Today's ingredient is a combo pack.
Toileting and incontinence care of your resident or loved one with dementia.
Each stage of the disease brings new challenges with all ADL's but many caregivers find toileting and incontinence care among the top stressors.
*ADL(Activities of Daily Living)
Activities of daily living (ADLs) are the basic skills needed for personal care and daily life.*
In the early stages of dementia, you may not notice much difference in your person's ability to toilet themselves and clean up afterwards.
The clean up is known as peri-cares.
Peri-care, also known as perineal care, is the practice of cleaning the genital and anal areas. It's an important part of personal hygiene and healthcare, especially for people who are bedridden, have limited mobility, or are at risk of infection.
Some things you can do to help your loved one during the beginning stages of dementia are:
*Remove clutter: Keep the path to the bathroom clear of obstacles and things that could be mistaken for a toilet, like flower pots and wastebaskets.
*Add visual cues: Put a picture of a toilet on the door, keep the toilet door ajar, and leave a light on at night.
*Install grab rails: Install a raised toilet seat and grab rails.
*Use a commode: For night-time use, consider a commode or portable urinal.
*Provide supplies: Keep wipes, hand. sanitizer, incontinence pads, clean. clothing, and disposable gloves in the. bathroom.
*Offer reminders: Remind the person to go to the bathroom, such as after a meal or before bedtime.
*Be understanding: When accidents occur, be calm and understanding. Don't make the person feel guilty or ashamed.
*Watch for signs of infection: Look for signs of a urinary tract infection, such as blood in urine or cloudy urine with sediment.
For someone in early stage dementia you want to provide them with the tools to be able to do things on their own for as long as they possibly can. This will be a good thing to keep in mind throughout your caregiving journey.
Allowing someone to be as independent as possible for as long as possible is a wonderful gift you can give to them. It may make your job a bit easier as well.
This is not always the case, often your loved one may be slower and not quite as adept at whatever task you are asking them to complete. However, the look of pride on their face when they do finish it should be well worth the few extra minutes it may take.
As the disease progresses, your loved one will become much more dependent on you to make sure that they stay clean and dry.
Losing the ability to know when they need to urinate or to know long enough in advance may be a couple of the signs that let you know you are going to have to take a more active roll in toileting your loved one.
You may see them hurrying to get to the bathroom on time and perhaps they even urinate a bit in their underwear or on the floor as they are pulling down their pants.
Most times a person with dementia is still able to comprehend what is happening at this point. They may be embarrassed and they probably won't yet want your help.
The in-between times when they still realize that they are losing something they once had can be devastating for them. As their loved one it is hard to watch but as the person with the disease it is even harder to accept that this is their reality.
This is a very delicate time and must be handled with compassion and understanding.
As soon as these little accidents start becoming a thing you will want to try and get your loved ones to begin wearing incontinence pads. Also known as briefs or depends.
Incontinence pads are absorbent pads worn to help manage bladder or bowel incontinence, or difficulty controlling urination or passing solid waste
These are underwear are made specifically for incontinence. They go on just like regular underwear. They are just a bit thicker and prevent leakage.
They are not diapers and should not be called as such.
Your loved one may really resist wearing this type of underwear. They will probably want the kind they've always worn. They may feel like you are treating them like a child. They may also have forgotten that these little accidents have become regular occurances and be angry that after "one little slip up", you want them to change their whole routine.
Knowing what to say and how to say it can go a very long way in helping your loved one feel comfortable with this change.
To convince a loved one to wear Depends, use positive language, avoid calling them "diapers," instead referring to them as "briefs," "disposable underwear," or even the brand name "Depends," and emphasize the benefits like protecting clothing, preventing embarrassment from accidents, and maintaining personal hygiene by addressing potential odor issues, while validating their feelings and concerns about using them; consider involving a trusted healthcare professional if necessary.
Be sure and acknowledge their feelings and their concerns about this change. Remember that every setback is an independence that they will never get back. It is a loss that will be gone from their lives forever. Be compassionate and caring at every turn.
What will this change mean for you as the caregiver?
It means that you are now going to have to become a hands on caregiver rather than just a stand by assist with occasional queuing.
Many folks find this idea to be a very daunting.
Providing toileting and peri-cares for someone can be an extremely personal task that you just had no plans of ever doing in your life. If that someone happens to be your mom or your dad, it may cause you even more distress.
I have been both a paid caregiver and a caregiver for a loved one, I know that this comes easier for me because of my training and because it has been my job for many many years.
I am extremely proud of your willingness to step up to this challenge with zero training under your belt. Although you may be simply winging it, I know you've got this.
So now that you are stepping in, let's talk about some things you should watch for.
When switching your loved one into briefs be sure that the brief is the right size for them. They may be resistant to making the switch from underwear to briefs so making the brief as comfortable as possible is a must. Your goal is to get them to keep it on. Too small will pinch and hurt and too big will bunch up and feel really uncomfortable.
Make sure you tell your loved one that these briefs are disposable. "It's ok if you have an accident or they get a bit wet, we have another new dry one right here."
If needed, meet your loved one in the bathroom when they go so you can help them change into fresh underwear each time and make sure they are cleaning properly.
