My dad is in a Care home and is not very co operative. When I complain that he hasn't had a shower for 3 weeks or is going to bed in his clothes I am told that he has to be able to choose these things to maintain his dignity. I think this is just the care home being lazy as it is easier not to have spend time with him to cajole him into washing or putting on his pyjamas. I think his "dignity" is being compromised by being unwashed and sleeping in his clothes. The Care home make me feel I am being unreasonable but I hate to see my Dad like this. Am I right to expect the Care home to keep him clean or should I accept that he is difficult and let him be unwashed. At what stage does choice give way to health concern? Similarly they let him sleep till lunchtime so he misses breakfast and doesn't get his morning medication. I don't think he knows what time it is or whether it is time to get up but it is certainly easier to have him asleep in bed than up and needing help. I am at my wits end. Advice please!
Dignity or wellbeing
- Thread starter Dazed
- Start date
Hi Dazed,
Sorry to hear of your frustrations. Most certainly it is reasonable to expect your dad be kept clean and safe. Nothing bathing him regularly absolutely puts him at risk for bacterial infection and plain old discomfort!
I am with you, I think it sounds as if the staff are using this as an excuse. Is there anyone at the home who is open to have a discussion about your Dad's needs? Have you checked on the home's CQC report? http://www.cqc.org.uk/ This will help you understand if this care home has an ongoing issue with these sorts of things, or if they are considered acceptable.
If you feel confident about arranging a sit-down discussion with the management, then that's where I would go, if you cannot get staff to work with you on this.
Hope it all is sorted soon. Very frustrating.
Cheers,
Benrese
Sorry to hear of your frustrations. Most certainly it is reasonable to expect your dad be kept clean and safe. Nothing bathing him regularly absolutely puts him at risk for bacterial infection and plain old discomfort!
I am with you, I think it sounds as if the staff are using this as an excuse. Is there anyone at the home who is open to have a discussion about your Dad's needs? Have you checked on the home's CQC report? http://www.cqc.org.uk/ This will help you understand if this care home has an ongoing issue with these sorts of things, or if they are considered acceptable.
If you feel confident about arranging a sit-down discussion with the management, then that's where I would go, if you cannot get staff to work with you on this.
Hope it all is sorted soon. Very frustrating.
Cheers,
Benrese
I'll side a bit with the carehome here a bit. Some years ago my wife and I looked after my mother in our home in her final years, she had dementia and now I am looking after my wife who has Alzheimer's and hands on it isn't easy. You have to strike a balance between what needs to be done and what is do-able with someone who isn't cooperative.
They could (as in physically) make your dad get up at the crack of dawn, strip off his clothes and make him have a shower and a shave and put on clean clothes but what would his life be like under a regime like that, how far go to can they make him do things to satisfy your expectations. If everyday was a constant battle between him and the staff how long before someone cracks and not in a good way?
The relationship between a carer and the cared is a difficult balance even when you're doing it for love and not for money I don't think you can know until you've done it, "cajoling" isn't always possible, where the fingers are pointing on a clock isn't important, what matters is that they live the last years of their life as happily as possible not fighting from the moment they're woken up in the morning until they're sent to bed at night.
I don't think anyone's "dignity" (your quotes not mine) is being compromised by letting them live in peace, on there own body clock and not to an imposed standard imposed on them.
I can sit here typing this at 3.30am as my wife got up an hour ago, if I leave her she'll wander round turning all the lights, plugging things in, tonight it's looking for something, she's sure what but is in one of the kitchen cupboards she's not sure what it is or which cupboard but it is definitely there and we'll know what it is when we find it, so far it isn't a pan or a tin of beans, she'll tire of it soon and back to bed.
NN all
xx K
They could (as in physically) make your dad get up at the crack of dawn, strip off his clothes and make him have a shower and a shave and put on clean clothes but what would his life be like under a regime like that, how far go to can they make him do things to satisfy your expectations. If everyday was a constant battle between him and the staff how long before someone cracks and not in a good way?
