Dad is in ALF and refuses to take showers. Staff is stressing, calls me, I feel threatened as if they will boot him out. Any advice?

There may be some state guideline they are required to follow and want to have adherence to. I'd touch base with your long term care ombudsman's office. Although, this is AL and not a NH....they can and probably do document his refusal which he has a right to....but this will also prove their point and his aroma may offend others impacting the environment and their quality of life so is it possible by guidelines he may be kicked out? Or they will charge an additional fee for giving him assistance....Keep us posted....

bath wipes. No shower or bath needed. They will leave him clean and skin soft and he'll smell great.

GG,

As others have suggested, it may be time for a higher level of care!

My understanding of assisted living is that they expect the residents to be able to bathe and dress themselves. Every day tasks with the exception of remembering to take their meds. They should be able to follow basic instructions.

I'm surprised that the ALF has not reccomended memory care.

(((Hugs)))

My mom is in assisted living and was not bathing herself.  I knew this because the soap and washcloths were going untouched week after week.  I would say why don't I help you into the shower and she would respond with, no I just showered.

I ended up adding a "bath assist" to the services we buy.  They are supposed to go in 3 times a week and say ok, its time for your shower, lets get all of your things together.  Sometimes she refuses.  When she does I tell her that they have to help all of the people that live there because the shower is a slipping hazard and the hand held nozzle is hard to operate.  They would be sued if they didn't help.  She seems to buy that story.  Maybe you could spin a tale that would appeal to your dad...

Tbh I think he has a right to decide for himself if and when to shower. My GPops showers once a week with extras if he’s had a mishap. Yes, on occasions he does get a bit ripe when it’s hot as he’s allergic to every deodorant I’ve tried him with so I just have to deal with it. It’s really not normal for us to shower daily and it’s not good for our skin and hair.
Now I have that off my chest....!😉 my best advice is a gentle discussion with him to find out what’s happening and why he doesn’t want to shower. If the problems can be fixed you’re onto a winner. It might be that he doesn’t like being told what to do by the staff if he’s not actually causing a real problem. If that’s the case maybe it’s time for a different facility if the staff are being too stubborn with their rules?

GG -Are there possibly any other things that AL staff has mentioned that are of concern? Could be something mentioned in passing... like concern about his getting to meals on time, or on being able to do a fire drill. I ask cause I’m in the camp with Llama, Leah and Disgusted2 that his not bathing just could be a pretext for the AL to tell you in the near future that he needs a higher level of care in a different facility. Or that he needs to pay for additional services.

Most AL expect the residents to be pretty functional in thier ADLs (Activities of Daily Living) and be somewhat social and be timely in the routine of the place (they know 2 be correctly dressed & presentable & get to dining room btw 7:30-8:30 if they want breakfast). Like they are expected to be able to get their day started and pull together wardrobe but maybe need help with a zipper or in transitioning in & out of the shower. If they need help taking medications that tends to be a seperate fee for “medication management”. If he’s unable to bathe or do daily hygiene on his own, there might be a separate fee for a bathing team or he schedules regular on premises barber shop visits. But if this is more that he doesn’t understand why it’s needed, the AL will want him out if he won’t cooperate.

Assuming his AL allows visitors right now, the next time you visit make it a long day so you can see just what his capabilities are. Is he doing what the others are? Really stand back and evaluate if he’s keeping up with the other residents.

If his AL is still in lockdown, I’d suggest that you ask the SW or nursing staff to do a care assessment phone call with you. If he didn’t get a needs assessment done before he moved in, it might be a good idea to have one done. If this is about his needing a higher level of care it’s best your aware if this ASAP so you can start to find him a NH or MC and figure out if he has the funds for it or if he’ll need to file for LTC Medicaid. The ALs have been through this before, they will have suggestions as to where. If they have a sister facility that’s MC or NH, it might could be a simple move.

