Inappropriate toileting in a care home

Discussion in 'I care for a person with dementia' started by love.dad.but.., Dec 5, 2015.

  1. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,442
    Kent
    #1 love.dad.but.., Dec 5, 2015
    Last edited: Dec 5, 2015
    Dad's lack of recognition of what a toilet is or where it is is increasing, it has become a problem first in his home where I lived in to care for him after mum's sudden death and gathered pace since arriving in the care home 16th months ago. I don't think there are any answers to this at the moment but wondered if anyone else's loved one has had similar experience in a care home. He is not incontinent yet, he gets the urge and knows he needs to take himself off somewhere to wee - the garden, corner of the lounge, corridor, waste paper bin, sink (in his mind probably looks like a urinal so I get that). Sometimes though he finds and uses the toilet appropriately, even sometimes flushing etc and can be guided if he can hold on. I visit every other day and guide him although he is sometimes reluctant as the urge is an immediate necessity, to the toilet. He is on water tablets for very swollen legs, which obviously exacerbates his need to wee. Yesterday was a particularly bad day apparently, pee'd in many places. The specialist dementia care home are very understanding, at the moment, and say it's just part of the illness for many, especially men who can easily pee anywhere. They have started today to put pull on incontinence pants on him which I can understand but surely if he still has the urge to pee and look for somewhere to do it, pants aren't going to stop this thought process. His problem in my mind is not loss of control just loss of toilet recognition and I don't know how or if that can be helped or overcome. He is physically reasonably well but mentally in early advanced.
     
  2. jaymor

    jaymor Volunteer Moderator

    Jul 14, 2006
    12,552
    Female
    England
    Why can't the staff assist your Dad once he is on his feet and heading off? If he is also on water tablets then they could be encouraging him to go to the toilet more often whether he has shown he needs to or not.

    In my husbands home the carers recognise the men's actions, one man gets agitated when he needs the loo, one pulls on the waist band of his trousers and one seems to need the loo when he smells food:) so he is encouraged to go before his meals.

    You are right the pull ups just cut out clothes changes not going in inappropriate places because the toilet cannot be found.
     
  3. Kitten71

    Kitten71 Registered User

    Jul 22, 2013
    157
    East Yorkshire
    Yes, I think jaymor has hit the nail on the head, the care staff need to take your dad to the toilet more frequently. Surely that would be in their best interests too as they don't always want to be mopping up or changing wet clothes. Maybe they could put it in his care plan that he needs assisting to the toilet every hour or so? X
     
  4. tigerlady

    tigerlady Registered User

    Nov 29, 2015
    427
    My husband is the same - he knows when he wants to go to the toilet but doesn't recognise the toilet, even though it is clearly marked with a picture on the door. He is a wanderer and so does wander into the toilets or bathrooms sometimes anyway, and then, if he has a need to use the toilet at that point in time, then he will. However, the staff say he is incontinent sometimes, but I am sure he knows he wants to go but because he is a very private man he wouldn't ask anyone, and anyway, he sometimes loses the ability to communicate his needs. Even before dementia, he was very anxious about going to toilet in a strange place and would hold on till he got home or else make me stop the car so he could go against a hedge. I know from signs that when he is restless or says something apparently meaningless, I can work it out that he wants the toilet. He is very aggressive when staff shower him and change him, and I have asked that they prompt him for the toilet more often to avoid unnecessary showers and changes, but I don't know if they are doing this enough. He is never incontinent when I am with him or take him out, and he lets me take him and help him if necessary.

    I am getting increasingly upset about this as it leads to more stress and aggression from him when he has to be forcibly changed or showered. They also put the incontinence pants on him, which he has got used to now, but it must mortify him if he has an "accident" because he is too "private" to communicate his need to a stranger.

    I really think the answer is more observation from the staff and more prompting. Even though the care home is very good and the staff are very kind and caring, I am torn with guilt because he is there and I am sure if he was still at home, toileting would not be such a problem, but due to his wandering, unpredictable aggression and severe cognitive impairment, he was assessed to need full time care in a care home. However, I think at least some of the aggression could be stopped if he was prompted to use the toilet more often.
     