The relationship between a carer and the cared is a difficult balance even when you're doing it for love and not for money I don't think you can know until you've done it, "cajoling" isn't always possible, where the fingers are pointing on a clock isn't important, what matters is that they live the last years of their life as happily as possible not fighting from the moment they're woken up in the morning until they're sent to bed at night.
I don't think anyone's "dignity" (your quotes not mine) is being compromised by letting them live in peace, on there own body clock and not to an imposed standard imposed on them.
I can sit here typing this at 3.30am as my wife got up an hour ago, if I leave her she'll wander round turning all the lights, plugging things in, tonight it's looking for something, she's sure what but is in one of the kitchen cupboards she's not sure what it is or which cupboard but it is definitely there and we'll know what it is when we find it, so far it isn't a pan or a tin of beans, she'll tire of it soon and back to bed.
NN all
xx K
Having gone through this with my mother, I agree with Kevin. Firstly, how do you consider they get your dad into a bath or a shower if he has indicated that he doesn't want to? Do they just manhandle him in there without regard to the distress it would cause, bearing in mind that with dementia his ability to comprehend what is happening to him will already be compromised. Have you tried to get him to wash - even just by giving him a cloth and a towel and helping him perhaps when you are visiting? Would he be more compliant for you? I know it is difficult but, provided there are no health concerns, this could be the few remaining thing he has control over in life,so, perhaps let him have that control if it means he is peaceful and contented.
Same goes with the sleeping really. If he is in a deep sleep then why disturb him? They days are long enough if you are sitting in a confused state of mind. Not being aware of time doesn't necessarily mean that the day passes quicker. By all means ask about whether missing breakfast is having an affect on his weight - maybe they could give more calories at lunch time if it is. Same goes with the medication. You are right to ask that if he is sleeping until lunchtime, what is the fallback position with regards to medication - can it be given later in the day perhaps? Also ask what the effect is of not having the medication if it isn't being given at all.
Sleeping in his clothes - is the same issue as bathing. If it avoids distress and he is contented overall, then it isn't really a big deal.
If there is an issue about his clothes not being changed - then you might have to resort to the accidental spillage which is what we had to do. Glass of water - trip - woops -- let me go get you some dry clothes to get into...job done! If you are REALLY lucky, grab that soapy cloth and towel and dry them off when changing into their new clothes!
I know how difficult this must be for you and it is frustrating and upsetting, especially when you know that pre-dementia they had always looked after their appearance etc. I know that it was hard for us but we had to accept that what was important was our mother's happiness and if that meant we had to see her in that green jumper yet again - then so be it - we gritted our teeth and let her get on with it. Afterall, the illness had robbed her of everything else that was important to her so letting her be at peace was a small thing for us to do really.
Fiona
Same goes with the sleeping really. If he is in a deep sleep then why disturb him? They days are long enough if you are sitting in a confused state of mind. Not being aware of time doesn't necessarily mean that the day passes quicker. By all means ask about whether missing breakfast is having an affect on his weight - maybe they could give more calories at lunch time if it is. Same goes with the medication. You are right to ask that if he is sleeping until lunchtime, what is the fallback position with regards to medication - can it be given later in the day perhaps? Also ask what the effect is of not having the medication if it isn't being given at all.
Sleeping in his clothes - is the same issue as bathing. If it avoids distress and he is contented overall, then it isn't really a big deal.
If there is an issue about his clothes not being changed - then you might have to resort to the accidental spillage which is what we had to do. Glass of water - trip - woops -- let me go get you some dry clothes to get into...job done! If you are REALLY lucky, grab that soapy cloth and towel and dry them off when changing into their new clothes!
I know how difficult this must be for you and it is frustrating and upsetting, especially when you know that pre-dementia they had always looked after their appearance etc. I know that it was hard for us but we had to accept that what was important was our mother's happiness and if that meant we had to see her in that green jumper yet again - then so be it - we gritted our teeth and let her get on with it. Afterall, the illness had robbed her of everything else that was important to her so letting her be at peace was a small thing for us to do really.
