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My 90 yo MIL lives with us in our home. She's been with us 8 months and as these things go, it has been ok.



She is diagnosed mid/moderate mixed dementia. She doesn't cook, clean, drive, etc. But, is able to handle her own self-care.



She's been able to bathe herself but lately she has mentioned she gets dizzy when bending over.



I'd like to hire an aide to help with bathing and hair washing once a week but MIL is pretty resistant. I know she is financially able to pay and I know it's not about being shy with strangers.



She says she's afraid of theft. But, I doubt this is the real reason.



I also know I'm not willing to handle all her hygiene needs as she worsens.



When did you decide to get in home help?



Thank you

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If your MIL has original Medicare she could probably get Medicare provided home health for the homebound who need intermittent skilled nursing. Ask her primary doctor to have her evaluated for home health services. This would give her a nurse visit once a week where her vitals are checked, her meds put in her pill planner and a CNA who would come in once or twice a week to help her with her bath. Additionally she could be evaluated for physical and occupational therapies. If you know of a home health company you would like to use, ask them to help you get an
order from her primary. When my DH aunt first started using them they just assisted her with her bath. She was afraid of falling. The cna would change her bed linens while she bathed herself. She preferred a bath to a shower. The therapy helped her mobility issues. Mention that she is dizzy and that is usually sufficient to get her evaluated.
Having home health helped aunt for several years before she needed to add a daily aide to help her with her ADLs each morning. If your MIL doesn’t qualify at this time, you will have a better idea of when she will after their visit. The advantage plans may offer this service as well but I am not familiar with them. This is covered by Part B of original Medicare.
The CNAs are very good with gaining the trust of the elder to get a bath and shampoo. She was about the same age and stage as your MIL when she first got home health.
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RedVanAnnie Mar 2023
I did not know Medicare Part B coveted any kind of home care except after a hospital stay. Is there really some provision for "intermittent skilled nursing?". That would be helpful.
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She’s 90!

Speak to her doctor about ordering home help. My mother did home health a few times. It does make a difference.

Go ahead and get help for her. She will become acclimated to having someone else there to help and most likely appreciate it.
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I am wondering actually if you could go about this another way. I know my brother would not have wanted any stranger "messing with him". He didn't live long enough for anyone to have to make that happen for/with him. But he never would have been comfortable with that.

Is there any chance that instead of getting help for HER you could get help for yourself?

How much better might it be for you to have a housesitter for a day, to clean a bit, cook a bit, watch Mom if she needs help, so that you can get out. Or just a housekeeper one day, meals ordered in, something like that to help YOU.

You are correct. This is only going to get worse. At some point there may be other options such as in facility care, but for now you could sure use a bit of help yourself I would think. I am wishing you the best of luck.
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Don’t give her an option. Just do it. My mom has dementia and had to put her in a nursing home and she would only let me bathe her. Now she’s let’s the staff because she has gotten comfortable with them. You need help you can’t do this on your own. I’ve went thru this with my mom now I’m having to help my aunt go thru the same thing. It’s to hard for you to do it yourself I know you want to but it will just wear you down. So call home health and get something set up if she is still going to stay with you. That way you can get some you time .
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Tell her doctor about the vertigo to get a cardiac work up. If all is OK, some forms of vertigo can be treated
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Its time when you decide it's time. If you are unable to do certain tasks. If you are "not willing", it's time.
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I found someone. Got to talk to her about mom and her history. Shared moms resume so the lady would be able to converse with mom and introduced the lady as a friend of mine. They first did a few things together like eating lunch or going to a church function. Then one day, I told mom I asked Diane to help mom wash up and that she would be using the heater to warm up the room and she would put lotions on mom and fix her hair. I told mom I would appreciate it if she would try this because Diane has wonderful experience and they get along so well. Mom said she would try. She is moderate dementia and still wants to have input. Asking her to do it for me and to try seems to work. It was a success. Diane heated that shower room up so much mom was toasty. I am sure Diane was drenched. Later, when Diane wasn’t enough, I got a couple other ladies who work 4 hours a day and do showers, lotions, warm eye compresses, walking, reading to mom, and 2 meals. Mom didn’t know she didn’t have a choice but introducing Diane as a friend who knew a little about mom’s background so they could converse (mostly Diane holding the conversation on topics that mom recognized) was a blessing to her and me.
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PatsyN Mar 2023
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It is my mother’s worst fear to be naked in front of a stranger. The concept of having someone bathe her was and is horrifying. It’s gotten worse with dementia. Probably the same as most in her generation.

