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

Specialties Geriatric

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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

Specializes in LTC, MDS, Education.

One word.....DOCUMENT :nurse:

we give our resident 1mg of ativan only on her shower days to keep her calm. she stays calms and we get our job done. i dont see why we cant give antianxiety to keep patient calm so he can have his shower done and i dont know what good discharging patient is gonna do to the patient.

Specializes in PICU, NICU, L&D, Public Health, Hospice.
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

I agree with previous posters...you have gotten some sound advice. As mentioned earlier you need to contact the DPOA. This is a serious situation and the DPOA needs to get involved, no choice, this is a health issue.

Obviously this gentleman has had symptoms previously that were treated with antipsychotics and antianxiety meds. It would certainly seem that the medication plan needs some review and updating, call the doc and tell him what you need. "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." Don't call and ask what he thinks, tell him that you have a pot hole and this is what you need to fill it. Document meticulously about your calls to him and requests of him and his responses. Make sure that you are clearly stating your professional nursing assessment of the situation and suggest appropriate interventions. A psychiatric evaluation is a good idea. Taking him away from his home to another facility will likely exacerbate his anxiety and aggressive symptoms, making it more likely that he will get his meds adjusted than if a doc came to your place to visit him.

In hospice, we often utilize xanax or ativan to allow drama free bathing of some alzheimers patients. It is unfortunate that this level of palliation is not common for those people outside of hospice.

Good luck.

Well one of the things works with and old coot we have ( no offense please I love this old coot) He would not get a bath or a shave and he was starting to look like Charles Manson and smelled like a snunk to put it nicely. We got all his clothes together , toiletry stuff, and wheeled him in there and the shower aide said firmly We are going to get a shower. He looked back very angry and said well I wish you blank blank blanks would hurry the blank up!! Of course we went to town and after that we paraded him around and said My oh my, does He not look handsome today. I know he felt better but he did not want to admit it. I always teach the nurse aide students to gather everything up, go on down the hall with them of course if they ask , then we tell them but we dont ask, Honey do you want a shower today because they will always say I had one yesterday, it is too cold I am sick blah blah. This particular gentleman loved to read so we get the lady from the library to come give him a book after-- the shower lol. That is careplanned also. I have had to call his nephew from time to time and he usually does put him in check. He just tells him man you stink. and he bribes with cigarettes lol . but for your fellow- psych meds may need to be adjusted.

We also have a lady that yells and is combative during the shower- we have a great shower aide she gets the shower started and gives her a washcloth and then has her begin to shampoo her own hair to keep the swinging at bay. Never let your gaurd down lol. Never get in a big argument and try to come back later -bribery works - for me a hershey's always does the trick and most of our people too of course within dietary limitations!!

Specializes in PICU, NICU, L&D, Public Health, Hospice.

The suggestion to avoid asking permission is right on point. It is similar to pediatrics...you inform them of the procedure and DO NOT ADD "OKAY?" on the end of the statement. Get your stuff ready, tell them what is going to happen, and get er done...."okay?"

Ah now, that is an entirely different kettle of fish! Many facilities will try to keep couples together for as long as possible, but it sounds as though this husband and wife admission may be near the end of its run. When both have dementia, and one is notably more severe than the other, the less demented spouse may try to protect and provide care for the more effected one (especially while the more effected one becomes more detached). It frequently becomes necessary to separate them (different rooms, different units, or different facilities) as their frustration levels increase and each one becomes an increasing interference in staff's care of the other.

Moreover, if she is physically aggressive with him, it is likely no longer appropriate to keep them together.

Sounds like both a medication adjustment and a living arrangement adjustment is in order for both of these behavioral residents.

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