Fiona
Well-good early morning to you Kevini-I hope your OH has found whatever she is looking for
I have to say I do agree with you Kevini.
When Pete was at home he went for about 7 weeks without a bath (he was frightened of the shower) because I couldn't get him out of it when he had oneHe is doubly incontinent so it wasn't great. Thank goodness for wet wipes
The CH he is in now do keep Pete clean and nicely shaved-but the cleaning doesn't always involve a full bath. Sometimes he's too sleepy, so it's a very thorough 'bed bath'.
It must be very difficult for Dementia sufferer's to understand what is happening when carers start giving personal care-so refusing may be their way of still having some control. That said 'cajoling' won't work (and I would never like to see/hear that happening) but patience and kindness MAY.
I would ALWAYS voice any concerns I had to the CH Manager-especially with the meds.
I hope this all gets sorted out to your satisfaction Dazed
Take care
Lyn T
I have to say I do agree with you Kevini.
When Pete was at home he went for about 7 weeks without a bath (he was frightened of the shower) because I couldn't get him out of it when he had one
He is doubly incontinent so it wasn't great. Thank goodness for wet wipesThe CH he is in now do keep Pete clean and nicely shaved-but the cleaning doesn't always involve a full bath. Sometimes he's too sleepy, so it's a very thorough 'bed bath'.
It must be very difficult for Dementia sufferer's to understand what is happening when carers start giving personal care-so refusing may be their way of still having some control. That said 'cajoling' won't work (and I would never like to see/hear that happening) but patience and kindness MAY.
I would ALWAYS voice any concerns I had to the CH Manager-especially with the meds.
I hope this all gets sorted out to your satisfaction Dazed
Take care
Lyn T
I too feel that the care home is doing it the right way. To force is to abuse.
When we were looking for a nursing home for my husband who needed one that specialised in challenging behaviour I was extremely worried that his care would involve him being forced to do things.
He is in a nursing home that is run as near to as is possible to our own home.
the residents go to bed when they are ready, they get up when they are ready. If they miss breakfast then they have toast, cereals, or what they fancy that can be prepared by the carers in their small kitchen. Shaving, bathing, showering is not made into a big issue and again will be carried out at sometime during the day if and when the resident will agree. A shower or bath is not necessary every day. As long as a good regime is in place for keeping the vulnerable places clean if incontinent.
It is the same at meal times, they are encouraged to sit at the table to eat but if they want it in the lounge or their room or even, as one resident used to, have it in the corridor, then a table is put in front of their chair and they eat where they want.
Life needs to be as good as it can be for someone with dementia and as close to as and as normal as possible. My husband like most people was governed by the clock for his whole working life, now he is in charge of time and does things in his own time.
My husband now is completely incapable of doing anything for himself or communicating his wishes but the staff treat him with dignity, they explain everything they do and ask him if it is ok to do it. They will never touch him without saying is it all right if I do this.
If he shows any sign of not wanting by pushing their hand away or when being fed turning his head away then they accept his refusal. They do keep trying during the day, they never give up but they never force and I would never want them to. My husband has had a shave at 3.30am in the morning because he was awake and compliant.
I can understand why you find it distressing, I did too. The constant wanting him to do what I thought he needed to do, at the time I thought he needed to do it was was waring on both of us. I eventually gave in, some battles you can win, some you retreat from and hope that tomorrow you won't be defeated when you try again.
Maybe the care home are not trying as hard as they should to encourage bathing and shaving so ask if you could try to persuade your husband to wash and change his clothes, he may be willing to do it for you.
Life certainly changes when dementia comes to live with us.
Take care,
Jay
When we were looking for a nursing home for my husband who needed one that specialised in challenging behaviour I was extremely worried that his care would involve him being forced to do things.
He is in a nursing home that is run as near to as is possible to our own home.
the residents go to bed when they are ready, they get up when they are ready. If they miss breakfast then they have toast, cereals, or what they fancy that can be prepared by the carers in their small kitchen. Shaving, bathing, showering is not made into a big issue and again will be carried out at sometime during the day if and when the resident will agree. A shower or bath is not necessary every day. As long as a good regime is in place for keeping the vulnerable places clean if incontinent.
