Not speaking up about needing to go to the toilet

Share your ideas about the practical side of caring.
Something that's started occurring recently is that, if there is a visitor at the house, my nan won't speak up to say that she needs to use the toilet - either by herself or with my grandad's help. Consequently, she ends up soiling herself and only says she's going to the toilet when the visitor has left. This usually means my grandad has to help clean her up. Fortunately, she's wearing pads. We thought it was just with people she's unfamiliar with (like when the social worker called in last week), but she's also done it when one of her other grandchildren (albeit seen less often) visited last week.

I think there have been instances during her stay in hospital where something similar has happened - I can't accurately recall - so it doesn't feel like it's something she's suddenly started doing. It's just become something more frequent with more visits to the house by various people.

We think it's that she's either i) embarrassed by the need to say that she needs the toilet or ii) that she doesn't want to cause an inconvenience to whoever's visiting (the logic of this is driving me up the wall). We could explain to her that it's not a problem, but she'll forget and/or it probably wouldn't sink in anyway.

She'll be staying in a care home for a couple of weeks from this weekend, so we're wondering how it will pan out in a new environment with unknown people around (both care workers and other residents).

Does anybody have any suggestions on how we might avoid these situations or at least manage them better? Or is this just the way it's going to be from now on?
We have a phrase "elderly toddler". When I was potty training my sons (one with severe learning difficulties) I would produce the potty very regularly, not say "do you need the potty" but "it's time for your potty". Might be worth trying you making the decision for her? No promises though!
I used to have to do exactly what BB is suggesting with my Mum ! and don't worry about the Care Home James - the Care staff there will have previous experience of dealing with the same issue - at the home my Mum was in they used to regularly take the ladies (and gents) to the loo (almost on a roster !) whether or not the resident had expressed a wish to 'go'.
Assuming she's suffering from some kind of dementia, I doubt if she's bothered about strangers as she won't be able to consider about embarrassing them, but hwatever the reason you need to approach it like BB says. Say its 'time' and insist on taking her whether or not she thinks she needs to 'go'. If she won't co-operate this won't help of course.
I used to think my Mum did it 'on purpose' just to annoy us, but with hindsight I realise she couldn't see it as a problem (funny, if you just caught her 'in the act' you could tell, by the blissful espression on her face, just what she was up to.)
My poor MIL now lives permanentlhy in nappies. SOunds like it's time for your nan to do so as well.

One of the most horrible aspects of dementia.
My Mum eventually had to wear them 24/7 but when they were wet she would simply stand up (with a struggle) and take them off, knickers and all and drop them on the carpet sopping wet and often soiled. It didn't matter how many visitors we had - it would have been funny if the nappy didn't stink to high heaven.
The only thing to do was scoop them up and say 'come on Mum, lets get you some new ones'.
Hard to laugh, really, isn't it? :(

Ghastly, just ghastly. And I know that is no answer, and certainly no help. How vile a disease dementia is. To reduce human beings to that.

Sorry, I know not helpful, but .....

I guess it's one of the main reasons why families so often just 'give up' and hand over dementia patients to care homes - which is what I did.

(I'm a bit caught in the middle - whilst if it had been my own mother, I could probably have done it, nappies and soiling and all - maybe! - and if it were complete strangers and I was a carer, again, possibly, but to have to keep my poor poor MIL clean - how horrendously 'undignified' for her - how she would have HATED the idea that one day her son's wife would have to clear away her soiled nappies....)
I honestly don't think I could do that for my own mum. Organising things, managing money, DIY even, fine; but always knew that I'd draw the line when it came to "bodily functions".
It was the 'bodily functions' that finished us off and as a family it made us all feel ashamed with ourselves because none of us could cope with the stink of the things - adults do make the most appalling smells and the whole house eventually gets infused with it. That and the sheer indignity of having to attend to such matters to a person who was once so dignified made us start looking for homes for her. This sounds a dreadful thing to say about your mum, but she obliged us by dying just as we'd decided on a place, and then of course we felt guilty of even thinking of such a thing.
Its a hiding to no where isn't it?
Now I have my friend of 60 years to look after - but only for 2 afternoons a week so its do-able..
Sad to say, I think you, and your mother, 'got off lightly', in that she left this life at the right time for you AND herself. Believe me, her future would not have been wonderful......so it was good that it was taken from her. I pray every night my poor MIL with deep dementia will be released in the only way possible now. It's a dreadful disease, and one would not wish on one's worst enemy (maybe, however, on the 'parents' of your worst enemy, if you get my meaning.....