Please realize that AL can do a “30 Day Notice” that states they cannot provide level of care needed and it’s basically an eviction notice. As he’s just in AL, the AL does NOT need to find him another place to move to. He’s in AL and in theory he’s good on his ADLs with maybe just assistance in some things so he can be evicted. He’s not in skilled nursing care which is a Medicare covered benefit and requires secure lateral placement by Medicare. However, it’s bad optics for AL to do this so they tend to instead call EMS to take him to the ER as something seems amiss (the classic is it looks like a TIA / transient ischemic attack as they are pretty subjective) and then the AL refuse to take him back. It then falls on the discharge planner at the hospital to find him a place &/or very heavily press upon family to come and get him. If he doesn’t meet the criteria for needing NH or MC, he can be discharged to a shelter. Yeah horrors!

if your getting a vibe that this place doesn’t find him to be a suitable resident, please pls be proactive in dealing with this. It’s pretty stressful to deal with a 30 Day situation and now with Covid concerns even more so.

It's no use arguing or pleading with someone who really believes that he did shower or that he doesn't need to. I know, because my mother was absolutely dead set against the idea that she needed to clean up. Mom never did go to assisted living or memory care. My brothers and I took turns caring for her in her own home and eventually in the home of one brother who lived in the same state. But something had to be done about the hygiene conundrum....

What finally worked was hiring a caregiver for a few hours each week. A nurse accompanied her for the first visit, and after the nurse did an exam, the caregiver took over and had my mother placidly allowing her to undress and bathe her. The nurse was amazed that my mother acquiesced so readily to a total stranger. Usually it takes a few visits before the caregiver becomes familiar enough. I told the nurse why I believed my mother was so compliant. The woman was a mixed blood native of the Caribbean like my mother. Even though she came from a different island, her accent was very close to my mother's. I believe Mom thought she was her mother. Near the end of her life she would ask if her mother was still asleep in the next room.

If your father has regressed far enough back in time, perhaps someone who he believes is his mother or father or other family member would be able to coax him to bathe.

I don't know if you could speak with your dad about taking a shower/bath because he don't want to get sores or something like that.  if he has dementia, not sure what they can do.......is he mobile enough or is he in wheelchair?  I know when my dad was in a NH when he no longer wanted to get the "shower" (in a special chair), they started to sponge bath him in bed.  Ask if they can or have tried that.  maybe doing just a little at a time.  plus as we all get older our skin gets thinner so I am sure they are careful as to not to rub to hard.  maybe they can talk to him about different things when he was younger while they give him a bed bath.  worth a try.....wishing you luck.

Has anyone calmly asked your Dad about why he is refusing showers? Is he afraid of falling? Is the room cold? Is he confused about the process? Does he need help? If someone helps him is he embarrassed? Are the soap and containers difficult for him to handle? Is he physically able to wash himself?

My Dad was avoiding showers at home until Mom had a fall and hip replacement. We put a transfer chair in the tub and a handheld shower head. He complained but soon started using them!

Have they mentioned what they expect you to do about it? Can you even go inside to do something about it? You didn't mention dementia or difficulty understanding directions, so basing my reply on: he knowingly just doesn't want to bathe. Perhaps he has become frightened of slipping or falling and just doesn't want to admit it.

If dad likes it there, see if a male employee can go in and tell him in order for him to continue living there he has to bathe. Or you could even get a man that you know to go in and question him - just tell dad he's there to evaluate things the facility has said. Doesn't have to say he's your friend or employed by facility - not really a lie - because he is trying to evaluate the situation.

- Ask, flat out, why he is not showering or bathing so the facility will understand what the problem is. Worried about slipping, doesn't like showers/prefers a bath (if that is an option), if he gets worried about falling, etc. Get him to tell the staff member why. If he says he just doesn't want to, staff member can reiterate he has to in order to stay at that facility. What can we do to get you to take a bath every day/3 times a week? If he is still refusing, have the male staff member suggest if he doesn't do it on his own, someone will have to be hired out of his money to come 3-4 times a week to do it for him. If he still refuses, have employee hint that he may have to move to a nursing home where they give you a bath every other day..period.