Moving forward the things you tell them will not be remembered and will have to be repeated, sometimes daily, sometimes hourly and most times minute to minute. The earlier you start with the reminders the better chance you have of it become routine down the road.
Off topic but this is also why we don't start a dementia resident with a walker deep into the disease once they start falling a lot. They will never remember how to use it or even what it is. It becomes more of a safety risk not less.
Now back to toileting. Get your loved ones into the briefs earlier rather than later. Tell them all the things that go with this new phase of toileting. Repeat repeat repeat and do it early.
Now that you are in the bathroom with them you may realize that their peri-cares are really being neglected. It is time for you to step in here as well.
When providing peri-cares you will need wipes or washcloths and towels and you will probably want disposable gloves.
There are many different kinds, colors and sizes of gloves out there.
These are the kind I prefer but get the ones that feel the most comfortable for you. Make sure you get the correct size as well. They won't work if you can't get them on or if they keep falling off your hands.
Reminder that wearing gloves is not a substitute for hand washing
When using disposable wipes, do not flush them no matter what they say on the package. Many disposable wipes will say "flushable" on the package, however, most septic/plumbing systems can not dispose of "disposable wipes." It's a much better idea to get yourself a garbage can with a seal tight lid and put all of your waste in there.
Maybe something like this
Some insurance companies will pay for briefs and supplies. Be sure to check in with your loved one's insurance
As long as your loved one is ok with you helping them you can simply use the wipe or your washcloth and warm water to clean them up when they finish using the toilet.
For any bowel movements use the wipes first. Once all bm is removed wash again gently with a washcloth.
While performing peri-cares, be sure and watch for any skin breakdown or irritation. Your loved one's skin may become more sensitive as they age. You might have to change to a sensitive skin wipe or a simple warm water solution or even purchase a skin protective barrier cream if you begin to notice any rashes or breakdown.
Sitting in a wet or soiled brief can also cause skin breakdown so be sure and toilet your loved one on a schedule. You always want to be proactive in both getting them into the bathroom and changing them if an accident should occur.
You might find that your loved one becomes more resistive to toileting as this disease takes over.
Teepa Snow is one of the top dementia educators in the country. She does a wonderful job of teaching us how to continue to provide quality care for a person who has become resistive. All of Teppa's videos can be found on YouTube and they are all free. I would strongly suggest looking her up if you find yourself struggling with a loved one who simply does not want your help.
You can also contact the Alzheimer’s Association for any and all questions.
If you are in the US, you can always call the Alzheimer’s Association 24/7 Helpline (1-800-272-3900) to vent, get advice, & resources.
With toileting, incontinence and peri-cares, you will always want as many tools in your tool box as you can possibly get. Moving forward, you will find that something as simple as keeping your loved one clean and dry can now become a full time job.
Toileting and incontinence care can get extremely messy, depending on how interested your loved one is with this particular body function.
Not only will you need to make sure they are getting toileted and changed regularly, it is quite possible that your loved one may begin to touch or smear their feces if they get the chance.
Because this is extremely difficult for most caregivers to handle and in fact tends to be one of the leading causes for placement, I wanted to touch on it here.
Most caregivers starting on this journey with a loved one have no idea what to expect and when it comes to poop they are absolutely shocked when something like this occurs.
People with dementia may touch or smear feces due to a number of reasons, including:
*Cognitive issues
Confusion and disorientation can cause people with dementia to act out inappropriately.
*Sensory changes
Dementia can alter how people process sensory information, such as touch, smell, and texture.
*Reduced inhibition
Dementia can cause people to act out or exhibit unacceptable behaviors.
*Environmental changes
Stress or disorientation can be caused by changes in a person's environment.
*Communication difficulties
Impaired verbal and nonverbal communication can lead to frustration or depression, which can cause people to express themselves in unusual ways.
Here are some ways to manage fecal smearing in people with dementia:
*Clothing: Use clothing that limits access to feces, such as one-piece items that zip up the back.
*Mittens: Mittens can make digging more difficult.
*Constipation: Constipation can be a primary reason for digging, so make sure to address it.
*Toileting schedule: Establish a routine toileting schedule so staff can provide hygiene.
If you you find yourself dealing with poop, poop and more poop please know you are not alone. Unfortunately it is a very common occurance with dementia, you will get through it.
The last thing we will touch on is a bedbound patient.
The final stage of dementia will often find your loved one unable to walk on their own anymore. Once the need to change your loved one in bed becomes a necessity you will want to purchase "wraps" instead of briefs.
These are incontinence pads that resemble a child's diaper and have tabs on each side.
This is one brand and style but just like everything else, there are many to chose from.
I would also suggest purchasing some cloth soaker pads such as these at this point if you haven't already.
They will really come in handy for keeping your sheets clean and dry and hopefully limiting your time spent on laundry. Cloth soaker pads can also be used to turn and move your loved ones around in the bed without actually touching their bodies. The aging body is way too fragile to pull, push or roll.
I know this sounds like a lot. It is a lot.
You will learn your loved one and come up with a routine of your own. Hopefully some of these ideas will help make things a bit easier for you.
Take advantage of the above resources as much and as often as you need.
This journey you are on is not for the weak and it is not one to be traveled alone.
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