My mom won't bathe.

August 15, 2012 6:42 AM

Ideas to help a mom who won't shower or bathe. Lots more details inside.

My mom has some fairly serious mental health issues. She attempted suicide last year, and was committed for several weeks in an institution. Since her release she has been living with her sister (my aunt) and receiving weekly visits from a county social worker, as well as semi-regular visits with a psychiatrist. She is prescribed an antidepressant and anti-psychotic, but I don't believe she's ever taken them both regularly. Several weeks ago she confessed that she had stopped taking her meds, and her social worker is now more closely monitoring them. I think she's taking them regularly now, but it's very hard to tell for sure. I live an hour away, so I can't check on her everyday, and while my aunt will ask her if she took them, she will not physically stand and watch my mom take them, so I'm only assuming mom is medicated, but I'm hoping the closer monitoring by the social worker will help sort it out.

The issue I'm asking about now is the fact that my mom resists/refuses to take showers or baths unless I am there to make her. Part of her mental health issue is that she believes she is covered in feces, and that showering or bathing only spreads it around further. She said she has a pervasive smell that also causes food to rot, so she only eats when encouraged to by others. It's complicated by the fact that she does seem to have frequent diarrhea, and so feels she's not clean because she isn't able to adequately (in her mind) clean it off. It would seem that the obvious solution to this problem would be to bathe/shower MORE, but as I said, she says it only makes it worse. When I visit her she will resist showering, but ultimately do it if I stand in the bathroom with her. As I said, though, I live an hour away, and am about to start my third semester of grad school, so I'm not able to go more than once a week (or ideally every two weeks) to get her to shower. I'm also very frustrated by the fact that the only way she will do it is if I'm there, and I don't quite know if there's a better way to reason with her that might get her to do it on her own. I've tried explaining that even if SHE doesn't feel clean, her showering makes my aunt and I happy, and could she just do it for that reason, but apparently that's not enough. I hope that if she's on her meds long enough they might help at least somewhat sort out her thinking, but I don't feel there's any guarantee that will happen. My aunt is very frustrated, and I'm afraid she might at some point decide my mom can't live with her any more if my mom continues to refuse to cooperate.

So, any suggestions on how I might work with my mom to try to get her to shower without me having to supervise her would be great. My only idea is to go myself once a week and watch her, but that's very difficult with my grad school/internship schedule, and also not ideal in terms of cleanliness, obviously. Thank you for wading through this very long post, and any ideas are greatly appreciated!

posted by odayoday to health & fitness (17 answers total)

One thing I'm struck with is besides a Social Worker, does your Mom attend therapy? Besides the drugs, what other things are involved in managing your Mom's illness?

Don't play the game of trying to get your Mom to see it your way. Your Aunt must insist that she bathe daily.

Here's how it works, "Mom, you're being irrational. You don't have feces on you, but you do stink to high heaven. You need to trust us, get in the shower and get clean. Put on some deodorant. This is not negotiable."

Reasoning with an irrational person is pointless.
posted by Ruthless Bunny at 6:47 AM on August 15, 2012

Does she actively resist taking her medication? If she is not vehemently opposed, then you might look into whether the medication can be given via injection rather than orally. A family member of mine was somehow convinced to make this switch, so now she only has to go get her shot about once a month. This has been life changing.

If your mother were adequately medicated it could make a world of difference in terms of establishing routine.

Tricky stuff. Best of luck!
posted by skrozidile at 6:59 AM on August 15, 2012 [2 favorites]

I know a lot of people who bathe infrequently. Showering every single day isn't necessary for most people, even if most of us do it anyway. If your mom is otherwise clean, I'd worry more about her mental health/meds/therapy and stop focusing on this issue.
posted by jabes at 7:06 AM on August 15, 2012 [1 favorite]

This happened with my grandmother, who has Alzheimers', and my mom. The best option turned out to be putting her in assisted living -- we feared for her health otherwise -- because they could physically take care of her in a way that my mom could not. I know it's not quite the same as your situation, but I think it might be an idea to consider as you cannot be there with her more and if your aunt is frustrated to the point where she won't monitor the medication process - which may be key in getting mom on a healthier routine - I wonder if some outside help might be appropriate.
posted by sm1tten at 7:07 AM on August 15, 2012 [2 favorites]

Assisted living is probably the best solution as it sounds like your mom needs more care than your aunt can provide. I do not know what area you are in but google "[your area] Department of Aging" and they might have links or referrals. Same with the social worker.

