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I don't know for sure but when we transitioned my Mom to the nursing home there were rules and guidelines that had to be read and signed. To be honest I don't recall there being anything about bathing per se. There were notes about services offered and one of them obviously was assistance with bathing. I don't think they can force bathe anyone or force feed anyone.
My Mom became really recalcitrant about bathing. They would ask nicely and if she refused they would just leave and try again the next day.
Skilled, experienced personal care assistants don't usually need recourse to law to get their charges bathed if necessary, and kept clean in any case. They use a variety of approaches and techniques that gently but firmly lead the person to accept the care.
Watch Teepa Snow videos!! She's awesome...teaches techniques on how to interact alz/dem. I have both parents at the same time developing dementia and watching these videos is helping me tremendously and to prepare....as well as being here everyday...wonderful support and caring people!! I agree with Bob, fourth is absolutely not necessary or acceptable, that only makes the person more agitated or upset.
I don't think force is the answer, but at some point for the health of the individual they will have to be kept clean. It is very common for a patient with dementia to refuse personal hygiene, but it can lead to a host of other issues. I think it is very important that you work with the facility on this issue. Perhaps making arrangements to be present if need be if the patient still recognizes you and finds comfort in your presence. Try to remember how upset you feel if you were caring for your parent at home and they needed a bath and refused. It's a hard place to be, I hope you can find a solution.
In Florida compelling a resident to bath has no legal base according to the state legal department. Resident dignity is at the heart of opposing imposition of bathing requirements. Facilities and families have lots of options for getting a resident to choose to do what they initially might object to. Listening, observing, patience and creativity can do most anything
Daily bathing is not necessary for most seniors to keep healthy. Most of us here in senior living are on a weekly schedule.
Most prefer showers as getting in and out of a tub is scary - too possible to fall. Is this the cause of the reluctance? Has the aide been too rushed or rough? The water too hot or too cold (what feels ok on my hands and front is very hot on my back!)
On bath day the question is not yes or no, but now or in a few minutes. An offer to wash the back and feet in a shower with the hose on the shower head may make the invitation more acceptable then an order to take a bath now. During his early or middle dementia a comment about a beginning odor sometimes encouraged my husband to take a shower.
Is there a walk in tub or spa available where one could soak a while? Is this closer to what she has preferred in the past? Does she like a certain kind of soap or shampoo? Are the towels soft or rough? What would make the whole process more desirable for your Mother? Can you eliminate whatever is causing her reluctance?
Bathing and maintenance of personal hygiene are considered proper care (vice neglect) . If that is not done, it opens the door for neglect charges and investigation by APS. Trust me. We KNOW. Our hospice caregivers were blowing that off and WE had to do it. But the day APS visited, her hair was messy, and WE got tagged for that as "neglect"
In my dad's assisted living contract there was a clause about failure to bathe and change clothes such that odor would be offensive to others as a reason for the person being made to move out.
Yep, absolutely! They most certainly can. When my foster dad wouldn't shower, the nursing home had no choice but to clean him up, and they sure did. When it threatens the health of themselves and others, yes they can pick them up and put them in the shower if they absolutely must, of themselves and others, yes they can pick them up and put them in the shower if they absolutely must, and I'm all for it if it means protecting the health of the person and others. Body odor is enough to make anyone lose their appetite at mealtime especially. It's not fair to others to have a stinky person ruining peoples appetites when they must eat to survive. I don't know how much the hospital dad to clean dad up, but I'm sure they did something but the nursing home definitely finished the job. Even in the military I've heard of a term called G.I. bath when they have someone in the unit who won't shower, and there's not a thing the sergeant will do to stop it from what I heard. I guess this is why there's a term called G.I. bath, And I don't blame the other is for picking up that stinky person and putting them in the shower and giving them a bath, good for them! I don't know how common it is, but from what I noticed we often don't hear about it except on rare occasions. I'm glad people are bold enough to act when the health of others is threatened. Furthermore, kudos to the nursing home who cleaned up my foster dad when he was filthy for who knows how long. I couldn't get him to base because I didn't have the physical back up or I would have. When you can smell someone all the way in the next apartment, that's definitely a disturbance and an intrusion on that next resident. I'm glad it took dad landing in the hospital before landing in a nursing home in order to get cleaned up. He had more than enough chance to take better care of himself in the free world but now he's facing the consequences of not doing so. Good for everyone who put him in the shower and made him clean up
I do believe every state has their own law in regards but for Tennessee I was told that they could not force them UNLESS their lack of hygiene put other residents at risk. A serious bacterial infection for lack of hygiene could put your loved one at risk. It's no different than with a petulant child who doesn't want to bathe. You can try everything but if they keep saying NO, for their own health you have got to bathe them. I appreciate all the videos, the coaxing, the "pretty pleases" but the reality is some of the elderly are simply going to refuse, no explanation. No, no, and no. And they could refuse even sponge bathing. So there is no easy answer. The last time I got my father to bathe, it had been 3 months. Three, people. And the technique I used was no different. He simply decided that that day, it was yes.
