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Long story but here it is. Mom's friend called and said she was declining and needed help. She refused to go to any home but mine. We are the closest out of her 4 kids but still haven’t been real close (narcissistic mom). We agreed to add on to our home to give her a place to feel comfortable and us to still have some normalcy. I’m noticing some signs of dementia. She gets angry if I remind her of anything so I bought a planner and just write what’s going on that day and cross out the previous day so she knows what’s going on.


My question is.. She gets really angry if I remind her of anything on hygiene or cleaning up after herself. So I have a dr appointment and wrote it in planner for her to shower before she looked at it and she ignored it. We have arguments at least 1 a week about her showering. I’ve asked if she’s scared she will fall, needs help, too much energy, forgets? She says no. Just that she doesn’t need to be told what to do. And that I’m not her mom. I’ve told her I put it in planner to remind her what day of week it is and that I put it 2 days a week so that I’m home to help if she needs it. She doesn’t want anyone for Home health coming in to help. She’s gone over 2 weeks when I just backed off and I can’t handle it! I’ve asked her to help me to understand so I can help her and she just says I’m bossy. She’s told me she wishes she were gone. She’s on antidepressants, I’ve tried to help her to focus on the positives. She just glares at me and goes down a rabbit hole of negative. This is getting so exhausting. Please any suggestions would be great. Another note and another topic she is a hoarder so I don’t know if this just attributes to it all? Things I should address with her dr and how to talk to them without her getting angry? 😣

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The lack of hygiene issue is so common with dementia patients. My mother is 88 years old. She was the most vain, self-aware person you could ever meet. Now, she doesn't care at all. Every time I, or my sister, bring up to her about needing to shower, she claims she just did that morning. We know it's not true. She avoids it like the plague. What we have to do is link it to some sort of incentive. Going out to a nice dinner, going for a drive, anything to make her see that there will be a reward. Yes, going out to eat even during covid. I'm 67, my sister is 68 and even during covid we did not stop going out when the restaurants were open. Wore a mask, use hand sanitizer, be smart. Better than wasting away & NONE of us got covid, yet.
She is not just resistant about showering, if she isn't given an incentive, she is downright explosive and vicious, as in "I hate you, get out of here." About 6 weeks ago she even told my sister she was taking Judo classes and would take her out. She lives alone, does not drive, goes nowhere without one of us, but is taking Judo. This is how much she hates showering.
Dangle a "carrot" in front of her face.
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Write it down, not too wordy, title it; “things I cannot say in front of my mom” then give it to the nurse to give the doctor (if the nurse is the first person she sees). That gives the doctor a minute to look it over before entering the room and the nurse needs to read it too.
Also, on a separate sheet of paper, ask her doctor/nurse team to write an order of sorts advising her to bathe every Monday or whatever day is best for you, on the doctor’s office letterhead. Keep this bathing order out where she can see it. Repetitious reading helps. Remind her when it’s bath day and produce the letter if she’s forgotten, and she will.
If your mom is receptive to her doctor’s advice then this might help and if she isn’t, it didn’t hurt to try.
Good luck!

My dad’s doctor did this for us and even wrote about the importance of bathing to shield against infections and bacteria. He also gave him a bedtime because my dad has more energy than is good for him. Doesn’t always work but oh how wonderful when it does.
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I always write down information I have for the doctor and questions I have for the doctor and slip him a note as we walk in.  That way I am not embarrassing her by bringing up things in front of her like she isn't there.  The doctor then finds ways to talk about the issues without it being so confrontational.

I don't know why this is such a common thread, but everyone complains about their family member with dementia not wanting to bathe.  I think they avoid bathing for many reasons....vulnerability, confusion on what to do and how to do it, a fear of falling, not remembering when they bathed last and I think they have lost their sense of self awareness.  They don't know how they look or how they smell, etc... but they still have that ingrained response of "it's none of your business and they don't want to talk about it". LOL
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Write out questions before you go to the doctor. Take notes and keep everything organized, for example, in a tabbed binder.

Try to make the bath and shower spa-like and fun. Nice music and comforting products may help.