If assisted living is absolutely not an option, can you hire a home health care aide to come in every morning and makes sure she takes her meds and a shower? I would also talk to the social worker and psychiatrist and tell them that the meds aren't working as well as they should be and part of the problem is she won't take them - can they offer solutions? can her doc tweak her meds? She really does need to be keeping herself clean, especially if she has diarrhea.

And if she has frequent diarrhea, does she have a food intolerance of some kind? Frequent diarrhea isn't normal and may indicate a gluten or lactose or other intolerance and she'll need a diet that eliminates gluten or whatever.
posted by Rosie M. Banks at 7:17 AM on August 15, 2012 [1 favorite]

I'd talk to your aunt about having her watch and make sure your mom takes her meds every day. It sounds to me like your mom isn't taking them, and if she is, they aren't working. So step 1, make sure she is taking them regularly and evaluate from there, then they can be adjusted if necessary. I'd phrase it to your aunt as you know how tough it is for her, and that you know she's frustrated, and maybe by working on the medication issue there might be some improvement, which would be good for your aunt as well. I'm sure your aunt doesn't want to have to do that, but it sounds to me like it would provide some valuable information that may help get some improvement.
posted by mrs. taters at 7:19 AM on August 15, 2012

or... ask the social worker to suggest it to your aunt?
posted by mrs. taters at 7:20 AM on August 15, 2012

My aunt will tell my mom to take a shower (or her meds), but my mom avoids her, and my aunt's personality is such that she avoids confrontation, so for whatever reason she isn't willing to stand and watch my mom take them. I've asked her if she'd do that before, and it didn't really work out.

My mom is only 58 years old, so I'm really not sure how assisted living might work at her age, and I'm afraid it would end up being much more than we could afford. Plus, my mom does go out to see family and to the movies and stuff with my aunt, so I'm afraid that assisted living environment might not be as ultimately healthy for her.

I have talked to her psychiatrist about the possibility of anti-psychotic med shots, and she said she would consider it after trying the social worker's more careful monitoring. My mom agreed to do it, so I'm hoping that will work out, but until then I'm relying on my mom being honest about whether or not she's taking the pills, which is a little scary.

Home health is a possibility, but I'm not sure my mom would even shower for them. It would be worth a try though...

Thank you all, and please keep the ideas coming!
posted by odayoday at 7:35 AM on August 15, 2012

Look into respite care and give it a try. She may kick up a fuss and rage at the "stranger" who comes to help take care of her, but on the other hand she might accept matter-of-fact instructions from a care worker that she would never follow from a family member. I've seen both happen with older family members.
posted by desuetude at 7:58 AM on August 15, 2012

Could the social worker get her in the shower? Once a week might not be ideal, but it would be better than nothing.
posted by looli at 9:33 AM on August 15, 2012

I think you might be burying the lede here. The problem isn't that your mom doesn't want to take a shower. The problem is that your mom is delusional. Her refusal to shower stems from that delusion.

You will probably get the best results if you work this problem from that angle. Especially when you are talking to your aunt and the social worker, be clear about the fact that "my mom is experiencing delusions that she is covered in filth and she believes that washing it off will only make it worse."

The hygiene issue is secondary to her psychosis in this situation. Hopefully she can be convinced to start taking her meds regularly and for reals.
posted by ErikaB at 12:26 PM on August 15, 2012 [4 favorites]

I knew of a woman with this exact delusion. She lived in an assisted living community, and when it got really bad every now and then, she'd go inpatient to have medication adjusted. She is also probably young enough to be your mom's daughter.