It is the same at meal times, they are encouraged to sit at the table to eat but if they want it in the lounge or their room or even, as one resident used to, have it in the corridor, then a table is put in front of their chair and they eat where they want.
Life needs to be as good as it can be for someone with dementia and as close to as and as normal as possible. My husband like most people was governed by the clock for his whole working life, now he is in charge of time and does things in his own time.
My husband now is completely incapable of doing anything for himself or communicating his wishes but the staff treat him with dignity, they explain everything they do and ask him if it is ok to do it. They will never touch him without saying is it all right if I do this.
If he shows any sign of not wanting by pushing their hand away or when being fed turning his head away then they accept his refusal. They do keep trying during the day, they never give up but they never force and I would never want them to. My husband has had a shave at 3.30am in the morning because he was awake and compliant.
I can understand why you find it distressing, I did too. The constant wanting him to do what I thought he needed to do, at the time I thought he needed to do it was was waring on both of us. I eventually gave in, some battles you can win, some you retreat from and hope that tomorrow you won't be defeated when you try again.
Maybe the care home are not trying as hard as they should to encourage bathing and shaving so ask if you could try to persuade your husband to wash and change his clothes, he may be willing to do it for you.
Life certainly changes when dementia comes to live with us.
Take care,
Jay
Bath not important, in my view strip wash is, well especially the vital areas to prevent UTI. I would expect these to be done morning and evening as often as possible as it is in the patients best interest to prevent illness. Just a personal view. I personally would be most upset if my loved one were not in clean clothes as this to me reduces dignity. In fact CQC do look at this because they comment on appearance of residents. If all refused then the place would stink and cqc comment on this too. I wonder if the inspectors have their sense of smell checked prior to getting job!
A friend of mine had a blood relative in an emi place. Challenging behaviour was there but she always commented on how well shaved he was and how well turned out he was. If well, our loved ones would be mortified to be left as they are. Meds are important and I would expect them to administer these as they do in hospital when you are sleepy.
Just my view -hope no one upset by it. Sorry had to briefly go but I would be inclined to tip off cqc to do an unscheduled visit. I sure your dad is not alone-sounds like a culture to make life easy for themselves. This in my view is unacceptable. I was once told that looking at fingernails is a sign of neglect if not cleanes!!!
A friend of mine had a blood relative in an emi place. Challenging behaviour was there but she always commented on how well shaved he was and how well turned out he was. If well, our loved ones would be mortified to be left as they are. Meds are important and I would expect them to administer these as they do in hospital when you are sleepy.
Just my view -hope no one upset by it. Sorry had to briefly go but I would be inclined to tip off cqc to do an unscheduled visit. I sure your dad is not alone-sounds like a culture to make life easy for themselves. This in my view is unacceptable. I was once told that looking at fingernails is a sign of neglect if not cleanes!!!
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Thanks for all your comments. I have mixed feelings about it all. I would gladly accept a strip wash but this isn't happening either. When I complained about lack of washing to the home they undertook to try a shower once a week but this isn't happening. I agree with Benrese that Meds could be administered even if he is sleepy and that ensuring he has his meds (for physical ailments) should be a given. I can't help thinking that if he was in a care home with cancer I wouldn't be having these issues he would be helped to be kept clean and given his meds even if he did want to remain in bed. The wikipedia definition of dignity is that it "comes from Latin dignitas (worthiness)by way of French dignité. In ordinary modern usage it denotes "respect" and "status", and it is often used to suggest that someone is not receiving a proper degree of respect, or even that they are failing to treat themselves with proper self-respect". I would say this must have some regard to how the person would want to be had they not been suffering from the illness in this case dementia. Therefore the carers should have regard to how the people they care for would have liked to have been before the illness robbed them of their ability to look after themselves. In my Dad's case he was impeccably dressed and showered every day. Even if this is too high a standard a weekly shower and regular clean clothes should be essential for his dignity. Surely the carers should be working to find a way of cajoling/reminding my Dad about his personal care I don't want it to be a battle but an intrinsic part of who my dad was. Sorry if this sounds a bit philosophical but I think there is a divergence of what my dad who is, by anyone's interpretation, not in his right mind wants now and what he would have wanted for himself before the illness. Incidentally the CQC have just done an unannounced inspection and although several of relatives complained about these personal care issues these comments were not included in the report which awarded 4*
My mum was always conscious of how she looked....Always well dressed, she wouldn't take the milk off the step unless she was wearing full makeup & hair just so........and dressed... That the neighbours might see her in a dressing gown would be the ultimate horror.
