We're out of ideas.....can you help?

[laurasc]

We're out of ideas on how to handle this situation and I hope you can help us out.

We have a resident with Alzheimer's who is refusing to take showers. He can get very aggressive and will physically attack anyone who tries to talk to him about showering. The problem is that he's filthy and really smells bad. When he's incontinent of stool, he refuses to take his clothes off let alone shower. His wife becomes very agitated and starts screaming at the care staff, even going so far as to push them away.

We've tried everything from trying to talk to him, bribe him, even had several male care managers try in case he was too proud to allow a woman to bathe him but he still refused. We tried to talk to his family, but when they confronted the resident he insisted he did take a shower. They don't seem to want to get too involved.

Meanwhile he's very, very dirty and we're getting concerned for his health.

I work in a facility that frowns upon any form of restraint...either physical or chemical (meds). He does take low doses of antipsychotics and antianxiety meds.

I would appreciate ANY ideas you may have that would work. Anything that worked for you?

Thanks in advance

[caliotter3]

The only advice I could offer would be to try to identify a staff member that can go that extra mile to try to develop a special relationship with him. Sometimes people will work with one person after awhile. We had our share of this type and it was awful. One would mess all over his (private) room and it was hazardous to even walk in there. No one could develop a rapport with him that I know of. That is why his room got to such a state.

[Vito Andolini]

Maybe he needs higher doses. Maybe a full psych eval, med changes.

Maybe he will go into tub or shower with his clothes on and get into dry clothes afterwards. not ideal, better than nothing?

Maybe you can tell the family he will have to leave if the man won't get to smelling better.

How about a tub? Bed bath? Two big dudes to hold him/carry him/whatever you can get Doc to order.

If your facility is so big on no restraint, ask them (DON, Admin, Risk Manager, Owner) what to do.

Try singing or playing Sinatra songs - or whoever he likes to listen to - maybe Loretta Lynn or The Gloved One.

Good luck.

[Rabid Response]

If you can't get the family to work with you on this issue (the wife is pushing staff away from the resident?), then you should tell them to find another facility for this man or to care for him themselves. If he is covered in feces, he poses a health risk to the other residents. I would not want a parent of mine having to share furniture etc... with this person.

[LucasRN]

Sounds like he needs to have his meds evaluated by Psych. We had a similar situation once, we transferred the patient to Acute care Psych for eval, when he returned to us his medications had been adjusted, he was a bit more cooperative and most importantly he was clean.

[CaLLaCoDe, BSN, RN]

fire hose ;-)

[pennyaline]

We're out of ideas on how to handle this situation and I hope you can help us out.

We have a resident with Alzheimer's who is refusing to take showers. He can get very aggressive and will physically attack anyone who tries to talk to him about showering. The problem is that he's filthy and really smells bad. When he's incontinent of stool, he refuses to take his clothes off let alone shower. His wife becomes very agitated and starts screaming at the care staff, even going so far as to push them away.

We've tried everything from trying to talk to him, bribe him, even had several male care managers try in case he was too proud to allow a woman to bathe him but he still refused. We tried to talk to his family, but when they confronted the resident he insisted he did take a shower. They don't seem to want to get too involved.

Meanwhile he's very, very dirty and we're getting concerned for his health.

I work in a facility that frowns upon any form of restraint...either physical or chemical (meds). He does take low doses of antipsychotics and antianxiety meds.

I would appreciate ANY ideas you may have that would work. Anything that worked for you?

Thanks in advance

What is the wife becoming agitated about: that he won't let anyone shower him, that he's incontinent and needs intervention, or that you're asking for her help? I guarantee that this woman went through hell with him at home over these problem behaviors, and she may re-experience the same helpless, end of her rope feeling now when she sees the same behaviors continuing in the care setting.

Hygiene and bathing issues are typical for patients with dementia. If no family or staff member has been able to persuade/cajole the resident into bathing and the resident's physical aggression escalates, it's time for a medication adjustment.

[classicdame, MSN, EdD]

not only his health is involved - so is yours and all the staff. Insist on compliance but create a plan with MD first.

[laurasc]

The only advice I could offer would be to try to identify a staff member that can go that extra mile to try to develop a special relationship with him. Sometimes people will work with one person after awhile. We had our share of this type and it was awful. One would mess all over his (private) room and it was hazardous to even walk in there. No one could develop a rapport with him that I know of. That is why his room got to such a state.

Hi Caliotter, we already do that. His care manager is phenomenal with him. He's usually pretty good with other things....it's just the showering.

Thanks

Laura

[laurasc]

Maybe he will go into tub or shower with his clothes on and get into dry clothes afterwards. not ideal, better than nothing?

We suggested that....he called us crazy! :icon_roll

If you can't get the family to work with you on this issue (the wife is pushing staff away from the resident?), then you should tell them to find another facility for this man or to care for him themselves. If he is covered in feces, he poses a health risk to the other residents. I would not want a parent of mine having to share furniture etc... with this person.

That's our last resort to be honest. Which is why I'm asking here.

Sounds like he needs to have his meds evaluated by Psych. We had a similar situation once, we transferred the patient to Acute care Psych for eval, when he returned to us his medications had been adjusted, he was a bit more cooperative and most importantly he was clean.

That's an idea. Problem is our residence doc is next to useless. He doesn't care about the residents and only pot-hole fills. I'm pushing to get him out. But with that said, the local psych hospital has a short-term alzheimer's clinic, I wonder if they could help? Thanks! That might be something to follow-up.

fire hose ;-)

Don't tempt me!

What is the wife becoming agitated about: that he won't let anyone shower him, that he's incontinent and needs intervention, or that you're asking for her help? I guarantee that this woman went through hell with him at home over these problem behaviors, and she may re-experience the same helpless, end of her rope feeling now when she sees the same behaviors continuing in the care setting.

They live together in our residence. She also has alzheimer's and doesn't quite understand. She also has a penchant for getting aggressive but her aggression is usually aimed at her hubby. I should have mentioned that in my original post....sorry.

Thanks all.....:loveya:

Laura

[CapeCodMermaid, RN]

You can't really have big 'dudes' carry him into the shower....can you spell abuse? If you've tried everything, give his wife a 30 day notice of discharge and try to help her find someplace else for him. You don't have to keep him if you cannot take care of him. Document everything.

[mamamerlee, LPN]

Where is the rest of the family? Who is POA/Guardian? Can you get him into the gero/psych Alzheimer's unit? This patient is a hazard to everyone else.