It may make her feel humiliated to hear she stinks. It may make her feel demeaned to see “take a shower” on the calendar. She is losing control over herself and that is scary. Be gentle with the words you choose.

What do you remember about her bathing habits? Did she like hot baths? Reading in the tub? Long showers? Try to recreate what made her happy as long as it’s safe. (Watch out for bubble baths which can cause UTIs).

Some luxury hotels offer “bath packages.” Take a look for inspiration.

Add grab bars and absorbent safety mats. If she takes a long hot bath, stay close to help her stand and exit the tub if needed.
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Imho, since a narcissist thinks of them in a different vein, your mother will never appreciate, nor like being told what to do.
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If you don't have any POAs set up yet, this is something that needs to be done, if it still can be. She may not be agreeable, but if you can get an initial consult with an EC atty, explain the situation. When it's time to take mom there, plan it around something she might like, perhaps lunch out, a treat, shopping, whatever. Do not mention the appointment, just take her. On the way to lunch, or whatever, say you have an errand to run. Let the atty talk with mom. S/he will have to anyway, to determine if mom is still capable of signing documents. We had POAs and will done previously, but with dementia we needed to do some more legal work and the atty took her aside to question her and decide she was okay to sign. If this atty is good, they can talk mom into understanding the POA is for when she might be unable to pay bills or sign checks, or agree to medical care, etc. Examples they could give is she falls and needs surgery - while she's out, the POA signs for treatment.

Next would be getting her to the doctor. Fibs are your friends. Medicare requires yearly (or more frequent) checkups. Document all your concerns and observations and provide those before the appt, so doc has time to review first (letter or through the portal.) If doc is also good, he won't mention your letter or documentation. He can use what you provide to explore what's going on with her. I would stay out of the exam room, since you already gave information. She might be more willing to be open or accept what the doctor says if you are not there. S/he might also be able to convince her to sign a health care proxy, same reasoning. Even if you have POA, this would be on file in the office, no need to find your copy of the POA.

I also wouldn't worry about her showering before the office visit. Let the doc see her in all her glory! All the more reason for the doc to believe you over her.

As for compliance at home... Arguments will only get you and her upset. Yes, we would prefer they, occasionally at least, can bathe and be clean, but arguing will get you nowhere fast! In MC they can't force any resident to do things they are refusing to do, such as bathing, taking medications, getting wound care or go for medical treatment. Even those with dementia have "rights." So, the staff has to coax the person, trying somehow to make it THEIR idea to do whatever needs to be done. Ask instead of tell. Does it always work? No, but it's worth a try! Wouldn't you like to get cleaned up mom, so we can go to _______ (that being something she likes to do.) Lay out fresh towels and clothes, perhaps some nice smelling soap, etc. Let it be HER idea. Don't try to correct her either, even when you know she's wrong. Acknowledge and move on to something else.

"...I’ve tried to help her to focus on the positives. She just glares at me and goes down a rabbit hole of negative." Keep your "chatter" light and breezy. If she still goes negative, tune it out and continue with chatting about happy things. It's hard to tune it out, but it does get easier with practice. You can always just drift away if she continues. Don't acknowledge her negatives. Let her ramble on.

Hoarding - what kind of things is she hoarding? Do you clean her "space"? When cleaning, perhaps sneak obvious small trash out, or get someone to take her out for a bit and get rid of some of the trash - don't go overboard, you don't want her to notice stuff is missing. A little each time gets the job done.

When clearing/cleaning out mom's condo, she was keeping the oddest things, but clearly it wasn't just hoarding. Cover of microwave mac n' cheese has the instructions - have to save those in case the next one is missing! The stuff she had multiples of is because she'd put them away and forget she had them and ask for more (TP, paper towels, trash bags, etc.) She lived 1.5 hr away, so I couldn't check before buying/delivering.
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The problem is that narcissist's hate being told what to do. Then when they refuse to listen and things go south quickly they blame everyone but themselves.

Be firm with her and inform her straight out that she stinks and you will not go anywhere with her until she has a bath. And, if she wants to stay with you she will be expected to have a bath twice a week. If she needs assistance just say so. It could be that she is too proud for her own good

No, you are not her mom, you are her caregiver. If she does not like the arrangement find someplace else to go.