And, in many hospitals, there are now a huge number of male nurses and aides. Mom would not accept help with toileting and bathing from a man. This made the male nurses and aides very angry. It heavily affected their treatment of her across the board.

There are modesty garments for showering you can buy. They might help. I have one, haven’t tried it yet.

http://www.dignityrc.org/

The organization is the Dignity Resource Council. I am really quite surprised there are not many options like this out there.

Here is the page where they offer what they call the “Honor Guard”. It is a cover to wear while showering, for men or women.

I have been very unhappy with the lack of discretion and sensitivity shown my parents by health professionals in their old age. When they protest, they are marked as “difficult patients” and I have seen vindictive responses from the male nurses especially. Again, I have been surprised that there are not more companies making products that address this need for modesty.
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It’s time now. We brought the first caregiver in last May to help. My parents were resistant at first but they got used to it quickly.
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Yesterday, the writing is on the wall.
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It’s possible she’s dehydrated. If you can resolve the dizziness, your mom should be able to continue self-care for the time being — and maybe you get her used to someone helping before you ask her to strip in front of a stranger.
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97yroldmom Mar 2023
Erikka
These CNAs who bath the elderly are professionals. They know how to help a senior If given half a chance. The two LOs I’ve helped with HH came to love their helpers. They are quickly not strangers.
But I agree dehydration is important to watch for.
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see what she wants to dp
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The “right time” is well before the hands on caregiver is sleeping on the floor less than 4 hours/night and has gained 60 pounds of stress weight.

Or perhaps when a scratch on one’s hand infects after a disposable brief goes the wrong way.

Or when the patient slips in the caregiver’s grasp and is bruised because the caregiver was unable to make a safe but less restrictive “catch”.

”Guilt” isn’t useful in decision making about this, but facts and being honest with yourself and your own limitations can be VERY helpful.
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When you ask this question, you are ready. The current caretaker decides this, not an incapacitated invalid.
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I am in the same boat to some extent. There are in home care companies which is not the same as home health. Here in DFW it’s about $26/hour and she will most likely get the same person or care group if you agree to a minimum number of hours per week. If she has a long term care policy it could cover some of the cost. They will bathe, dress, do light housekeeping, laundry, linens changed, errands, drive her to appointments and even take her to eat or to the park…wherever. Google in home care, not home health. Good luck!
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Get help sooner rather than later...
Perhaps you could go ahead and decide which home health services you will use and see if they will begin for example 2 x week....that won't overwhelm anyone and, yet will give some adjustment time before more care is needed.
She will always be resistant to agree up front; this is normally the case. The caregiver, you, must not let this deter making the changes needed for both her safety and well being and, your own well being.
She may try to guilt trip you, get angry, try other things to avoid this but remember this is her denial and avoidance of the reality, her grief associated with aging and changing needs. At some point you may want to speak with a hospice of your choice , especially if you are thinking that in home care is the path you will continue; the clinical director of the hospice can probably give you some good guidance; they are always glad to educate family and caregivers ( and patients is pt. is cognitively able to engage).

Practice good self care.....you are worthy and,will need it for the long haul.
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RedVanAnnie posted the following. I’m replying here so that others won’t miss this information.


“I did not know Medicare Part B coveted any kind of home care except after a hospital stay. Is there really some provision for "intermittent skilled nursing?". That would be helpful.”

Yes. There is a sweet spot in medicare part B which is very helpful for the insured like Lia, OP’s MIL. Part A covers the after the hospital/rehab stay.

https://www.medicare.gov/coverage/home-health-services
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It sounds like now is the right time to get help.

