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Posted December 3, 2008

Ask An Expert

Elderly Care: How to Get Mom to Bathe, Wash Hands

Q. How can I get my 92-year-old mother to bathe, and to wash hands after using the bathroom? I might be able to get her to bathe once a month if I'm lucky. I'm at my wits end. Help!!!

Carolyn P., Savannah, Georgia.

A.

Oh, my! I certainly can't blame you for being beside yourself. I'm also sure it's no comfort to know that hygiene issues are one of the primary reasons family caregivers ultimately find themselves with no choice but to look for a professional care facility.
 
You haven't given much information to go on, but I'll try to give you some ideas that may help you avoid having to make that choice.
 
If your mother lives alone, there is very little you can do about her hygiene issues except to be sure you don't eat anything she's touched and to be sure to bring your own water bottle when you visit.
 
If she lives with you, then you have more options. I might be roundly criticized for my position on this, but anyone living in your home MUST live by your rules. It is difficult to create boundaries, and you will meet anger and resistance. However, it is imperative that you firmly and lovingly draw the line between what is and what is not acceptable.
 
Unless you're assisting her in the bathroom, you will simply have to assume that she hasn't washed her hands. I suggest that the first rule should be that everyone who will partake of a meal goes to the sink and washes their hands with soap and warm/hot water publicly and thoroughly before sitting down. Food is presented only after hands have been washed. Call everyone in your home to the sink and all of you wash your hands together. 
 
Of course, you will have to alert everyone in your household to the new program and have a line-up at the sink before every meal for this to work with your mother because your mother will most certainly tell you she's already washed her hands.
Stand firm. Everyone washes hands together at "this" sink, even if they have "already washed." This will at least insure that her hands are washed several times daily.
 
Also, make sure you have a good nail brush handy and encourage your family – and your mother – to use it.
 
As to the bathing, do you have any idea why your mother does not bathe? Does she not remember how? Is she truly forgetting how long it has been? Is she overly anxious or frightened? Has she had a fall? Some of these questions may seem odd because they should seem obvious, but don’t assume anything.
 
If she is having unusually high anxiety, you may want to consult with her doctor before you take any new steps. Be sure the bathroom she uses is warm, is equipped with grab bars, has a shower stool if she needs it, and has any other safety equipment she might need and creature comforts she might enjoy. Be sure there is a very non-slip surface to stand on. If she does not see well, put a brightly-colored mat on the floor of the tub or shower so that she can clearly see where the floor is.
 
Then you may want to call in the troops. Now, sometimes this battle is best left to the professionals, so if you possibly can, hire a homecare agency to bathe your mother once or twice a week. It is often the case that our parents will be more cooperative and less embarrassed with an outsider than with a family member.
 
Another approach might be to check out adult day programs. Some day activity programs for seniors offer bathing services to their enrollees. This may be a solution that would also give your mother something interesting and stimulating to do one or more days per week. And at the same time, it would give you a caregiving break!
 
These suggestions are only that, of course: suggestions. What works in one instance will not work universally. Whatever you try, be prepared to meet resistance and to be the "bad guy," at least for a while.

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 http://www.eldercareteam.com, and she can be reached at molly@eldercareteam.com

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