There is no "too young" for assisted living, your mom is sick the point where many would consider an inpatient tune up, and she sounds disabled enough to qualify for all of those resources without breaking the bank.
posted by availablelight at 12:57 PM on August 15, 2012 [1 favorite]

I have considered assisted living, but am afraid that once there my mom will lose the stimulation and connections to family that she has at my aunt's. Things are by no means perfect there (or even great), but for a while my mom was managing fairly well, and despite the no shower (and irregular med taking), she still goes out with my aunt to eat and to the movies, and to see other family members. I'm scared that if she were in a facility she would just lay in bed all day. She says that she doesn't enjoy going out with my aunt, but agrees to do so to "keep her company," and I feel like that's at least a somewhat healthy thing for her to be doing, to stay engaged with the world.
posted by odayoday at 1:17 PM on August 15, 2012

If you want to keep your mom living with your sister, and you do give some good reasons for her to live there: Do her psychiatrist and social worker know she's not taking her medications regularly, and are they doing anything about it? Because your mom is delusional with the believing she is causing food to rot, is spreading feces everywhere, etc. She needs to be taking her meds regularly and her doctor and social worker absolutely need to be helping with this.

I don't know how easy it is to find a new doctor or social worker but if they are just shrugging their shoulders or are saying "it's up to you to make sure she takes her meds regularly, and we can't do much about it" then maybe it's time for a second opinion or a change of professionals. Her doc an social worker must be proactively helping your mom get better and not shuffling it all off onto the family.

A stopgap again would be to hire a home health care aide to give your mom her meds. Mom might take instructions from a stranger who is a "professional" better than your aunt, especially if she knows that Aunt is a pushover.
posted by Rosie M. Banks at 2:07 PM on August 15, 2012 [1 favorite]

The ideas on home health care aides and other assistance are great, but unless you've got deep pockets, they're going to suck money. Your aunt is a wonderful woman for letting your mom live there, it's not easy being around the mentally ill. It sounds like she does quite a bit keeping your mom going out and about and mentally stimulated. Expecting her to be a policeman for meds and personal hygiene is a bit much. You might think about giving her a break or a small treat now and again.

ErikaB is right concerning the issue of her being in charge of her self-care. I would give it another two weeks, and if the meds are still problematic, you absolutely must go into the docs and tell them she needs to be on injections. If the meds aren't working, the bathing issue isn't ever going to resolve itself, and she may turn to other negative behaviors if forced to shower or bathe. Not to mention the problematic eating issue needs to be resolved PDQ. Am in-depth talk with her GP about diet is in order. Beyond that, her social worker needs to be informed and to work with her toward self-care. Unfortunately, it sounds like this is going to be pretty intensive for you for a couple of months, but you should be able to get her on track to where you only have to drive over twice a month and keep in touch with frequent phone calls. Get the docs on the ball here!
posted by BlueHorse at 5:55 PM on August 15, 2012

I don't know what the people who run assisted living facilities would recommend in your specific case or what they are like in your area, but my grandmother isn't confined to the premises and they really don't let patients just lay in bed all day. But most importantly, they enforce the kind of mentally and physically healthy routine that you and your aunt can't/won't. I don't mean to come off as this is the BEST decision but I think you may want to do more research before dismissing it.

I really think that ultimately what to do with your mom's situation is bigger than her not bathing, even though that's your actual question here -- and that your best bet is to consult with her doctors/social workers/your aunt and or other family about where to go from here and what the costs will be, financial and otherwise. Had my mom done this earlier my grandmother's quality of life probably would not have declined so precipitously, and it'll always be my regret that I didn't push harder to get real answers, instead of relying on my mom's assurances that things were okay -- both because there's a large part of who my grandmother was that is completley lost to me now, and because the strain of maintaining this charade completely aggravated my mother's mental health issues to a point where she may end up in a similar place.

Sorry if I just made that way more about me than you. It's just something that has been very much on my mind lately.
posted by sm1tten at 8:56 AM on August 16, 2012

Thank you all again for your thoughtful advice. I went to visit my mom this morning (and to make her shower) and she again confessed that she's not taking her meds. I called her social worker and left a message letting her know, and am planning to go with my mom when she sees the psychiatric nurse (who communicates with the psychiatrist) and the social worker next week. I plan to push strongly for the injection, and if that does not improve mom's mental situation, I will start researching assisted care facilities. I told my mom all of this this morning, and she accepted all of it (I guess the one saving grace of her depression is that she allows me to make most of these types of decisions for her), so I'm hoping the injections will help, but feel like I have a clearer path to proceed if it doesn't.

Once again, thank you for your thoughts and kindness.
posted by odayoday at 12:12 PM on August 16, 2012 [2 favorites]