Hire someone who makes her feel like she is getting a spa treatment so it is fun and a happy, relaxing and comfortable time for her.

Obviously this is a difficult point of dignity/privacy and anyone in her position might feel vulnerable and strange.

Her concerns about stealing are slightly paranoid, but also in line with reality and current events. Don’t discount these concerns. Find some way to make her feel protected, such as buying her a small safe that she can keep wherever she chooses.

Let her be part of the interviewing and hiring process so she feels less of a loss of control.
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Justretired99 Mar 2023
She can also get cameras. I have one in my mom’s bedroom and the living area. This gives me piece of mind and the caregiver I have know’s I’m watching.
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I hired a lovely lady to come in once a week to shower my 101 year old father who lives with me. Before she came, he objected, but I told him I couldn’t handle it myself, and that the only other option was a nursing home. With that, he quickly agreed and there’s never been a problem since. This lady was a retired home health care PT. I found her by asking everyone I could think of, and it was my hairdresser who gave me her name! Hope you find someone for your mother. I believe that the only way I can continue to care for my dad is if I hire the help I need to relieve the burden.
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When it became too much for me to handle assisting my mom’s showers 7 days a week. We first started off with someone three days a week. The young lady is so good with my mom her caregiver now come’s 5 days a week 8 hrs each day. I assist my mom on the weekends. Her caregiver also, does my mom’s laundry, keeps her room bathroom clean, fixes her break, and lunch and goes with mom’s doctor’s appointment with me or one of my siblings. She is paid with my mom’s saving and income. Best decision ever!!!
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https://www.amazon.com/shower-chair/s?k=shower+chair

You could introduce a Visiting Angel as a highly recommended friend from one of mom's old friends. You could ask Mom to help if she ever gets inspired to do so.

Anything of value can be hidden or removed to someone else's home. I already sent my youngest daughter all my "real jewelry" so that there's no issue with little valuable things missing.

If all else fails, seek medications from a Geriatric Psychiatrist...................and placement may be in the near future without cooperation.
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Our PCP ordered home health aide for my husband and Medicare paid 100%. I was present and the aides were wonderful. They had him wash his own private areas. When hospice came in he was already accustomed to a helping hand.

I personally can understand the hesitance she might have. Who wouldn't? You certainly have a lot of great answers to your questions. May God grant you and your family strength for the coming days ahead. God certainly helped me tremendously. Bless you.
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I was caring for my dad all by myself. I still did all his bathing, shaving, haircuts etc. but he couldn’t be left alone. He qualified for paid care about 4 hours a week through a local agency we have in my state called seniors with disabilities. We also paid a man from my church that was retired to come and stay with him 4 hours another day of the week just so I could get out to do errands and have some free time. The person on the other day who was from the agency, did household chores and fed him lunch and was just there to make sure he made it back and forth from the bathroom etc. he got to like these people even though he had a hard time remembering they had been there the previous week. Maybe if you had respite care for awhile and had them do some household chores, your mom could get to know them and feel more comfortable in their presence by the time you will need them to help with bathing etc.
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You make a decision when you feel it is needed for the safety of the elder.
- Expect resistance. It is something new for her. Be patient.

* Do not leave 'too much' up to her. Although do give her 'lots of room' to vent. She needs / [everyone who is losing independence + dealing with decline] wants and needs to be heard / listened to which shows respect and interest.
- Offer reflective listening, i.e., I hear you saying XXX" (this doens't mean you agree with what she says, it means you acknowledge her feelings and thoughts).
- It is recommended (by many, and specifically Teepa Snow, one of the country's leading experts on dementia) to offer someone two choices.

In this case "Do you want a person to assist you with bathing ISN'T ONE OF THOSE QUESTIONS. As, of course, she'll say NO.

You want to set up questions to receive a "yes" or choosing one of the two options you pose. For instance, (you'll need to figure out the questions that'll work) -

* Do you want to use a pink towel or a white towel after your shower?
* Do you like the water soft or harder?
* Do you want to use a face cloth or a (?) spongy thing to wash your back?
* After your shower, do you want to put on xxx or xxx?
* Would you prefer to use (in the shower) XXX soap, shampoo (mention scents or brands) and see what she says.