If she wants to stay with you, she will behave with respect towards you and your family or get out.

If her doctor is any good they will be more concerned about what you have to say rather than her hurt feelings.

Moms doctor expects me to behave in such a manner as to be attentive to what is happening and report it to her.

I was horribly abused for six years. Now, I have had enough and put my foot down. She does not like it but she dislikes the alternative even worse ( the alternative is off to the old folks home she goes. See how long they tolerate that behavior, hint. It will not be too long. And, she knows it too )

You have to be strong but respectful towards narcissist's or they will treat you like crap.

I speak from a lot of experience both in my family and in society.

As for her wanting to die, it is just to get attention.

My mom does the same thing but there have been a few times she actually though she was going to die. She was terrified because she knew she was going to Hell where narcissist's belong. I do not say that in anger but from a Biblical perspective.
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I recommend that you make sure that you have documents designating you as POA - financially and health care. - You need them in order for the doctors to really talk with you and to pay her bills. You don't mention if you already have these. You want to get them while your mother is still able and competent enough to sign them . You might want to talk with an estate lawyer to make sure you have all the necessary documents to handle your mother's situation. I would make sure that you know what , where and how much your mom has in financial resources - does she have bank accounts with access to money? What bills does she have - are they being paid timely? You may want to talk with your siblings about what kind of help they are willing to provide - especially if there are limited financial resources. Make sure you take care of yourself and your own family.
Best of luck to you - being a caregiver -as you know- is not easy or simple. It is very demanding and you may want to talk with a counselor yourself or spiritual advisor.
I do encourage you to get the documents noted above a s soon as possible before you reach the point that without them doctors cannot talk with you and you don't have the authority to pay her bills or keep track of her monies.
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In regards to how to talk to the doctor. I would advise that you carry a typed letter to the Doctor the day of visit or mail it to him/her. I did this all the time with my Mom and now do the same with my husband. I hand it to the check in nurse with a note on top to give to the Doctor before seeing her/him. Works great for all.

With the not wanting to take a shower of which my husband is a real challenge for I have found that I tell him it is change the bedsheet day and only clean bodies get into clean bed. I call it “strip the sheets and shower day”. Another idea might be to make it a spa day, with special products, towels, etc and see if that will draw her to basking in the treat. Don’t know if this will help you, but I hope it does.
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Hey...I don't even bring it up with my mom, it's useless and we're going on 4 years without a bath or shower...yeah, I know, and no, not kidding. We remember easily because we think it was just prior to my dad's 100th birthday bash and he will be 104 in May. We never had a good relationship and the "good" daughter is out of state in FL and useless. Mom might have responded to her or to my father, but no more. We tried getting an aide in, even one who was supposedly a retired nurse who was useless and inept and showed zero initiative and generated more stress. I would find out the MD's fax number and type up or write neatly a note to the MD of the issues of concern. If she is cognitively intact, then I would think she could clearly be told these are the house rules if she wants to stay, otherwise she will be going to an assisted living or nursing home. I actually used at one a home care agency affiliated with a hospital and the nurse who came out to do an assessment said "you know what I would do?" NOTHING. I was shocked. But in a way saw her point...what sense did it make to take her kicking and screaming either at home or in a nursing home? Oddly, there is not much of an odor but the thought of her is offensive, also means I must be careful to keep all of my clothing and wearables locked and safe from her filth. She thinks EVERYthing is HERS. She wears size 6 shoes, but dare you forget and leave your own size 8.5 around, she will put her filthy feet into them. If her MD does not practice family medicine or specialize in geriatrics, I'd be looking for someone else. And don't worry about presentation...let them see the real "her". And for gosh sake, take care of YOU and your family. I tried to do my best, and still am, but last fall all of my efforts came back to slap me in the face when 911 carried ME out of the house and rushed me to the hospital where I was diagnosed and had surgery for a dissected aorta. And let me tell you, that and recuperation from it will make you unavailable to help ANYone. If you warn the MD he can bring stuff up in his role and you won't have to worry about her anger. We ultimately got my not so darling mother to a neurologist who specialized in dementia/Alzheimer's with her thinking the appt was for my father. Being a meddling witch of course she wanted to go. The MD just met with all of us and it seemed like a lovely, casual conversation as he assessed things but he figured it all out. In fact, the Alzheimer'S Assn may be a good starting point. If you go to a support group meeting you will get valuable info on who is a good MD from others who have been down your trail. Wishing you luck ,and sending you hugs....
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InFamilyService Mar 2021
Thank you for your post. Sister and I including aide have been fighting with mom every week about showers. We are all ready to give up. I bought adult size extra large bath wipes for her to sponge with. Her sponge baths are supervised so she does not contaminate herself when she has yeast or fungal rashes.
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Seems your mom may have OCD - hoarding is a form of OCD. She may feel like life is out of control so hoarding and arguing with you are symptoms of her trying to control her life. She needs to be evaluated for dementia and mental health issues, Talk to her doctor and ask for referrals to a neurologist (for dementia diagnosis and treatment options) and a geriatric psychiatrist (for depression, Obsessive Compulsive Disorder and other mental health issues). She will probably get mad at you; don't let her outbursts keep you from getting her the help she needs.

