June, you and your brother would be very well advised to invest in a
visit to a lawyer. It will save you money and trouble to have expert
advice on the very convoluted legislation around medicaid and medicare
etc.

Here is a good article
http://moneycentral.msn.com/content/CollegeandFamily/Caringforparents/P96529.asp

If she is needing help with bathing, this is just the tip of the
iceburg. Get some good legal and financial advice from an eldercare
specialist so you can be ready. In short order, she may be incontinent
and you can't be taking care of the costs of that - I mean, what is the
point of assisted living if they aren't helping her with personal
hygene?

M.

We all just went to an elder attorney and learn some things to protect
ourselves for later. I suggest you and your brother find one soon.

Linda Jean

Hi June,

My mother in law got utterly filthy, in fact so bad that I have no idea how
she didn't itch or feel crawly all over.  Her bathtub was obviously not
being used.  It had an inch of dirt in the bottom, and she was using it to
store stuff in.    So when she came here, it was a real serious need that we
had to take care of first.

Now first of all let me tell you this was a woman who was formerly
meticulous, took great pride in her home and her grooming, before she
started getting sick.    That alone was enough to make us realize just how
serious this thing had gotten.

When she finally came here the only way we got her to bathe the first time,
my husband had to yell at her and ordered her to take off her things and
head on into the shower.   Boy was she mad!   But with patience, care, help,
and sometimes some serious urging, ultimately I got her to not only not to
object, but to actually enjoy getting a shower.   It became almost like a
spa experience for her.    I did everything to make it easy for her because
even when she thought she could do it herself, it was obvious she couldn't.

I have posted several rather lengthy posts in the past about bathing issues,
and how we overcame them.  In case you aren't good at Google searches, here
are a couple of quick tips.

Catch her when she is getting up in the morning and isn't yet dressed, or
last thing at night when she is getting ready to go to bed.   That way she
is already undressed and it is just one obstacle out of the way.

You will have to help her through it, no matter how huffy she gets about
doing it herself.   I will bet anything she is having issues about what
comes first and what sequence to follow.   Coach her along.

I consider a shower chair and a shower head on a hose essential to the
process.

I only bathed her about twice a week.   Elderly people don't sweat like
young working people do, especially since she had limited activity and we
are air conditioned in the summer.  I put clean clothing on her every day,
so it was fine.

If you establish a routine and make it a nice experience, she won't object
forever about it.   I can promise you that even though they can't learn new
things, there is a certain kind of a memory they develop for routine things,
especially if they haven't been unpleasant ones.

June, I can't offer any help on the financial aspect because thankfully my
SIL has been taking care of that part for years. I'm willing to help her if
she needs it but I'd have to do a lot of research first.

Bathing? Oh, you poor dear - I went through that also!! I posted about it in
a panic a few months back. Got good replies, as you have:)

After the initial resistance, my MIL finally settled into it. A few hitches
here & there but for the most part, it has been fairly smooth sailing. Of
course, I say that knocking on wood with my fingers crossed. Because with
this dern disease, each day can be a new zoo.

The biggest problem I ran into a few times is that if she went to her
bathroom to potty, she would then start putting on her clothes, which we
left out on top of a small dresser in there. At that point, I often had heck
getting her to take them off so she could get cleaned up first, even for
just a quick sponge work on the bottom. Just this week (after being here
five months), I had enough of that business & put her bras that were in
there in the closet. I took all her clothes off of the rack that was in her
bedroom - too handy for her to also get, in the closet. Only thing I left in
the small bathroom drawers are lots of disposable underware in case she gets
a hankering to change them (yeah, right). At night, she takes off her own
clothes. I've been letting her do that in order to give her just that little
bit of independence while she can have it because she doesn't do anything
else. When it gets to the point she needs more assistance, I'll do it. She
always has left her clothes on that small cabinet. Very handy for the next
day, but since it has caused problems more than once, I go in the mornings
(or catch it at night) & make sure her clothes are back in the closet. So
the first & biggest adivce (& I think it was Evelyn who also mentioned it?)
is this - whatever you do, do *not* let them put on clothes before you are
ready. Otherwise, that is where you are going to have a problem. I figured
out, or I speculate that it takes her so long to put her clothes on by
herself (which I don't want her to do but I don't know she is doing it as I
think she is toileting) that she is then exhausted/too lazy to take them off
again, even with assistance. Also I speculate, after I remind her with a
sweet smile "Oh, but you have to get clean first before you put on clothes -
just like we do every morning." -- I think she is embarrassed & then
"covers" it by not wanting to take her clothes off & getting cleaned. When
that happens, I just keep trying until she eventually does it. Like tell her
someone might come over & you know she doesn't want to be stinky. If things
get escalated, I know (& try very hard to remember) to let her cool down for
several minutes then try again. Otherwise, it's like cats going 'round &
'round.