* I acknowledge you for knowing your limits/boundaries in dealing / engaging in her hygiene needs. Hopefully you are not conflicted with your decision. It is certainly understandable (as) It is critically important that you 'trust your own gut' in getting the assistance (you need that) she needs - as it is for her safety.
- She may not agree and that is okay. Expecting that she won't agree and will resist is half the 'battle' of you preparing for these types of needs/changes in care.
- Start with introducing someone to her to assist - perhaps with getting dressed or having a cup of tea with her - so she can get to know someone new. You want to create an environment of trust and comfort - so it is well worth the investment to for you to pre-screen someone and invite them over for a 'visit.' Don't necessarily start with a new person and SHOWER on the same day.

* Be sure that the caregiver is used to working with elders who are resistent.

- Ask the caregiver (on the phone) "How do you handle XXX" and mention a few possible scenarios that might / likely will come up.

- Patience, compassion, understanding are key and most experienced care providers know this. Although many caregivers are doing this work because they need a job and unable to do other types of work; their heart isn't in it - along with lack of experience).

Important qualities of a care provider:

- Smiling and looking into an elder's eyes, i.e., making this contact
- tone of voice
- How a caregiver physically touches an elder is important (gently, slowly) = no sudden moves (having a cup of tea and gently touching an elder's hand could be very helpful - that personal 'touch' / making a connection.

An elder sensing/knowing / feeling another person CARES is more likely to accept their support than a person who is 'matter of fact' and lacking compassion.

- It is always important to see the situation from the elder's point-of-view. This is how we develop / are aware of / and extend compassion. It is always helpful to say "I understand ..." "you are not alone."

* Logic often doesn't work in these situations due to:
- Based on the elder's perspective/feelings. So saying that it isn't safe for her to shower alone as she might fall likely won't get the result(s) you want and need. Mom is likely thinking of losing independence, fearful, feeling uncertain about how she's declining (these are the issues / concerns to address).
- Although, you know her. Is she concerned about falls? breaking bones? being hospitalized? These are the reality of what could / might happen if she doesn't get the support/assistance she needs.

Gena / Touch Matters
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grammiegoose Mar 2023
Thank you for your thoughtful response. I work in Home Healthcare. Everything that you mentioned, matters. LOVE is where you start.
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" but MIL is pretty resistant."

You're in charge here so take charge. If she's truly worried about theft then have someone around while the aide is there. You could also get cameras and an in-home safe. Her health is at risk if she's getting dizzy.
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I'm the OP. Thank you to everyone who took the time to respond. I've read each of your helpful suggestions.

She does need more social interaction so a Visiting Angel type who can help with a shower, shampoo and companionship would be perfect.
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Take the blame for help you need: I need the help to help you and keep you safe in the home. Becoming dizzy tells me that you should not be in the bath alone. I know you don't want help, but I need help.

When do you decide she needs in home health? When you know you don't want the hygiene chore and she needs help with it. You're there, dear. Get someone to come in a few days a week to handle it for you.
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Start bringing in the homecare now while your MIL can still understand what the purpose of the home/health aide is. This wasy she can get used to the person and get to know them.
Start with having the aide come once a week to wash her hair. Do this for a few weeks with you there then have her start assisting with the bathing.
Tell your MIL that you must insist she accept this help because you can't help her with personal hygiene care but that you want her to be safe and comfortable.
Make her understand that no one is going to steal from her because you're going to be there keeping an eye on the homecare worker.
Once she gets used to whoever is hired you won't have to stay with her.
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ThinkingOutLoud: Begin now to discuss with and then bring in home health for your MIL while she has cognition. Start slow.
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To agree and elaborate on some other comments, you definitely need cameras and you definitely need to lock up anything of real or sentimental value. I had caregivers in the house for seven years and I wish I had done a better job in this area. So no matter what you think no matter how nice they seem, I am sorry but protect your assets - your mothers right. I have cameras that have caught abuse and theft from people you wouldn’t imagine. Good luck
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