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Mum in care home refusing personal care - Page 2 - Carers UK Forum

Mum in care home refusing personal care

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I was wondering if she liked to "pick a fight" over other things as well. Whilst I'm not in favour of drugging people without need, it does seem, from other threads I've read on the forum, that sometimes gentle calming medication can help the behaviour of difficult parents. Maybe talk to the matron/Care Manager at the home and see what she thinks?
Hello Jenny,

Thank you for posting and reassuring!

Yes, it is true mum seems to have a degree of inertia or 'defeatist stance' when she finds herself wet. I think this is possibly because it so overwhelmingly goes against the grain of her OCD (which was always cleanliness related) that as a result, she becomes bewildered and 'shuts down'.

Also, having spoken to her gp, it seems in mum's case there is a blurred line between deteriorating mental health vs capacity. Like others, I also thought it would be self evident that capacity was questionable if she is happy to sit wet for hours on end but it seems it is not so straight forward. I am still learning!

I will update in due course. Thank you once again for your response, it really does help to have the different angle on it.
I think that knowing that many of us experience similar issues with our own elderly carees is reassuring yes (in an odd sense of the word reassuring!). Always remember, too, that the care professionals have, for the most part 'seen it all before' and what may be very alarming to us about our own parent, is less alarming for them because they are familiar with these issues. The increasing loss of what might be called 'independent self-care' (ie, in the sense of things like personal hygiene) is very distressing to witness in the very elderly (and presumably pretty distressing to experience by them too, if they realise it's happening!) - it's a kind of 'reverse growing up', as in, with our children, we see babies having no control at all over their bodily functions, and then gradually as they grow into children they get more and more capable of their own 'self-care', so to see that deteriorate at the end of their lives is desperately sad and depressing (I find). How horrible, after all, to 'end one's days in nappies'.......dreadful, dreadful, dreadful.....

As for dementia, again, very tricky indeed! Obviously there is no 'binary' boundary at which one side of the person doesn't have dementia, and on the other they do, no 'sudden' occurrence (maybe in a catastrophic stroke??), where they pass across that barrier.

Looking back at my own MIL, it took me a LONG time to realise that yes, this was dementia setting in, not just the general 'infirmity' of old age, and even when I knew she definitely had dementia, it went through several 'blurred' stages, and still is progressing (or rather, regressing) along that sad pathway. It was only in the last 9 months of so that she's been doubly incontinent, for example.

The issue of 'legal capacity' is again tricky too - I know that there are tests and so on, but to be honest, from what I've read here, they don't always 'detect' accurately, as in, they ask questions which a person could still answer 'correctly' (eg, what year is it), even when they are clearly completely 'out of it' when it comes to things like being able to manage their own finances, or make their own meals any more.

One term I learnt on this forum was 'acopic' and I think that is very useful. It's a 'made up' word, as it simply means 'not capable of coping with normal life', and applies to, really, people when they get to the stage your poor mum is at - 'not capable' of coping with getting to the loo on time etc etc etc. But, yet again, they don't suddenly become acopic, it sets in gradually and insidiously and can be hard to notice - and of course, we keep hoping it isn't dementia at all......

And on top of all of that, of course, if there have always been 'complications' such as, as in your mother's example, OCD, that can make the whole situation even trickier....

(That said, one thing that my own family noticed VERY markedly was that when my SIL's mother developed dementia, her eating disorder disappeared! She'd had one all her life - probably anorexic but never really diagnosed in her generation - and she was a VERY reluctant and 'faddy-to-the-point-of-revulsed' eater. But when her dementia got a grip that all went by the board, and she became a hearty eater!!! So, the mind is a strange place, that is for certain.....)

I do hope that your mum will soon consent to being changed by the staff more often, and come to terms with what is happening to her increasingly frail body.

(PS - you might indeed want to discuss the possibility of a 'mild tranquilliser' - my MIL was put on a low dose of Diazapam to allay her anxiety and restlessness when she first went into a residential care home. Now she is settled they have eased back on it. Might that be an option for your mum maybe???)(it is usually only cautiously prescribed, as it can relax the muscles as well as the mind, and trigger falls....)
Thank you Jenny and BB for your helpful inputs. Mum has been on a very low dose of an antipsychotic for her anxiety for quite a while now. I will certainly enquire about whether, if and when appropriate, a mild tranquilliser might be added in.

I met with the social worker and senior nurse yesterday to discuss mum's best interests. This was useful; one suggestion by the senior nurse was having a 'reminder for carers' list put up in mum's room, regarding her preferences and rituals whilst having a shower or a wash. It was felt that this would remove some of mum's anxiety in having to relate this each time to any carer who came in to her and hopefully, reduce the chances of her giving up because it was all too much trouble.

The social worker also clarified whether staff could dangle little carrots in front of mum to help encourage her to agree to being washed. I think this is the area they find most difficult because of the grey area between dangling carrots and mild threats (and hence abuse), so this was helpful although I feel it will depend on how comfortable the individual carers themselves feel.

So all in all it feels like a move in the right direction. As you say, no changes (either way) happen overnight, so I will have to be patient!

Thank you again for your responses.