That might help you figure out what dad's needs might be - bath/shower chair, mat in the floor of tub/shower to prevent slipping, more grab bars. If dad indicates any issues about falling, hire someone to go there and do the bath for him.

If you can at least talk to dad on the phone, yourself, then tell him if you don't start taking a bath, I will have to hire someone to do it and you may not be happy with that idea. Is it possible he's just mad because you put him in the AL?

AL is for people who can pretty much manage on their own but need oversight. Does he have any other things he can no longer do for himself. Maybe he really doesn't need to be there

Imho, since your father is not following the protocols set in place by the AL (not bathing/showering), he most likely requires a higher level of care than the Assisted Living and that will be Memory Care.

Sounds like your father has Alzheimers/dementia, according to your profile, and he's been accepted into Assisted Living when he should have been placed in Memory Care assisted living instead. Any Assisted Living facility can ask a resident to leave if he's refusing to bide by their rules & regulations. Taking a shower is one of the rules of hygiene required in AL.

If this was a new move into AL, you'll need to ask WHY your father was accepted as a resident with Alzheimer's and dementia present? He should have been turned down by the intake coordinator and referred to Memory Care at the outset, if this was a new move. If his dementia has progressed recently and he's been living in AL for a while, they can STILL ask him to leave since he's now refusing to bathe.

Does this AL have a Memory Care annex? If so, he can move into it, if there is availability. If not, and he's asked to leave, you'll have to find him another AL that has Memory Care accommodations that will accept him.

The current AL will give you time to find new accommodations for him, so be sure to speak to the ED about everything.

One of my biggest worries has always been one or both of my folks getting booted out of AL and we were almost there with my father when he became a 2 person assist. He then went on hospice and they agreed to keep him in the AL until death as a result. Once an AL resident becomes a hospice patient, THEN they will usually keep the resident on, no matter what issues he has. I don't know if your dad has declined to that point, but it's something to keep in mind for future reference.

It's also a good idea to have a frank conversation with the ED of the AL and lay all your cards out on the table NOW, so you're not blindsided if/when the time comes that dad becomes too much for them to handle. What is the criteria for an AL resident at his current place? What constitutes 'too much' for them to handle? How much notice will they give YOU before they ask him to leave? That kind of thing. The one thing I cannot tolerate is being sucker punched at the 11th hour and having no idea WHAT to do with my mother if she's asked to leave her current Memory Care AL.

Wishing you the best of luck with a stressful situation.

I hate the thought of anyone not wanting to take showers. That is something that no matter how disabled I am (and I have become disabled) and how much pain, etc., I would never, ever NOT do SEVEN DAYS A WEEK. I will not go into clinical details but it is absolutely MANDATORY and the doctors agree and understand, I need a full daily shower. I am in agony in my joints so it would be and is impossible for me to wash myself - and certainly not my private parts. I need to be spotlessly clean to feel good and function well and how people cannot take showers is beyond my realm of understanding. There are always safe ways to get showers, with help if need be (even though I take care of myself completely). Short of physically forcing someone into the shower, perhaps with a same sex aide, I don't know what to suggest other than a complete sponge bath which someone would have to do. It disgusts me that people don't want to wash.

OP - when you say your dad is in ALF, is this regular AL or MC AL? The difference is one is for people who need, or might soon need, assistance with some ADLs, such as help with bathing, mobility issues, etc, but still are more or less cognitively fine. MC also helps those who need help with ADLS, but it is for those with cognitive declines. Along with those differences are the skill sets of the staff who provide the hands-on care.

AL staff can help with bathing, getting to/from room to dining, activities, etc, managing medications, laundry and/or cleaning. They are NOT typically trained to work with those who have cognitive disorders. There might be some mixed into the staff, but just by coincidence. It really *isn't* their job to get compliance, it is their just to assist in getting the deed done, either scheduled or requested by the resident.