She has urinary incontinence and can get smelly in just one day. So daily,
it is either a sponge or a bath. So far, she hasn't given me too hard of a
time but I'm always slightly apprehensive when I mention it is time to get
up & get cleaned & dressed. I never know if she will be willing or balk. If
she balks, I say that's okay, we'll do it later. Sometimes "later" means
only like 10-15 minutes & then she's ok. Depends on how sleepy she seems or
whatever. I don't push her about getting started unless we are pressed for
time & I really have to. When I got here, home health had already been
coming for a week or two & they showered her twice a week. They said they
could do it 3 times as they did with some patients. So I did it the third
time. The one time I had a very bad problem & she really had to get clean,
my SIL came & did it. It helps when you have someone else as a backup when
you really need it.

The routine I developed after they left is I give her a shower either every
other day or after 2 days. With incontinence, even trying to go 3 days
barely makes it on sponging. On the non-shower days, she gets sponged.
Sometimes if she felt dirty, she would sponge under herself under her arms &
breasts. But always the bottom part at least due to the urinary incontinence
& also because to put it delicately, she can't really get her backside
clean. On the occasion when she balks, I just calmly (or try to stay calm)
keep cajoleing her & she finally does it. She is able to do the "front" part
herself, I step her through it with 2 washcloths. One soapy, one with just
water to rinse. While she is rinsing her front, I tell her I'm going to do
her backside & use the soapy one. Then I tell her (warn her) "this is the
cold part" & I use disposable wipes & a spray bottle with a mixture of water
& vinegar (as the home health suggested) to make sure her back side gets
clean. She is so sensitive to cold, sometimes even when I warm her she still
jumps & says "that's cold!".

Evelyn gave you great instructions & tips about showering. I'm going to back
up that you absolutely need a shower chair & hose. My MIL still has her hair
done once a week so I thankfully don't do her hair. When it gets to the
point she can't go out to the beauty shop, I'll take Evelyn's advice about
getting that part going first.

Getting into the tub is a process. Basically she needs to sit on the end,
then scoot enough so you can get one leg in there. Then scoot some more to
get the other leg in. Then scoot all the way over to the edge. Getting out
is the same thing in reverse. She may try to get out standing up. The safe
way is to sit down first. Keep telling her to sit down first. Step her
through it, assist as needed.... I take two towels & start drying her back
while she is drying part of her front. Then we finish drying after she gets
out & stands. She holds onto the toilet chair as needed.

I dab a little ponds soap on her face & let her start rubbing that around
while I use a puff on her back, arms, legs. She loves for me to scrub her
back! I give her a washcloth to let her rinse her face. Then tell her to
switch with me. She takes the soapy puff & gets under her arms & breasts. I
tell her to carefully stand up & then tell her to get between her legs.
After soaping the cloth, I do her back side. I rinse her, then hand her the
shower hose & tell her to rinse between her legs really good. She sometimes
also goes ahead & rinses her front again. I ask if she is done rinsing
before I turn off the water. I tell her to go ahead & sit back down so she
can get started drying.

I put a small towel on the toilet seat so it won't be "cold". She must sit
down to safely get dressed & of course never remembers that so I just remind
her. If she acts like she is wanting the clothes first, I just tell her she
isn't putting anything on until she is sitting. I finish drying her legs &
feet. Use lotion on her arms, using a firm upward massaging method. Lotion
on her legs, she has varicose, so I don't massage it in or very lightly on
the one leg that doesn't have it so bad- upward motion. If she has spray on
deod, I cup my hand in front of the armpit so it doesn't go in her face.

Keep at it, you will most likely develop your own routine. I know my SIL
does it a tad differently, and so did the home health lady. Whoever is doing
it must be comfortable with what she/he is doing. Otherwise "the patient" is
going to sense it.

I don't know how well I've explained it. Basically, I go slow, I tell her
every single step. Going slow & repeating everything a gazillion times I bet
is probably the most difficult most wearing part for caregivers. Even
someone like me, who is just naturally not someone who rushes around to do
anything.  Patience, patience, patience. And some times much easier said
than done:)

Sometimes something will happen & I make a joke out of it so she will laugh.
Like I tell her both of us have big tushies (it's true) when we bump into
each other or whatever - we both get a giggle. When I make a mistake &
forget something myself, like trying to put on her pants before I've done
the underware, I make a joke out of it. Be firm throughout the process so
you don't give her room to wiggle out of doing something. Yet keeping it
light at appropriate moments also helps, & let's her know she isn't alone.

Wishing you much patience & luck:) ~~~Octavia

I don't know if this will work. Here is a Google search on this group about
bathing.

http://groups.google.com/group/alt.support.alzheimers/search?group=alt.support.a
lzheimers&q=bathing&qt_g=1