  5. hvml

    hvml Registered User

    Oct 10, 2015
    297
    North Cornwall
    My Dad is still at home, but is starting to lose recognition of the toilet. He points at it and says - is that the toilet? We toilet him every hour and a half, so as to avoid him sitting in wet pants at all. It also helps with his mobility as we encourage him to walk there. I think the consensus is right, that your husband should be prompted to go on a regular basis, especially as the situation is causing such stress for him.
     
  6. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,442
    Kent
    #6 love.dad.but.., Dec 6, 2015
    Last edited: Dec 6, 2015
    Thank you for your input. The toileting situation isn't straightforward. Dad wanders and paces and the spacious wide lengthy corridors help him with is one of the reasons I chose it,but it also means he can go into corners without being noticed. As at most homes, some staff are better than others at being observant to his signs of needing the toilet some have more common sense are are proactive rather than reactive. There are 6 carers and 2 nurses for 34 residents so compared to other homes reasonably staffed and with many bed ridden residents, however if the 6 carers are doing double handed personal care there are times when no one is around to see his fidgeting or getting up etc. He is resistant to personal care, not physically aggressive but can swear and have a little boy reaction of please no but on the whole they sometimes battle through it. Unless he loses this reaction when he does become incontinent changing his pads etc will be a nightmare but that worry is for another day. He was and is an intensely private man so it's not surprising if he still has some awareness at times that things can be difficult. He doesn't/can't toilet on demand I have taken him quite a few times when I have thought be needed to go but he doesn't understand why he is there, although sometimes he has clarity of why he is in the toilet, but doesn't need to pee. He can stand next to the toilet with me trying to demonstrate and help but he sometimes doesn't know it is a toilet and what is required. 5/10 mins later however he does so it is very unpredictable. I can liken it to when a small child has the urge and it suddenly becomes urgent so when you've got to go, you've got to go! He doesn't wet himself only sometimes the mechanics of putting his penis away while still dripping wets his pants and trousers by the flies. First day of incontinence pants yesterday and I watched him managing to negotiate his flies and pants without too much problem although it did take longer. He can't ask for the toilet and if asked doesn't know he needs to go until he does need to if you see what I mean. He sometimes uses other resident's en suites which isn't ideal for those residents but at least a toilet! This inbetween toileting stage is very difficult, I have Dad's monthly review this week so will be chatting to the lead nurse then. All of his toileting is in his care plan and is regularly discussed but I just don't know how we can help his behaviour at the moment all the while he knows he has to 'go somewhere'! I visit for a few hours every other day and can give 1-1 toileting attention, he then has never pee'd inappropriately but I have also had to be very forceful and determined in moving him along the corridor to get to the toilet because his need has become very urgent so I can see how he would just have to go even if in the corridor. Interestingly he uses his own en suite without prompting during the night except when he is often wandering around the home during night time. Oh hells bells! The loss of dignity is so sad especially when has happened recently he has 'performed' in front of a visitor in the lounge and I get a blow by blow account from this chap's wife! She doesn't understand her husband's dementia so no chance for Dad and I find myself explaining yet again that the problem isn't loss of control but loss of recognition!
     
  7. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,442
    Kent
    It's a vicious circle, Dad had started to pee in odd places when I looked after him at this home 16 months ago so the loss of recognition was already starting. Dad always called the toilet - lavatory - so if he is back in his childhood I always use this term but not all the staff as some are non English first language use this term. Even then, if dad is in non understanding mode, it makes no difference. However the home early on in his stay put up lavatory signs for dad on all the toilets to try and help but it has gone beyond that now. I cried all the way back from the home yesterday for dad, his declining dignity and that there is no easy answer unless he can have a carer with him all the time, goodness knows his £72,000 annual fees (very expensive SE) should pay for more attention but in practice I can see how it's difficult to achieve in a dementia home.
     

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