In the meantime. try to have a series of discussions with your mom about what life could look like with her living in your home. Explain your values: cleanliness of home and person, respectful conversations... Ask your mom what she values and expects. I have a feeling mom values her privacy and her freedom of choice. Try to find ways to incorporate both. For example, she agrees to bathe more often and you both put the dates and times on her planner. Another example, she agrees to allow you to clean her "place" and throw out garbage, and that 1 thing kept = 1 thing let go of.
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If she's a hoarder, moving her probably cost her some of the hoard. Might still be a little angry about what she doesn't see in her new room - from the missing hoard.

Write a letter to dr prior to visit and ask him if he would ask mom some questions during the visit. How often do you take a bath? Brush teeth? Walk around house or outside? See what her answers are with you standing in the room listening to her answers - correct her as needed. Ask dr to tell her she needs to bathe X times a week, walk so far each day, etc. And if she needs help to do those things, he will order it. Home health can send a person to help, as needed, with a bath, phys therapy if she needs some exercise, etc.

If mom understands your conversation, then let her know these are the rules of the house regarding hygiene. If she wants rules set down by someone else, she can move to some kind of facility care that fits her needs. Ask her what she prefers so you can help her live where she wants to live
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disgustedtoo Mar 2021
It would be better to document everything before the visit and answer all these kind of questions so doc knows how to lead the discussion and questions. I would not recommend "correcting" her in front of the doc. She already doesn't like OP correcting her or being "bossy", so it would be best to avoid that. Maybe even stay out of the room, so the doc can weigh her responses with what he's been told.

Doc should also write the instructions in addition to recommending what she needs to do. She likely won't remember. Maybe, just maybe, coming from a doctor she might read it and do it. Have copies so if she loses or tosses her copy, you have another to post on the wall or include in her "planner."
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Take her to a neurologist & he or she will give mom a brain MRI . Make a plan to move her to assisted living if possible. This will only get worse & she will bring you down with her. Hugs 🤗
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disgustedtoo Mar 2021
While an MRI might be advisable if other less intrusive testing doesn't point to anything, esp if it doesn't seem to be Alz or Vascular dementia, this is likely not going to fly with OP's mother. Ever had an MRI? Especially upper body? Claustrophobic and noisy! It would probably scare the bejesus out of someone with dementia!

