Elder Care Guide
Section I: Hygiene
First of all, is hygiene; This is one of the most difficult aspects of caring for an elderly person. There is bathing, going to the bathroom, eating, oral care, hair, nails, skin, and more.
I have had many people tell me that because an older person has more delicate skin that they should not bathe as much, but my experience has shown the opposite. Just as babies have delicate skin that needs special care- older adults have skin that is thinner and more fragile. However, just like a baby, cleanliness is the secret.
Haven't we all met the mom who doesn't clean her baby's nose simply because she says that it hurts? This is ludicrous. Leaving it dirty will cause sores to form and cause the skin to be red and not heal. Skin needs to be dry and clean to remain healthy.
The same applies to adults. Hand baths are okay, but limited. If possible, a walk-in tub and handicap shower are the ultimate gifts for caring for your elder. We have been blessed financially and when we built a mother-in-law suite on to our home, we added both.
My mother was heavy and was not able to get around very well. She used a walker and could only navigate a 3 inch step. A walk - in tub allowed her to still take long baths.
Bathing by soaking in warm water is very healing. She had an auto-immune skin condition called Bulbous Phemgroid where blisters form on the skin, ooze, then leave open sores.
Soaking allows the skin to soften, be cleaned completely, and to pull any infection out.
All this without rubbing the skin, which actually is a negative in an elderly person.
Also, while she was in the tub, I had her lift her legs up and I was able to cut her nails much easier than when she was in bed or her chair. The water facilitated her lifting her legs up as it is easier in the water.
I also washed her hair, ears, shoulders, and back-- using baby shampoo and gave her a soft wash cloth to wash her face and eyes.
If you are not fortunate enough to be able to have a walk-in tub, there are stools for showers, bars and steps for tubs, and so on.
You just have to keep modifying things as they keep going downhill and progressively get where they can do less and less.
I added the shower for when she could not bathe any more...or when she had an accident. I had it made with no step or edge so I could push her wheelchair right into the shower, help her move to a stool, and then bathe her using a hand held shower head with a long hose.
I saw such a shower years ago in a home where their daughter had Cerebral Palsy and was confined to a wheelchair.
When we built mom's addition we made everything handicap accessible.
As for oral hygiene, my mother didn't have any teeth, refused to wear her dentures- so really, we didn't have to do a lot, just make sure that she drank plenty of water and took vitamin C.
As for going to the bathroom, this was the tricky part. It was a lot of trial and error before I finally figured out the system that I ended up using.
First of all, you need to understand that most of the falls that seniors have - occur in the night when the person is up trying to go to the bathroom. Therefore, it is crucial that one of the first things that you set up is a potty near the bed.
Seniors and family both fight this in the beginning. The caregiver doesn't want the work of having to empty and clean the potty; and the elderly person sees this as a testament of their decline.
However, this is so important. And I will show you how to do it where it will not be hard or create a mess or lots of work.
Buy a plastic floor mat that covers your carpet--the kind that goes under chairs in front of desks so the chair can roll around.
I kept cleaning wipes nearby and with the mat covering the carpet, an accident was just a simple wipe (not a stain on the carpet that needed shampooing). Another thing I learned to do, was to keep the furniture covered that your elderly person uses.
As people age, incontinence becomes a real problem. Many times, they cannot even tell or feel that they are leaking or that they or their clothes are wet. They lose their sense of smell and have no clue that they; their room, their house, or their clothes are stinky.
My mother fought me on this issue all the time. She couldn't smell anything.
The best way to explain it is to compare them to two-year olds. Many toddlers do not understand the potty concept or why they need to use it. Older adults revert to toddler status in cognitive ways.
However, we cannot just treat them like a big two-year-old. There has to be a certain decorum or respect. We have to incorporate dignity for the life they've lived, even as we slowly see their cognitive skills digress and disappear. It is a hard and sad thing to see.
Getting an adult to start wearing diapers is very hard. My mom refused to do so until one day when we had a long conversation and I explained that it wasn't fair for me to have to keep changing the bedding.
Also, after she started wearing diapers, then it began to be that she wouldn’t change them. I would have to come into her room on a regular basis. First, to make sure she had a diaper on, and then second; to have her change it if she was wearing one.
Then as the years went by, I had to start helping her clean herself or give her a shower or bath to clean her.
Another thing I did to make my job easier was to put two trash bags in her potty. One is the odor fighting kind and the other is a kitchen trash bag leakless. Then I would add about 2 inches of water, then ¼ to ½ cup of Fabuloso. I tried bleach and other cleaners, but Fabuloso cuts the smell the best.
