Hey guys!
Just curious...my mum is in the late stages of HD. At the moment she has started hitting the nurses when she has a shower. She has given a few nurses big fat lips and its starting to become an issue for the staff. Ive given the NH a handout that Jimmy created on showering a HD patient (Im sure they dont follow all those directions, but they have it!) They give her extra valium at shower time (which worries me a bit as she is on maximum doses of everything)...and they have spoken about having an extra staff member there to hold her hands and talk to her while she is in the shower (which sounded like a really good idea to me but practically they are really understaffed and she is still hitting them)

Mum gets really upset and crys after she has hit them and says she feels frustrated. Does anyone have any other ideas??

Have you gone in and she how they shower her? First thing I did was have them turn up the water heat to as warm as possible. They are so worried about scalding someone. It was almost a cool shower.. and to me it would feel cold. I assume the shower is hand held and she is sitting, so when not wetting or rinsing leave that water on them.. even if it has to rest in their lap. That helps keep them warm ... might be as simple as that.

Also are they staying on schedule to when she didn't hit? They aren't waking her to shower now are they? The shower room may be too bright... just check it out and see what's shaking. Bet it something like that.



Edited 2 time(s). Last edit at 09/20/2010 05:05PM by Eric.

my uncle has hd pretty bad. he's in a nursing home.
he's always bitinvg the residents n staaff
they dontmake him take showers and they let him eat and eat til he barfs then he eats some more.

I actually find showering very painful. What feels lukewarm on my hands, turns out to be way too hot when i jump in, but my biggest problem is the water pressure. I'm just more sensitive than i used to be. The pressure of the water hitting my skin is very painful, so the only way i can shower is to have the water lukewarm, and to turn the water down to the lowest softest setting there is on the shower handle. I dont know if this might help, but more likely eric is right that most people like their shower warmer. I don't know michelle, i wonder if she didnt mind the shower before, what brought on the sudden change?

i personally love the hot showers
unless i'm too hot.

Could be the exact opposite barb... I am just saying some minor change might make a big difference.

Michelle, have you been present as she is showered? Some of my challenged patients feel very threatened by the "extra attention" that we have to give in order to get the study done. Maybe having a familiar face would be of comfort to her. My HD+ mother has mentioned something about her skin always being hypersensitive, but it's nothing that has increased due to the disease to her knowledge.

My son was diagnosed with autism at a young age and he has had many sensitivty issues (not so much now that he's older). I feel certain that Eric is on to something. And listen to Barb too. It can be baffling trying to figure it out, but I'd say go in and watch. Lighting, noise (my son has had trouble with loud noise and especially echoes), water pressure, water temp could all play a role. If she has gotten a bad association with showering it may take awhile for her to get comfortable with it even once you've fixed the problem. so don't give up. Maybe a compromise such as sponge baths to stretch out the time in between and not have so many showers might even be an option. Good luck!



Edited 1 time(s). Last edit at 09/20/2010 08:16PM by eve.

I am at my most helpless in a shower. Inside is like fireworks I aam the same in rain. I have a para 3 times a week for a shower. I have grab bars to get in and I hold one grab bar. We have an old water pick shower head which helps with stiffness etc and I clean my mouth with water from the shower too.
I had a shower in Arizona once which great because the air dried you fast.
I loose temp very fast, so I have a big bath sheet towel which I wrap behind the curtain where it is warm, then take the plunge and hold the bars and move to the toilet seat awhich is covered by another towel and a head has a towel. My old roommate Norla came from Arizona and had a heart condition. She used a heating lamp to warm the bathroom to avoid shock.

What about a bath instead of a shower.

Hey guys thanks so much for your thoughts. Yeah it has kinda come out of the blue...she used to be fine in the shower...probably over the last month or so this has started. I thought the same eric that it might be something simple...but im not sure...

To be honest I always feel really awkward about suggesting i go in to watch staff do stuff, as the staff are really sensitive to any feedback..even though i try to be constructive and sensitive! So i havent gone in yet. I did say to the nurse today that I could come in and watch and she basically said " our staff are doing everything right...its your mum, she is fixated on hitting them" So thats kinda the vibe I get. I asked if I could do anything to help and she said i can visit more...hmmmm....ive been visiting once a week for 1o years and im kinda getting tiered!.. and comments like that leave me with alot of guilt!!


