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I would appreciate some input from those that have experience with this issue.

The short version is that I think the skin in mom's groin area has deteriorated considerably since dad moved mom into an Alzheimer's Care Facility in December. I would like to know what is "normal" and acceptable for totally incontinent patients in this setting so I don't make a bigger deal of this than necessary for mom's health. I would imagine some redness is inevitable but she has what look like scabby areas and several other bump headed in the direction of sores. Her buttocks are purple and her groin area is very red. I would appreciate some guidance in recognizing whether they are doing everything they can for her. I live out of town. My dad is sometimes more concerned with his relationship with mom's Alzheimer's Facility and how much they love HIM, than he is with dealing with these issues. He doesn't like to rock the boat and always makes me the bad guy when a significant issue comes up. I'm trying to pick my battles. Below are more details if helpful.

Mom began wearing depends 24/7 last summer. We were cautioned by the Home Health Care provider to watch for any kind of breakdown of the skin and to apply Calmoseptine as a barrier if she got pink. Within a few months, we had round the clock professional care for mom at home and a few months later Dad moved her into an Alzheimers Care Facility. I see mom every 3-6 weeks. I take a careful look at her backside and underside each time to see how things look. When I saw her this weekend I was very concerned. Her buttocks are very dry and purple, there are some areas that were recently scabby and others that seem headed in the direction of open sores. Her groin is more red than purple. There was no evidence of Calmoseptine on her. I discovered this as I was taking mom to the bathroom for a straight forward BM. Her depends were clean and dry when I took down her pants. She had a small BM. Her backside was clean, but her underside was not. There is no possible way the current BM could have ended up in her vaginal creases. It was already there. I tried for 5 minutes to get her clean and couldn't so I called for help. The attendant used over a dozen wipes to clean her. She did not use a clean one with each wipe and honestly, was cleaning her vaginal area with wipes that had feces on them. Every few wipes she would fold it over before taking another swipe. I asked "at what point is it best to just put her in the shower" and she agreed we were at that point. My concern is that mom had been soiled for at least a few hours and in combination with the condition of her skin, I'm concerned they are not always keeping her clean.

I talked to my dad about this. He is a very self absorbed person who insists on controlling everything. He really doesn't want any "bad news". All communication with the facility is to go through him. I suggested he talk to the nurse TODAY and let her know I monitor mom's backside and feel it's deteriorated substantially in the last 6 weeks, ask her to examine mom and provide her assessment/treatment plan, etc. And follow up in 3 days. Any other suggestions? I've been wondering whether a (female) geriatric care specialist would be more beneficial for mom than her primary physician who is a (male) Nurse Practitioner who has never examined mom "down there".

Thanks for your help and input.

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Dahlia - I'm not a nurse, but my mother-in-law wore diapers and pads to help with her incontinence for years. This is totally unacceptable whether your dad likes it or not. She can get many infections by using the wipes that way both on her skin and vagina - which will make things even worse. Yes they can get a little red from chafing, skin folds and having a urine soaked diaper on too long, etc., but there are creams and powders to alleviate this so it shouldn't be more than a day or two. You say your dad likes to control things, but it may be time for you to approach him or your mom about becoming her Medical Power of Attorney and deal with the facility yourself - especially since you're a female and this is a female problem. Someone needs to be her advocate and talk to the head nurse or director about what is going on right now. It could be that the attendants need more training or oversight as they are not checking her enough or they just don't know the "proper" way to clean someone up - but talking to the head nurse should help tremendously with this. And it could be as simple as she needs to be bathed more often during the week. They were only bathing my mother-in-law twice a week - and I had a discussion with the nurse about the diapers/urine and got it changed to at least three times a week which helped her with both the skin and smell. Good luck!!!
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Dahlia, my mom was in Depends for over 13 years. Yes, she would get severe redness and scaling skin and hot to the touch. Yes, you will start to see little pimples popping up - these avoid ASAP from growing bigger. Because these pimples with whiteheads will become bedsores. It's an ongoing struggle to fight against the redness, the scaliness, the pimples.

Mom had UTI and blood poisoning and ended up in the hospital for a month. The nurses would chase us out when they cleaned/bathed her. When mom came home, OMG!!! She had a real McCoy bedsore digging down into her butt muscle! It was really really gross looking. Her groin was super red - angry red. To even have water touch it, she flinched.

Father and I aggressively attacked her problems. We made sure that when the govt caregivers came to sponge bath mom, that they really washed off the soap from her skin. As for her groin, I had to make sure it was softly, gently thoroughly cleaned and put all kinds of ointments on it trying to rid of it. I've tried the Creamy Desitin (Creamy is easy to come off - don't want to do any rubbing during bath time trying to get rid of the old cream. Rubbing hurts her.) I've tried the other baby ointments for rashes. I've never put Calmoseptine in mom's groins. Calmo is very difficult to come off. It's better to use Desitin. I Have used Calmo on her red butt area. Her butt is not as sensitive as her groin.