In medical centers, they just have patients pee in the bags; but, whew, pee stinks big time. If you have the water mixed with Fabuloso, there really is no smell even if there is bowel movement.
Then simply tie the first bag off, then the second bag and throw them away. We throw away diapers all the time and don’t think anything of it, so I see this as the same.
No potty to wash; no toilet to clog. No smell.
I also worried about the mattress and mom’s chair. At first, I kept towels on them to protect them, then realized that wasn’t enough. I bought mattress covers, but had to change them constantly and realized they leaked a little.
Then one day the thought came to me and I took several contractor trash bags (they are an extremely strong plastic). I cut them open and flat then laid them on the mattress and used duct tape to hold them on.
On top of that was a cushioned mattress pad, a fitted sheet, an old towel, then the disposable pad.
Section II: Setting Up the Furniture
This is my mom, with Gandalf. He became her friend, but then disappeared. But later, our neighbor's cat had kittens that looked exactly like him (although he was neutered)...I wonder?
She had an electric adjustable bed. As she had sleep apnea, lung problems, and was obese; she had to sleep with her upper torso elevated. She either slept in the bed elevated or in her recliner.
Do you see that I kept disposable pads all over the bed? And there is an old towel under the pads. Her sores would ooze; also her diaper would leak. So the pads helped many times to prevent extra laundry.
This picture (above) shows the black contractor plastic trash bags that I cut into sheets and duct- taped to the bed to protect the mattress. (I still used a padded mattress cover, but the plastic mattress cover never worked as well as this thick plastic). This really helped with cleaning and eliminating smell.
Beside the person's bed or chair, you need a table or something to hold all their things: a water bottle (and just as little children...eventually...something with a cap and sippy or straw will be needed), books, puzzles, pens, powder, creams, lip protection, etc. Whatever, your senior uses and needs most.
A potty by the bed is essential. Most falls in elders occur at night while trying to go to the restroom. But no one wants to take this step.
I have a plastic floor mat that you buy at any office store underneath the potty to protect the carpet. Then two trash bags inside the potty. Believe me, this is the easiest and best setup.
A full potty can clog a toilet.
A potty without a few inches of water mixed with Fabuloso is very stinky.
Potties without trash bags are really yucky to clean.
By doing it this way, you can eliminate much work and yuckiness. Just knot off the first bag, then the second, then throw the complete mess away....just like a diaper.
You need a shelf by the potty and a covered trash can as well. The shelf can hold baby wipes, toilet paper, creams or lotions, baby powder, a magazine, diapers, etc.
As people age, their reasoning abilities simply disappear. My mom kept putting dirty clothes in the trash until I labeled the trash can thus.
I also took a permanent marker and wrote as large as I could: PLAY, STOP, EJECT, etc. on her VCR. She lost the ability to use a remote control and couldn't use the DVD player, but did fine with the marked VCR player by her chair.
Perhaps, the VCR was a greater part of her memory or psyche, I do not know. I only know you keep trying different things with people who have dementia, trying to find ways to cope.
Some things, she never lost. Mainly, things from her long-term memory. It was her short-term memory that suffered the most.
She would even ask if it were night, when she was sitting in her chair and could plainly see outside and it was day. Think it was winter when it was green and beautiful outside.
I also found that if I wrote something down that I really wanted her to know, remember, or make a decision over; I would write it down and let her read it over and over. This process seemed to save it to her long-term memory and then on her good days we could have a discussion about what it was and she could reason at those times.
Dementia is very strange. With my mom, it was a come and go sort of thing.
Here you can see that there is a trash can right beside her chair. There is also a shelf with videos, snack, tissues, etc.
The VCR is right where she can reach it and see the note taped to the side table? It's to remind her to go change her diaper...I would leave such notes to help her to remember things.
Okay, see the remote control to the chair is duct-taped to the arm of the chair. My mom used a reclining rocking chair for years, but then finally declined to the point she needed a lift chair. However, she would lose the remote, even sitting on it and then get stuck in her chair and have to buzz for us.
After I taped it to the side and took a permanent marker and marked in large print UP and DOWN; she had a much easier time.
See the towel on the back? An older person has a lot of dandruff. This kept the chair clean as I changed it as needed. I also used plastic, then a towel, then a disposable pad on the chair to prevent smells from leakage or accidents.
Here you can see the layers of protection. Contractor bag taped on with duct tape, then a towel, then a disposable pad.
I will add more later...giving up driving is a big hurdle, also for my mom; going from a cane to using a walker was a huge hurdle.
Finances, family matters, death of a loved one, loneliness, sickness, leaving your home, rejection from a loved one, nursing care, preparing for death, etc....there are so many aspects of aging.