Dementia Anger Issues - bathing

Posted by kateia @kateia, Sep 15, 2016

My mom is in a memory care unit. They insist on giving her a bath/shower. It takes 3-4 people to get her to do so and she is very angry after it’s all over. I understand that they have rules to follow….but when her anger leads to hitting other patients and they then pushing my mother and causing her to fall, I cannot see their reasoning for giving her the shower/bath in the first place. The family has asked for them to just do sponge baths but they don’t seem to listen. What do we do?

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I suggest you speak to unit manager and ask for a team meeting with RN, Doctor, social worker, OT and family. Sounds like showering is not safe for your Mom or the other patients. Some dementia patients can experience pain (tactile hallucination) from the water on their skin or have visual hallucination re the water pouring on them. I would read up on this before meeting. You need to be her advocate.

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@marilee

I suggest you speak to unit manager and ask for a team meeting with RN, Doctor, social worker, OT and family. Sounds like showering is not safe for your Mom or the other patients. Some dementia patients can experience pain (tactile hallucination) from the water on their skin or have visual hallucination re the water pouring on them. I would read up on this before meeting. You need to be her advocate.

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Thanks, Marilee, I am aware of the sensitivity that my mother has and have shared this with my brother and sister. We have care meetings every three months and have addressed the issue. The staff still has it in their heads that mom has to have a tub bath or shower even though it agitates her greatly and they have to give her aderol afterwards. It has to do with some crazy rule that they have about getting baths twice a week. I feel that sponge baths fit the bill!! The next time I go, I’m checking to see what they have done. If mom continues to hit other patients they will require her to leave the unit. Sometimes I wonder if they don’t just agitate her so they can.

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Ok I have been a nurse manager for patients like your Mom and there should never be such a rule that she HAS to be bathed twice a week the way they determine. Today is all about patient centred care and what is good for the patient not the staff. It could also be in the approach and attitudes of the staff. I hear your delemna but something is wrong here. Maybe time to go over the unit staff heads. If the unit manager is not into patient cantered care then time to go higher . You may

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I am going to stay on it and visit with staff each time I go. My brother and sister are so afraid that if we make waves they will kick her out of the unit so they just kind of go with the flow. My mom sleeps a lot and therefore misses meals or turns them down. They are not being charted like they should be. My concern isn’t that she’s missed the meal. It’s “feed her” when she is ready to eat. I’m the farthest one away and seem to be questioning the most as to what’s going on. I’m not backing down. Thanks for your reply

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Ask your Moms Dr. to prescribe Xanzx to be given prior to bath time.

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She is on so many meds now that we’d have to check if Xanax interferes. He go to med is Aderol for emergencies. It’s an idea. She also has balance issues and we don’t want her falling. Plus she HATES taking medication. All we can do is try. I’ll see what they say. Thanks.

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Hi @kateia. I am Scott and was my wife’s primary caregiver for her 14 year brain cancer battle during which we struggled with many dementia-like symptoms. I understand your concerns as bathing was a challenge for my wife as well.

I’ll just make a couple of points based on our experiences (I am not a doctor nor am I a medical professional of any sort).

First, many organizations talk about ‘patient centered care’ but don’t practice it nor understand it. It is easier for them to create ‘standards’ that have to be followed so all patients get the same thing — easier for them to ‘grade’ staff, but not so good at evaluating patient care! In your case I might ask to see the ‘rule’ on how often patients have to be bathed and in what manner.

Second, if you believe sponge baths would be better, keep up the effort to get that changed. We had to change to sponge baths for my wife and actually she cane to appreciate them more than the discomfort and anxiety of a more traditional shower with aides, etc. She was just as clean, did not develop sores, or have any negative side effects from them as we were cautioned about. Far less intrusive to her and went from an ordeal to a comfort.

Peace and strength,

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Yes keep up your efforts. Sponge baths should not be an issue. Many patients on Memory Units are combative so there is no reason to move your Mom. I would not suggest sedating her just to give her a bath/shower as this will increase her mobility issues and you say she already has balance issues. Perhaps the doctor needs to do a drug review as she may be on too many meds. Ask to have a meeting with the Unit manager/Head Nurse re the showers and if that doesn’t work then go to Administration. Yes many staff do not follow client-centered care and you need to ask if this is the in play here. do you mean Adderall – can’t find Aderol in pharmacological book.

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Yes, it’s probably Adderall. My biggest problem is getting my brother and sister on board for the sponge baths as well. My sister has suggested it but my brother’s attitude is “don’t rock the boat”. However, if mom hits another patient because she’s mad about having to take a bath/shower I bet the boat’s been rocked already. I’m visiting next Monday. Will make sure I visit with staff. Thanks

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I suggest when you visit you ask to see the Unit manager, not the Charge Nurse as these may be 2 different people. If a LTC facility you may need to ask to see the Administrator. Don’t be afraid to rock the boat – this is your Mom and her welfare and care comes first. No place these days should have stringent rules especially for dementia patients unless it involves safety – bathing is not safety. Everyone is different. Families who keep in the “face” of staff make sure their love-ones get good care. Staff should also be documenting every time she refuses to eat. How is her weight? Patients with dementia do sleep a lot so they should be wakened to eat. Good luck.

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