MC, on the other hand, has to have staff that understand the complexities of dementia and how to "work" with the residents to get things done. There will be a lot of non-compliance with taking medications, bathing, getting medical treatments, etc. MC staff need to have knowledge and skill sets to get residents to be compliant, hopefully by getting them to agree to whatever as if it was their idea! They are NOT allowed to "force" residents to do anything.

So, if your dad is in regular AL, it sounds like his dementia has progressed further and he needs to be in MC. Your profile indicates he was moved to ALF 4.5 years ago. That is MORE than enough time for it to progress. If he is in AL and they are asking YOU to do something about it, I would question their knowledge/ability to recognize changes in residents! Does the facility have a MC section? If so, perhaps he can move there? If there's no room, at least get him on a wait list.

If he is in MC, then there is a serious disconnect somewhere. THEY should be the ones coming up with solutions, not you. Even if you were local, do they really think you are going to get this done or get him to agree? This is THEIR job! If this is the case, I would push back on them.

They did assessment on my mother before moving in (they do this for everyone. Mom skipped AL, but I knew she needed MC. Staff had to convince YB and their assessment helped.) Every 6 months they had a review of mom's skills and went over them with me. If changes happened, then they would make changes to the care plan. If dad's facility isn't doing this, perhaps it would be best to find some other place for him, but move right to MC if you do move him.

Consider installing a bidet attachment to his toilet. He will get his bottom cleaned every time he uses the bathroom.

Ask the staff to "assist" him in cleaning up when he gets up in the morning (when folks are usually more cooperative) with sponge bath: face, hands, arm pits. A few weeks of this may make him more amenable to adding the rest of the body once or twice a week. Some folks prefer warmed up wipes since they don't have to expose the whole body (which can be a bit chilly) and is easier than the usual bathing routine of get wet, soap up, rinse off and dry routine,

Some people don't need a shower more than once a week. If they don't stink, they can clean their own rear, then why force them to shower? Some older people, like my hubby, feel unbalanced in a shower. He also doesn't sweat very much. If he needs something, then the body washcloths you can buy work well and don't require a following rinse.

I find it rather odd that a care facility would ask a child to figure out a way to change their parent's behavior. In my experience, parents rarely feel obligated to do what their children want at any time and that only gets worse with age. Also, you are not there and have no idea why your father is not taking showers. I believe that I would answer all their comments with questions. "Why is that?", "What do you intend to do about this?" In all your questions be sure that the point of the question is aimed at how they are meeting their responsibility, not at anything that they might expect of you. If they directly ask you to do something, like explain or order him or some such ridiculous thing, respond "Why do you think he would listen to me? Aren't you his caregivers?"

The fact is that you are NOT responsible for your father, as much as you may love him and want the best for him. Older people can be quite determined to do exactly what they want simply because they have lost control over so much of what used to be important in their lives. You are not going to change this.

They may also be trying to find out what your reaction may be to whatever next steps they have in mind. Will you sue if they try to force him to shower? If that is the case, their indirect method is not very effective. You may suggest that when they come up with a solution to the problem you would be interested in discussing it with them.

It is also not cast in stone that a person must shower. He may be more comfortable using a washcloth to cleanse himself while sitting on a chair by a sink of warm water. One summer I lived with an aunt and uncle who did not have running water. (This was in the 1950's and they lived in an old stone farmhouse and were saving money to have a proper kitchen and bathroom added.) Every night my aunt boiled several containers of water from the well and we took turns standing by the washstand washing our bodies clean of the accumulated dirt and sweat of the day. They lived that way for several years before they managed to add a bathroom and a kitchen, yet they were always clean and well-groomed.

We tend to forget that taking a daily shower is a very modern concept. Using a washcloth is not such a terrible or difficult thing. He can wear a warm flannel robe while cleaning himself and stay warm and covered and safely seated. He may need help getting his feet washed every few days.