Now? she looks like a bag lady.
My last visit to mum was horrendous, she was anxious & hysterical. One of the things she was saying was that " They" had put stuff on her head & were trying to kill her. In fact I posted on here because it was the worst I've seen her.
I thought of UTI, but no. The carers had given her a bath & washed her hair. She doesn't like having a bath or wash or personal care, she fights it every time.
If this is how she is afterwards, I can understand why mum doesn't get bathed more often.
I do understand, though, how hard it is to see someone who use to be so smart now look like no-one cares.
Lin x
Now? she looks like a bag lady.
My last visit to mum was horrendous, she was anxious & hysterical. One of the things she was saying was that " They" had put stuff on her head & were trying to kill her. In fact I posted on here because it was the worst I've seen her.
I thought of UTI, but no. The carers had given her a bath & washed her hair. She doesn't like having a bath or wash or personal care, she fights it every time.
If this is how she is afterwards, I can understand why mum doesn't get bathed more often.
I do understand, though, how hard it is to see someone who use to be so smart now look like no-one cares.
Lin x
It is heart breaking, isn't it? My mum isn't in a CH, she is still at home, so her cleanliness or otherwise is my responsibility (or feels as though it is). I am so upset by the lack of support from health and social care, no-one else seems to give a fig what she looks like or how she smells. It matters to me, of course, but the fact that it doesn't to her, is another sign that I am losing mum as mum
Distressing as I find this, I do have some sympathy with the CH, because I know that I can't fairly ask anyone else to do what I can't ...
That said, when I take mum out, I find myself meeting the eyes of waitresses, etc, daring them to judge her as she appears now (which is all they see), rather than the person she was / is
Good luck, Dazed. I hope the CH can do more for your dad than I can for my mum
Lindy xx
Distressing as I find this, I do have some sympathy with the CH, because I know that I can't fairly ask anyone else to do what I can't ...
That said, when I take mum out, I find myself meeting the eyes of waitresses, etc, daring them to judge her as she appears now (which is all they see), rather than the person she was / is
Good luck, Dazed. I hope the CH can do more for your dad than I can for my mum
Lindy xx
Personal care AND dignity
Good afternoon
I have very strong views on the subject, and after both working in care for around 15 years and also caring this year 24/7 for my mum who lived with myself, all i can say is BOTH are important.
In a care home setting, a compromise can be achieved, sometimes a bath or a shower can be extremely upsetting, so that's where a full body wash can be just as good. Get the person involved as much as possible, don't just overtake and 'get on' with the task in hand, make the person feel useful, use it as a bit of a 'pamper' session, same with any problems with nail trimming or hair washing. It CAN be done. If the situation is distressing at the time of trying to bathe etc, stop, and try again later, OR perhaps ask another carer to step in. Distraction and a bit of coaxing, along with a friendly atmosphere works wonders. I've managed to successfully give the most 'stubborn' person good personal care, it's all about attitude and patience. That said, I KNOW carer's are rushed at certain times of the day, but there's nothing stopping someone attempting later on in the day. I've worked in some homes where it's easier NOT to bother. Wrong, wrong, WRONG.
When in your own home, or at the loved ones home, I think it's actually far easier. Although you may not be able to physically get the person into a bath, or a shower ( I couldn't, mum was bed bound ) there's no excuse for poor hygiene. A full body wash will be more than ample. As for hair washing, inflatable sinks are fab, don't cost much ( i paid around £17.00 ) and it can be done on the bed.
