Talking to Your Parent About Hygiene
From the Mailbag: My elderly mom smells and I want to discuss it with her but don't know how to broach the subject without upsetting her. She has a little dementia that is well managed - mostly forgetfulness and some confusion. She claims to shower every day but I can't believe everything she says about anything. She also has a bad incontinence issue and wears pads. She claims to change them often but who knows. She told me recently that she doesn't need to wash her clothing because "it doesn't get dirty." She promised to wash her clothes more regularly but again I don't know if that happens. Her apt also smells -- more of an ammonia smell so I think it's related to urine. I can stay away from her apt for the most part- its her personal smell that is the problem. I literally cringe when she getting in my car and my teenage sons cringe when she hugs them. Any suggestions?
Answer: What you describe is something we hear quite often from caregiving families. Individuals with dementia frequently seem to lose the hygiene habits that they have practiced for decades. Whether it is forgetting how long it has actually been since a bath or shower, or a fear of bathing, or who knows (?), bathing is one of the issues that frequently crops up with dementing illnesses.
Incontinence is also a common problem. From your description it sounds like your mother is probably wetting the upholstery on her chairs, and possibly her mattress and the carpet, as well as her clothing. This will create a very unpleasant odor in her apartment very quickly.
Put the reluctance to bathe and incontinence together and you have a situation that definitely needs intervention.
Unfortunately, as you probably already really know, there is no way to address bad personal body odor without being personal. There is no doubt that however you approach her, your mother will be offended and upset.
If you have involved siblings, it might be easier for you to ask them to accompany you when you have the conversation so that you can give each other support. If you don't, and you have to do this alone, then it will be more difficult. But, of course you have no choice.
The symptoms you are describing indicate that your mother may have reached the stage where she needs more care than she receives where she lives. She is unlikely to remember what you told her about washing her clothes or herself, and these task may truly be too much for her now. Her statement that her clothes "don't get dirty" is typical of someone with dementia who is no longer managing well and trying to hide the fact.
I also wonder whether she is taking any prescribed medications properly. You might want to check on that.
What we always recommend is that you pick the time of day when your mother is usually at her best. Don't plan any other activity in conjunction with this visit. Sit quietly with her, in private, and tell her the truth: that she probably can't smell what others can smell, and that you know it can sometimes be hard for her to remember about bathing and changing her clothing. Tell her that you don't want her to be embarrassed if other residents begin avoiding her (which they probably already are).
She will want to argue. Don't allow yourself to be drawn into an argument. Simply have two options to offer: Having personal care and laundry help where she is, or moving to a place where care is routinely offered - assisted living. (You might want to check out one or two of these options before you talk to her).
Tell her gently, but firmly, that you cannot have her in your car any more if she is not clean and fresh, and that the management will eventually force her to move if she and her apartment are offensive.
I doubt you will have instant success. From the point of this conversation, refuse to take her anywhere in your car unless she has bathed and changed her clothing. If you are planning an outing, be sure to call ahead and remind her to bathe and change her clothes, and arrive in plenty of time for her to bathe after you get there if need be. If she refuses, then say goodbye nicely and tell her you will reschedule. Do not argue about whether she has bathed or not, do not hang around, do not argue, do not take her out anyway, and do not argue.
And give your teenagers a break from having to hug their grandmother for a while.