No, a long-term care facility can NOT force someone to bathe. If a resident is refusing the staff should try and find out why they don't want to bathe. Sometimes it is the water pressure hurts their skin, the shower room is too cold, they are trying to bathe them during their favorite TV show or when they are expecting guests, or sometimes the resident does not get along with a particular staff that is giving the bath. Any of these reasons can be resolved. If the team has tried everything and the resident still refuses then the facility should get a medical evaluation to see if anything is going on. The doctor might order an anti-anxiety medication that can be given to the resident before bathing time. One thought to remember. If a staff person forces a resident to bathe and during the bath, the resident gets a skin tear, bruise or worse that staff can be guilty of elder abuse and lose their license! Anytime staff forces treatment on a resident and they are injured it is ABUSE!
A seasoned caregiver should be trained in alternative methods and approaches to get the resident to want to bathe. Force is NEVER an option regardless of state law.
I'm going to be a little blunt and might get beaten up here. Elderly people don't need to bathe every day but maybe every 2 or 3 days unless they require it to be more often. Bathing is important for every one because everyone has strains of staph and who knows what ever else that can make somebody else sick on their skin. Bathing helps keep that stuff in check and helps people preventing UTI's. It should be required that people in nursing homes be given baths twice a week. All the dirt, grit, grime and bacteria can make that person sick and others sick. I do have asthma and I am more sensitive to things like that. Besides, who wants to sit next to someone at the dinner table who hasn't bathed in 5 months? Could you eat next to them?
Even before my mother went into the NH, when she was still of fairly sound mind, she would refuse to shower. When I moved in, I got her to start showering on a regular basis, but it was a struggle. She fought me on it every time - not physically, but the manipulative way she's always had - "I'll do it later". "After breakfast". "After this tv show is over." "After dinner." "No, it's too late now, I'll do it in the morning." I finally had to get really stern with her and tell her she was *going* to shower and that was all there was to it.
Unfortunately, when she went into the nursing home, she realized that they can't force her to shower, so she went without for weeks at a time, getting only a wipe down of the important areas on a daily basis when they toileted her. Teeth not brushed and almost growing fur, they were so dirty. Body odor that would knock you over when you entered the room. The staff finally started resorting to bribery - they'd offer her food, like pudding or something sweet, if she would get into the shower or walk-in tub. That worked - most of the time.
But to answer your question - no, they can't force them. They can ask, bribe, beg, etc - but they can't force them. I was told that by the nursing home administrator, because I wanted mom washed more often - and was told they couldn't make her do it.
My husband with late stage dementia always says no but there is one caregiver he has somewhat bonded with. She does not ask. If you ask, the answer is no. She just says "good morning. It's time to get ready for the day." And gently leads him into the shower with bars and chair. He sees her coming and says "Oh, no" but follows her. One day he said "Oh, sh*# when he saw her and he's never been one to curse!