Have they sent a male staff member to get him to shower? He may be modest and too embarrassed to say so given the way men are so often mocked or bullied by female staff when they express any modesty concerns. "You don't have anything I haven't seen" and similarly unprofessional and dismissive comments. That often gets the compliance the staff want but it serves to increase the patient's embarrassment which can result in simple refusal in the future. Men have been socialized from a young age to suffer embarrassment quietly which causes some to choose avoidance as the path of least resistance.

Beatty just brought up a good point in a reply to me. I found this when Mom was in rehab. The staff "asks" "Do you want to get a shower" Well of course someone suffering from Dementia is going to say "no". They are like children. You don't ask, you just do. They did this with my Mom in rehab "Mrs E do you want to go to therapy" of course Mom said no. I asked why do they ask it that way. Just say "Mrs. E time for therapy" and take her. If she fights you then u can't force her but asking you will probably get a NO.

My dad's facility had a "shower list." I spoke to the administrator and they added him to it. Staff would come in and assist with shower each time. It really helped. I realize this might not be available at every facility.

At my mother's facility (memory care), when she doesn't want to take a shower they use dry shampoo and clean her in the bed. Will your father's facility do this for him?

Depending on the level of care offered at the assisted living, the residents may be responsible for their own bathing and toileting. I suggest you speak with the manager of the ALF to sort out solutions. He may have to go into a higher level of care.

You may have to pay for increased assistance or move him to a higher- care facility.

Our Papa, who had dementia, had been living in an ALF about six years and bathing, shaving, changing his clothes himself then just decided he wasn't going to do it any more. This is a totally typical occurrence with anyone with dementia. I had to ask the ALF to add these hygiene activities to the services for him. All the caregivers were female and Papa fought it tooth and nail for almost a year with their trying different people to do it. Finally there was a woman who simply would not take no for an answer and did it despite him. After a while he accepted it. The ALF never threatened to have him leave but worked with me and him. Hope you can get the same service and cooperation. Good luck and God bless.

Find out why he doesn't like them.

Maybe whoever helps him is too rough, as what was going on with my 96 yr old dad.

Have them just give him a sponge bath to clean him up as that is what the Home Caregiver does and my Dad doesn't smell.

The facility I worked in created a temporary position in assisted living to take care of showering a client whose dementia was progressing. She was waiting to get into long term care so needed extra help until then.
They had consulted the family and that was the solution.

With dementia he should probably be in Memory Care NOT in AL.
With dementia there is a level of care that is different than that of AL or even in a Skilled Nursing Facility.
the staff in Memory Care is better equipped to handle the daily needs of someone with dementia. While is is probably not great the staff ratio is better in MC than AL.

Really good solutions already posted. The staff is not allowed to "force" the resident to shower, so they're reaching out to you.
When my Mom was in a rehabilitation/nursing home, she refused to shower. I talked to Mom and told her that I would come to the shower room with her and the CNA, whom Mom liked. This worked for her.
Does your Dad get assistance for showering? As others mentioned...bars, shower chair, adjustable shower head are needed for safety and comfort. My Mom is fearful of water in her face. Talk to Dad to see why he won't shower.
If all else fails, a sponge bath and clean clothes may do the trick.
Good luck.

I doubt they can kick your dad out over not showering or they would lose too much money! This is their problem, Facilities love to have the family solve things instead of doing it themselves. I agree this is their issue not yours. If you want voice your concerns to the director of nursing and ask her how she trains her staff to deal with showering refusals. Put the monkey back on her back not yours. What the heck are they being paid for...and it’s not cheap as we all well know.

Last 2 were good tips for home caregivers but the Dad is in an ALF. The relative does not need to go shower supervise or take this over. It is the ALF's responsibility. That's why they have care plans, behaviour charts & strategies. Speak to the Manager directly. Ask to schedule a meeting in a month to give you feedback of what behaviour modification strategies they trialled & if successful. If not, what will they be doing about it.