When i went in today mum was in her room crying saying she wanted to die (which she hasnt said for about 2 months!) She says that she is "naughty" and they put her to bed for hitting. And today she hit them and they were giving her a bowl wash for her shower??? So maybe she is fixated on that time of day to hit??? She isnt asleep...its 9.30am so its a pretty good time for her. I ask her why she hits them and she says she doesnt know. She just says frustrated, had enough. So maybe she is just really frustrated with everything.

Hey does it always seem like there's always "something"... like there is always a fixation or a challenge to solve?? It like we overcome something and before you know it there's something else! lol

So i told her today is she doesnt hit for a week ill bring in the biggest bowl of ice cream i can find..she thought that was funny

Thanks for all your experiences and for listening!

Oh gosh michelle, im so upset how they treated you. Sounds like they need to know who's boss, she's your mom, and they are the staff. Gosh i'm so sorry. Maybe your mom just doesnt want to be up that early in the day any more. She sounds depressed actually, and would probably like to sleep more. But it sounds like you're saying morning is a good time of day for your mom. You know, i'm so mad though, they treated you like what's happening with your mom is none of your business, and that they are the boss. I know you don't want to cause any friction, but sounds like they need to know who the real boss is, and that maybe it's time for you to call a staff meeting about your mom, and have her depression meds discussed, discuss what you expect out of them, and how you expect your mom and yourself to be treated. If they treat you that way, how are they treating your mom? Do they make her wash up every day, and always that early in the morning?

I agree with barb 100%, Michelle. The response you are getting from them is total crap, IMHO. It's also completely unacceptable from a caregiver's point of view. Although we may employ the help of additional personnel for challenging patients, we never exclude the family from the care. They are a vital part of the comfort level for the patient and actually can help diffuse a tense situation for the patient, in most cases. I would give a call to the director of the department/floor that oversees the caregivers involved in your mother's treatment. They MUST remember that as frustrated as they may become, your mother is STILL THE PATIENT. I have always been taught that you not only treat the patient, but you treat the family, as well. They chose this career and quite frankly, if they can't handle their job, perhaps a career change is in order.

Dealing with nursing homes can be tough. You really aren't the boss.. nor do you want to be. You want to be part of a care team. Contribute what you can, and let them do what they do. They aren't hired servants.

If mum is fixated on hitting she will be during all activities.. so that's not it. She will hit during sponge baths too. I only hear of hitting during showers. So I would stick with that as the problem. I am not in favor of a 4 or 6 hour chemical restraint for cooperation during a ten minute wash. I would rather someone stands guard and blocks a swing. How hard can she be hitting anyway? Three fat lips? But anyway.. it's no fun to dodge swings at work. Sounds like they are justifying Valium for a shower though.. maybe over playing the trouble.

Now I am not opposed to sponge baths... they do the job. Bowl bath. It might break her hitting routine. She's sad because she is being disciplined .. I wouldn't call that depression. Actually sounds more like pouting. But if you are treating someone like a child, they will behave like one. I would bring that up. She is an adult woman... treat her like one.

Lastly.. I don't think they are showering mum wrong. I am sure they are doing it by the book. Something about it that is right for everyone else is wrong for her is all. It would be easier just to identify that and be done with it. This is situational hitting.. so change the situation is all. And yes it does have to work for the employees too. It's a hard job, and intolerable for a lot of people. So we do have negotiate with that in mind. We want people to stay their in the job and like the job.

Just get spiel together that makes sense. Some of the answers to their problems they are having have to be answered by something besides medication. Not everything is a medical problem. Some can be a care problem... with a care solution.

Hey eric she did hit them yesterday during the bowl bath (maybe i didnt write that clearly) would that change why we think she is doing it??
Unfortunately she hits really hard. For someone who can hardly move, when she throws a wack it is in full force!

I'll suggest we have a meeting. Yeah barb she does get really depressed. I asked her yesterday if she wanted a shower in the night and she said no! They are going to start alternating bowl bath to shower days...so i guess if the hitting continues on the bowl bath day maybe its something else??