Quite honestly, I was able to determine my mother had dementia, and most likely it was vascular. She had been on BP meds for MANY years and the progression was much as described for vascular. The doctors didn't do any testing. The aide company we tried to use to keep mom in her condo longer DID send a nurse first, for an evaluation, which included a much better test than the doctor offices use (our latest one did try the test with mom, but she was already in MC 2 years at that point, had lost her hearing aid, so that test was a bust!) The nice part about that evaluation is having it done in mom's place, sitting at the kitchen table, with 2 of us present. It was a lot less "dr" like, and less threatening. Medicare paid for this. We were also given some pointers, like using a timed/locked dispenser for her meds.
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Thank you for all the answers. We went to Dr yesterday they are sending her for bloodwork and I’m putting together a note of all the things I need them to know so we can for sure know it’s dementia. She definitely has all the signs. I honestly think she realizes she’s slipping and it’s making her more irritable and worried about losing control of her life. She told the Dr yesterday she doesn’t want to have dementia when she couldn’t answer them why she had come to Dr. praying for answers and direction.
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Geaton777 Mar 2021
Yay! I also pray it is not a cognitive issue.
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If you're noticing signs of dementia, I would write down all of those instances you see and bring it with you to the drs appt. It's fairly common place now, that PCPs will conduct a dementia screening evaluation. Do not tell her that she is going for a screening, just another dr follow up. Her hoarding could be the result of not knowing what to toss and what to keep, if anything. It's easier to just throw something in the corner rather than decide what to do with it. This isn't unusual in dementia cases. Hoarding can present some significant safety issues both as a fire hazard and a tripping hazard. Tripping can result in broken bones for us old timers and greatly accelerate dementia symptoms and physical decline.
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Except for the hoarding issue, our stories are the SAME.

I would bring up issues with my mother's doctors, but being that she couldn't remember what the doctor said, she would just angrily dismiss the doc's wisdom when ever I reminded her. "THE DOCTOR IS NOT LIVING IN MY BODY!", she would say. Okay, then. So much for that.

The arguing and snappiness and general unwillingness of my mother to live according to my simple rules, along with the other effects of dementia, stressed me out so much that I was soon incapable of functioning, myself. I live with health concerns of my own, and it was all TOO MUCH.

She now resides in a LOVELY Memory Care Assisted Living Facility.

I even bought my mother a planner, like you did! She now carries it around with her in the Memory Care, and it feeds into her OCD. She eats a bite of food, comments out loud, writes something down in the planner, and REPEAT!

As they say in some programs, "Keep Coming Back!" You will learn a lot here! :-)

Best wishes.
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Sounds like poor mom is heading into dementia territory. Or could be a UTI as otherwise mentioned.

Lots of people with dementia are reluctant to shower for some reason. Maybe she needs an aide to help her or give her a sponge bath regardless of whether she thinks she needs it or not.

Tell her there's no shame in not remembering everything and that it happens to a lot of people.

And yes dealing with someone being negative and argumentative and difficult is VERY exhausting.

And a hoarder too. Wow lots of things going on there.

Definitely contact the doctor's office before the visit so they can be aware of what is going on so they can discreetly asses her.

Good luck.
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If at all possible (and using any "therapeutic fib" or ruse to accomplish it) get her in to the doctor to check for a UTI or medication imbalance. UTI's are extremely common in senior women and are caused by physiological changes, not just hygiene issues.

If you are your mom's PoA, that's great and you are in a good position to help her when she can no longer make good decisions for herself. Please read the PoA paperwork to understand the conditions under which that authority can become active (some require 2 diagnosis of cognitive incapacity).

If you (or no one) is her PoA, please make every attempt to encourage her to get this taken care of. Without a designated, documented PoA it will become increasing difficult to legally act on her behalf. And, if she gets a medical diagnosis of cognitive decline, this can prevent her from creating the PoA in the future (as well as cause issues of control among siblings).

If you manage to get her to the doctor (use a fib like, Medicare requires it) then go with her with a pre-written note explaining who you are and your concerns about your mom's behaviors and to request a check for UTI, medication, and memory and discretely give it to the staff or doc. They will do it for you. They did it for me. Also while there try to get her to assign you as her Medical Representative (a separate thing from medical PoA) this way the docs can legally disclose her private (HIPAA) info to you and you can supply them with info about her. I wish you much success in working to help your mom!
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You should definitely let the doctor know the truth of what’s going on. You can send a note or use the patient portal to do this ahead of the visit. You can also let the nurse know and to pass it along. Tell what you’ve said here. Consider telling her that regular showering is a condition of living in your home. If dementia is coming on, know that a planner isn’t likely to work. Consider also if this is too much for your peace, health, and home. Her health and mental status will worsen. With it being so frustrating now, you’ll have to decide if you can keep it up as it gets more intense. I wish you both peace
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