Don't be fobbed off by care staff, see their senior or manager, I'm sorry but it CAN be classed as neglect if the person who's being cared for isn't receiving the care they should be. If you can't speak to the staff there, or the manager, you can report it to CCQ and your SS or LA. Skin integrity and self worth for the individual will suffer. Sorry for going on, but, like i said I feel very strongly about the subject.
Take care
Vicky
Good afternoon
I have very strong views on the subject, and after both working in care for around 15 years and also caring this year 24/7 for my mum who lived with myself, all i can say is BOTH are important.
In a care home setting, a compromise can be achieved, sometimes a bath or a shower can be extremely upsetting, so that's where a full body wash can be just as good. Get the person involved as much as possible, don't just overtake and 'get on' with the task in hand, make the person feel useful, use it as a bit of a 'pamper' session, same with any problems with nail trimming or hair washing. It CAN be done. If the situation is distressing at the time of trying to bathe etc, stop, and try again later, OR perhaps ask another carer to step in. Distraction and a bit of coaxing, along with a friendly atmosphere works wonders. I've managed to successfully give the most 'stubborn' person good personal care, it's all about attitude and patience. That said, I KNOW carer's are rushed at certain times of the day, but there's nothing stopping someone attempting later on in the day. I've worked in some homes where it's easier NOT to bother. Wrong, wrong, WRONG.
When in your own home, or at the loved ones home, I think it's actually far easier. Although you may not be able to physically get the person into a bath, or a shower ( I couldn't, mum was bed bound ) there's no excuse for poor hygiene. A full body wash will be more than ample. As for hair washing, inflatable sinks are fab, don't cost much ( i paid around £17.00 ) and it can be done on the bed.
Don't be fobbed off by care staff, see their senior or manager, I'm sorry but it CAN be classed as neglect if the person who's being cared for isn't receiving the care they should be. If you can't speak to the staff there, or the manager, you can report it to CCQ and your SS or LA. Skin integrity and self worth for the individual will suffer. Sorry for going on, but, like i said I feel very strongly about the subject.
Take care
Vicky
I have some sympathy with what I know is a very difficult job but I do think that one of the reasons for choosing a care home is that professionals who are used to dealing with residents with dementia should be more skilled at dealing with these issues than I am. They have had the training after all, and do not have the emotional relationship which makes it harder for a relative IMO.
I would not attempt to lift or move my immobile mother as both she and I would be at risk from my lack of skill/knowledge, and I think personal care is the same. It"s a mix of technical knowledge and the right attitude.
Thanks VickiG - I will keep pressing for the CH not to give up on him. He often accepts personal care from one staff member but she has been on holiday then off sick but if she can manage, someone else must be able to find a way of persuading him without it turning into a battle.
Hi Dazed,
My mother too is in a care home since March 2014. I was bathing her regularly myself, but her attitude has changed. She refused to be bathed, and I let it go for three weeks, then I said to the care workers, "We need to force the bath." We forced it and she was traumatized (hitting, kicking, shouting); but it has become somewhat easier since then. She doesn't strike out much anymore. I was concerned that she would end up with sores and then we would have a heck of a time treating them, because she can be so uncooperative. I think my mother sleeps in her clothes. I don't expect the staff to fight with her to put her in pajamas. I know that there are wonderful staff members in this care home, but I don't expect the impossible from them. I just take it one day at a time.
denturedaughter
My mother too is in a care home since March 2014. I was bathing her regularly myself, but her attitude has changed. She refused to be bathed, and I let it go for three weeks, then I said to the care workers, "We need to force the bath." We forced it and she was traumatized (hitting, kicking, shouting); but it has become somewhat easier since then. She doesn't strike out much anymore. I was concerned that she would end up with sores and then we would have a heck of a time treating them, because she can be so uncooperative. I think my mother sleeps in her clothes. I don't expect the staff to fight with her to put her in pajamas. I know that there are wonderful staff members in this care home, but I don't expect the impossible from them. I just take it one day at a time.
denturedaughter