Residents of nursing homes have a right, under federal regulations, to refuse care and treatment. Bathing is considered care. Keep in mind, we all have the right to make what others would consider bad decisions. It is not any different for folks living in nursing homes. In addition, forcing a person with dementia to do anything can result in harm to the resident. This doesn't mean that if a resident refused a shower/bath, that they shouldn't be asked later. It is important to convey to staff the time of day and method the resident prefers. Don't give someone a shower who doesn't like getting water in their face. Also, it is not necessary to take a shower or bath to achieve the level of cleanliness that is healthy. There are techniques that can be used to get a person clean in a calm cooperative manor. One of the best resources I have encountered is the information on the Bathing without a Battle website. Things to ask: Is staff telling the person they have to take a shower? Usually met with resistance. Is staff saying "Do you want to take a shower?" Usually met with a "No." response. Is the shower room the appropriate temperature for the resident? Is the resident afforded as much privacy as possible? Is the staff person taking his/her time and allowing the resident to do as much as possible to feel in control. Is the resident being done to or are they informed of what is coming next? This could be accomplished by giving the resident a warm wet washcloth to use to wash their face and any other area they can reach. Hope this helps.
My mom was VERY reluctant about being bathed, would become combative (she was non-ambulatory and thankfully not very strong), the decision of hospice was to increase (one time) her anxiety medication which was a plus for my mom (she was still some what combative); however, it is legally the greater issue of the client being clean than the excuse the client is 'unclean' because of an anxiety issue.
When my friend with frontal temporal dementia and living in a memory care apartment was incontinent and needed cleaning, she began to resist that, not letting anyone work with her. Obviously, that could not be ignored. It was unsafe and smelly. They recommended I take her to a geri-psych ward at a near-by hospital to find an anti-psychotic drug that would calm her without doping her up. That was the answer. It took 3 1/2 weeks to find the proper medication, dosage, and timing, but she was a happy camper then and cooperative until she passed on. Such resistance is often a part of the dementia process. The trick is to find a way to get the person clean without a lot of struggle or force involved. My friend's husband resists the suggestions about showering, too, thinking he already has, but gets himself clean someway. For many years he could not step into the tub due to a bad hip and just stood with a wash cloth in front of the sink to clean himself. I suspect he still does that even though he has a walk-in shower now. The staff does monitor whether he smells or not, but doesn't bring up the issue if there is no reason to. Everyone is happier in the process. As long as the staff is aware and paying attention, I am satisfied with his care. I am the one paying the bills for my friend and so I monitor his care, too. I am grateful to have found a place that does a good job of providing care in a thoughtful and friendly way.
'There is nothing illegal about not bathing and no one can force anyone to bathe legally because it is not against the law.'
Yes, there is absolutely everything wrong with a client NOT being cleaned. Wash cloth baths, or bedsides baths; gentle touch and kind touch gentle words go a long way even if the bath takes a long time. Medication might have to be considered when all else has failed IF the client is combative a danger to the client (being combative) and to the staff. There is an abuse law about a client being dirty and not bathing.
It might have something to do with a fear of falling, or not liking the caregiver who is giving the bath. I never had a problem with my mom, or my friend Twyla who I played CNA to, but now that Twyla is in a care facility she is afraid of the staff who giver her her showers. I bet I could go and do it and she would be happy to let me, but I am now a two hour drive away. I used to give a bed bath to an old man (101) and if he didn't want to do something I would just rub his back and then he would let me do whatever it is I needed to do, but some of the other caregivers would cause him to put up a fight. Try bribery or something.
Any skilled nursing medical professional knows that the skin is the largest organ in the body and as such, must be kept clean, else infection and a whole host other problems could set in.