Because elderly peoples skins are getting thinner, best to use Unscented Body wash. If you have to use scented (can't find the unscented), I try to buy the body wash that the scent is not overwhelming. Find moisturizing wash, or hydrating wash. Baby shampoo for the hair. And always make sure that after washing, that there is No Soap on Their Skin. I noticed when the caregiver leaves, and I'm changing mom's pampers, her skin is super slippery! If I ignore this, when mom sweats, she breaks out in rashes. Dangerous because this can lead to fungus infection - which mom had several times.

How can you tell if it's regular red skin vs fungus infection? No matter what you do, the redness gets super red and hot to the touch. And it Spreads! No matter how well you wash her, wipe her, calmoseptine it - it continues to get red and spread. Time for the doctor to prescribe some very strong anti-fungal creams. Very expensive creams - use lightly on her skin. No need to drown her skin like you would with calmoseptine.

Super red skin is bad. Treat ASAP with unscented soap and wash thoroughly. And yes, the caregivers here clean mom's groin first and then her butt last. I, too, think that using the same wash rag is unsanitary - but that is how they are taught.

Hope this helps. If you have any more questions, please feel free to click my name and ask it on my Wall post. Later! Gotta go to work! I hope your mom gets better.
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Dahlia, as a caregiving spouse myself, I would not appreciate my kids making a bigger deal out of something than I thought necessary. On the other hand, we are not talking about whether her hair gets styled or what time she goes to bed. This is a very basic health issue. If you have to go against Dad's wishes to advocate for her, so be it. Mom is lucky to have you to look out for her in this situation.
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Thanks PamelaSue. As a mom myself, I would have hoped the answer to my question would be "no redness at all"... the standard we hold ourselves to for our children. But I fear that may be too much to expect with 80 year old skin that has so many creases, atrophied muscles underneath,very little fresh air, lots of time in bed, etc. I'm hoping some nurses will chime in here with what is visually normal so I don't make a mountain out of a molehill if that's just where we are. The facility provides the incontinence supplies because my dad and brother said it would be easier for them that way. I have no input into this other than to let my dad know whether we have a problem. Its frustrating but it's the way it is. Thanks again for your input.
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Thanks vw9729. You're right about mom needing an advocate. I'm number two in line behind Dad with regard to POA. He will not allow me to be responsible for her care. I will approach the Nurse or Director if Dad hesitates.
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The best thing I found for my dad's pressure sores and recurrent fungal infections in the folds of his belly and hip area is to clean with warm water and a gentle soap, like Aveeno. Balmex (a diaper rash cream,) is used by the hospital and the visiting nurses that have been here. It doesn't stain, doesn't smell, and goes on very easily. I also wear latex gloves when cleaning the area and have to keep a steady stream of clean towels and wash clothes available, so I do a lot of laundry. Don't put a dressing over the area. If you can, after cleaning, expose the area to fresh area for a little bit. Does your mom sit or stay in bed for long periods of time? My dad does and that is the big contributor to the pressure sores. He also has wets himself and the urine will break down the skin. Hope this helps! Stay on it with the nursing staff, been there with my mom.
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Based on the description of your mom's skin, it sounds like she is developing pressure sores (bedsores,) on her buttocks. Try to make sure the nurses get her up at least every couple of hours or change her position to relieve the pressure. I used Balmex on my dad's bedsores per the visiting nurses that came to my house, they also use Balmex in the hospital here in Ventura, CA. Since it is a diaper rash ointment, you can find it in the drugstore in the baby aisle. It goes on easily, is non-staining and no odor. Knock on wood, I am heading into 2 months with no signs off sores since I followed the nurse's direction! The redness sounds like a fungal infection to me. We used Lotrimin athlete's foot spray, worked pretty well. It is a spray powder. Try to expose the area to the air as well. Is your mom on antibiotics by any chance? Dad was on antibiotics for a straight seven months for cellulitis, and I think this contributed to the fungal problem. So far he has managed to stay out of the hospital for four months, so this all seems to be working. Lastly, he was on prescription antifungal powders and creams, it got so bad. Stay on the head nurse and don't feel bad about speaking up. Your mom deserves good care and this is the last thing you need to worry about. God bless!
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58yrold - I never tried the Lotrimin' athlete feet spray. I've always used the cream and never worked. Maybe next time - if father ever runs into that problem - I will try the spray. So much cheaper than paying for a roundtrip medic transport + clinic fees just so that we can get a $30.00 prescribed antifungal cream.
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Honestly, I cannot imagine any redness being acceptable. I will be truthful and say that I have never dealt with diapered adults, but having diapered many babies in my lifetime including my own four, the only thing acceptable is pink healthy skin. Once a wipe has crap on it, it's tossed aside and a new wipe is used. I don't care how cost ineffective it is for the facility.

Also the wipes are probably irritating your mom's open sores, (check the ingredients for citric acid and alcohol), and it would probably be best to use washcloths with baby shampoo and water. That's what I had to do for my daughter's bottom when she had a very bad rash once.
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I forgot to say, you don't put straight shampoo on her bottom, you put a little shampoo into a bowl of warm water and swish it around until it is mixed, then you put a few washcloths into it. You will also need some washcloths that are wet with plain water for rinsing.

If the facility personal complain about this, tell them that if they had taken proper care of your mother in the first place . . .

I hope that she will heal quickly, the pain and itching must be horrible.
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