Swgirl I wish i felt a sense of what your saying at the NH...Ive pretty much backed off the last few years and learnt to be quiet because i dont feel what i say is listened to or acknowledged(and also because i needed to take care of myself better and not exert so much energy feeling like im fighting every battle). Its not that they are really bad or anything...they generally do a good job, and there are a few nurses I love because there approach to mum is respectful and adult like...but for some nurses when issues arise there's an attitude of personal blame on mum. Like "she knows what she is doing" I felt like saying to the nurse yesterday Im sure if you had the brain damage my mum has you would be hitting too! But i would never speak that out loud lol

Yeah I cant stand the word "naughty"...and totally agree eric she will behave like a child if they treat her like one. I hate the fact they put her to bed...but i guess maybe thats all they can do...and its a"time out"...but it does leave her feeling miserable and "naughty"



Edited 3 time(s). Last edit at 09/21/2010 03:35PM by Michelle.

I haven't had anyone in LTC yet so I know not what I speak, but could it be simply a humility issue with not having a private experience when being bathed? Would your mother tell you if you asked her?
Again, I know not what I speak in this matter, just the first thing that came to my mind. Does she toilet herself?

Could it be that she dislikes the person giving her the shower or bath? Is it always the same person? My Mom was in a NH after a brain aneurysm and believe me, if she didn't like you watch out! There were a couple of people that we requested not take care of her because they were rough with her and she would always get really upset the minute they set foot in her room. If you know the day and time of her shower days then just show up without giving them the heads up just to see what goes on. I used to do that all the time. I would go at all different times so that they would never know when to expect me. Just a thought.

The real danger is that if she keeps doing it, they may find some reason to move her. I believe the most common reason is "we can no longer meet HER needs".

Happened to me 3 times.

You would think that after all this, they would have figured a way to stop this on their own. That's a red flag. My only suggestion is to stay on top of it and ride it out. I'd say that she's just going through a phase, and sometime in the future this will stop.

Nobody can predict WHEN however. If she keeps it up, they may (will) slack off. They obviously have some routine they don't want to change or they would have solved this.

Eric is right, they will do whatever they need to do in order to keep their staff. If she ends up punching somebody other than staff, that could seal the deal. So this is a very serious situation. They will do what they want to do for their own purposes, make no mistake about that.

Keep up with it, and make suggestions. Use a different type of shower, one where she sits. See if they can get some behavioral people in to make suggestions. Ask them what they intend to do, over and over. Make them think about it and do their job.

Has there been a change in the person(s) who give personal care to her?
It could be their attitude that upsets her. My daughter was never in a facility but we did have home health and at times she reacted to some of them. Once I caught one rinsing her mouth after they brushed her teeth in the shower by squirting water in her mouth when she could barely swallow. I came unglued and that did not happen again. I also reported that aide.
My mother (dementia, not HD) started to hit them when they showered her in the nursing home. We found out it was a certain aide and she did some abusive things to her and was fired. So I would certainly try to be there and also talk to some of the staff that you have a good communication with to see if they have some ideas of why this is happening so suddenly. Just in case it is not just HD related.

Sounds like a challenge for all involved. Actually bathing would be, from an energy standpoint a better option and would calm her more. This because the heat balance is there which relaxes the body.
In chinese medicin we see the movements caused by an imbalance of inner and outer heat therefore a complete warming through calms the movements.
After the bath it is important to also dress adequate to keep the heat.
All the best.

Thanks everyone. Ill take these thoughts and ideas in with me to the meeting. Yeah I know what you mean fred about it being serious, they have booted her once because she was hurting staff and patients...and i really don't want it getting to that point again. Fortunately now for them she cant walk, so i guess that's why they put her in bed cause she cant get up..but i don't like it.

I like the bath idea Ernst...with candles and soft music. Somehow i dont think they'll be up for that though Time is always their biggest constraint. But they don't do any activities with her so don't see why they cant make her bath/shower time an extra special activity!

She has a massage lady come once a week that i pay for and there is no way she would ever hit her..she absolutely loves it!