products is sadly no longer his to make.

Everyone has a different idea about the "best" way to approach refusal to use an incontinent brief. You may have to try several approaches to find what works for you.

First, don't discuss, don't explain, and don't argue -- to the greatest degree possible. Putting underwear on is simply a part of getting dressed, and this is what we wear. If you have to discuss, make it as brief and matter-of-fact as possible. Sometimes saying "the doctor prescribed these" works. Sometimes not.

Try inserting a disposable brief inside a pair of regular briefs. This won't work with boxer-style underwear, of course, but is often successful with briefs. After a while, you can remove the outer layer and leave just the disposable.

Unsuccessful with that? Let the laundry "pile up" so there is no more clean underwear. Have him use the disposables until the laundry is "done." The laundry will never be "done," of course. You may have to remove all his regular underwear so he can't find it on his own. Store the disposables in the same place he kept his traditional underwear. Then you can just go to the usual drawer and pull out a pair, keeping the dressing routine the same.

Experiment with brands. Some are more comfortable than others for a particular individual. If they feel "funny," he will be more aware that he is wearing them, and he will be more resistant.

Sometimes our loved ones are much more cooperative with a non-family member. It may be a good investment to bring in a paid caregiver for just a few hours in the morning to assist with bathing and dressing. This would have the added benefit of giving your mother-in-law some respite time. If a professional caregiver can get him into a disposable just a couple of times during a three or four hour visit it may be easier for your mother-in-law to continue the routine throughout the rest of the day. This may sound prohibitively expensive until you compare it to the cost of facility care, which is many times more costly.

None of these ideas is guaranteed to work, of course. If ever a caregiver is to be tested, incontinence and refusal to wear protective undergarments will be that test. It can be exhausting and frustrating. This stage, too, will pass. Don't get discouraged, don't give up, and get the doctor involved if you can.

This answer is provided by Molly Shomer, MSSW, LMSW, a family caregiving specialist and licensed geriatric care manager. Molly, a nationally recognized expert on eldercare issues, is the author of The Insider's Guide to Assisted Living. Her website is www.eldercareteam.com, and she can be reached at molly@eldercareteam.com.

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