My mom after living in a very abusive situation.removed by adult protective services ward of the state of Florida dad passed about a month later .Mom. Can bear any weight they would sponge baths her .One on each side.state homes very understaffed. Moved her to Ohio in the ritz of nh.still never wanted a shower have schedule 2 days per week .She finally said she wanted morning they arranged that. Moved to private room they once again arranged schedule still very reluctant.after moved to her permanent room would take shower on arranged days she is in wheelchair all the time. Aids are always on schedule so they only have alloted time used highjacked shower chair. Some aides better than others .They rotate Hall's e every two weeks. Now hospice are involved aids comes three times a week shower on Tuesday and Friday visits o. Thursdays the difference is unbelievable! That aids only has the time to be with her.sadd that she is declining but worth it to see her clean. Now that am caregiver I would even pay for someone trained. Still hard for mom as oxygen must be removed but a godsend. Ask facility for help no asking resident just say today is shower day. I always have her own clean sheets ready. It is do able. Sorry for the run on and on post.my 59 year old brother just passed from massive heart attack. She is heart broken as well as I his wife daughters etc but I do feel very blessed that I have this time with her as I believe she was probably not bathed in years when living with my evil sister. But very worth a trained professional. Once again sorry for run on .Good for circulation UTI I know that warm water feels great!!!!
No, a rest home cannot legally force a resident to have a shower. However, in the interests of the resident concerned, it is in their best interest to do so. Elderly people deserve to be clean and wear clean clothes, even if it takes a lot of convincing from the staff. Some elderly people don't care if they smell, or are offensive to others, or have been in the same clothes for a week. This is when the staff step in. I hope this helps, Arlene Hutcheon
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
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My Mom became really recalcitrant about bathing. They would ask nicely and if she refused they would just leave and try again the next day.
What exactly has been the problem here?
I believe that is unwise when it comes to bathing, but that is the law as I understand it..
Grace + Peace,
Bob
I agree with Bob, fourth is absolutely not necessary or acceptable, that only makes the person more agitated or upset.
I think it is very important that you work with the facility on this issue. Perhaps making arrangements to be present if need be if the patient still recognizes you and finds comfort in your presence. Try to remember how upset you feel if you were caring for your parent at home and they needed a bath and refused. It's a hard place to be, I hope you can find a solution.
Most prefer showers as getting in and out of a tub is scary - too possible to fall. Is this the cause of the reluctance? Has the aide been too rushed or rough? The water too hot or too cold (what feels ok on my hands and front is very hot on my back!)
On bath day the question is not yes or no, but now or in a few minutes. An offer to wash the back and feet in a shower with the hose on the shower head may make the invitation more acceptable then an order to take a bath now. During his early or middle dementia a comment about a beginning odor sometimes encouraged my husband to take a shower.
Is there a walk in tub or spa available where one could soak a while? Is this closer to what she has preferred in the past? Does she like a certain kind of soap or shampoo? Are the towels soft or rough? What would make the whole process more desirable for your Mother? Can you eliminate whatever is causing her reluctance?
One thought to remember. If a staff person forces a resident to bathe and during the bath, the resident gets a skin tear, bruise or worse that staff can be guilty of elder abuse and lose their license! Anytime staff forces treatment on a resident and they are injured it is ABUSE!
Unfortunately, when she went into the nursing home, she realized that they can't force her to shower, so she went without for weeks at a time, getting only a wipe down of the important areas on a daily basis when they toileted her. Teeth not brushed and almost growing fur, they were so dirty. Body odor that would knock you over when you entered the room. The staff finally started resorting to bribery - they'd offer her food, like pudding or something sweet, if she would get into the shower or walk-in tub. That worked - most of the time.
But to answer your question - no, they can't force them. They can ask, bribe, beg, etc - but they can't force them. I was told that by the nursing home administrator, because I wanted mom washed more often - and was told they couldn't make her do it.
Yes, there is absolutely everything wrong with a client NOT being cleaned.
Wash cloth baths, or bedsides baths; gentle touch and kind touch gentle words go a long way even if the bath takes a long time. Medication might
have to be considered when all else has failed IF the client is combative a danger to the client (being combative) and to the staff. There is an abuse law about a client being dirty and not bathing.
Sorry for the run on and on post.my 59 year old brother just passed from massive heart attack. She is heart broken as well as I his wife daughters etc but I do feel very blessed that I have this time with her as I believe she was probably not bathed in years when living with my evil sister. But very worth a trained professional. Once again sorry for run on .Good for circulation UTI I know that warm water feels great!!!!
I