FAQ

1. Rating: +1

   

   Hi! I was wondering if you could give us your opinion. We are considering converting a bathtub to a shower so our 86 year old (feeble) Mom can gain access. It is my sister's thinking that the warm shower will help sooth aches and pains as well as the obvious shower advantage. The other alternative would be to take the money spent on doing the tub to shower conversion and just have a CNA come in twice a week to give her a bath. Mom is quite feeble, so we realize that additional assistance will be needed eventually. I live here with my Mom right now and give her sponge baths and she takes care of keeping her personal hygiene maintained. She has major problems with incontinence and has to change her pull ups a couple of times per day. At this point, what do you think is the best idea...investing in shower or using that money to have someone come in and help her with total bath. I'm just thinking what's best as we move forward. Thanks for your feedback! Pam B

   Hi Pam,

   Thank you for your question.

   There are a number of things to consider when contemplating a bathroom remodel, the first, of course, being cost vs benefit. Will rerouting of the current plumbing be necessary? (Sometimes the drains from a bathtub will not match up to where the drain from a shower will need to be placed). Space is also a consideration. Is there enough space for a conversion? Additionally, will the remodel increase or decrease the resale value of the home?

   From what I am reading, I am thinking that the bath tub that your Mom is using right now does not have a shower attachment above the tub. If you are simply wanting to add the shower component, I think that it would be a worthwhile investment. Be sure that the shower attachement is one that is convertible and can be used like a wand.

   You also mentioned ease of access which leads me to believe that you'd prefer something other than JUST the addition of a shower attachment.

   Ease of access is a big consideration with elders, espcially with women who are more prone to osteoporosis and possible hip fractures. (Treatment and recovery of one hip fracture would be almost the same cost of a small bathroom conversion.) Of course, it is also generally easier for caregivers to assist with bathing a care recipient in a shower than in a bath tub.

   There are actually 4 types of conversions that you could consider.

   The first one is the handicap-accessible shower which features a slightly slanted floor and allows for a wheelchair or rolling shower chair to be placed directly into the shower. It's probably not the best option for you.

   The second option is the walk-in bath tub/shower combination which can also be purchased with massage therapy jets. These are also expensive (about $9,000 - $13,000 after installation), are definitely not for persons who have dementia and will not add resale value to your home (unless, of course, the person buying your home has an aging loved one). (I will tell you that this is the option that I chose for my father and I regretted that decision.)

   The third option is also a version of a walk-in bath tub. A piece of the bath tub is taken out and fitted with a small door. The piece is saved and can be used to convert the tub back to a regular bath tub at a later date. A shower attachment can be added above. The cost of this conversion can be $4000 - $9000 depending upon your plumbing needs.

   Lastly, a conversion from a bath tub to a walk-in shower may be possible, depending upon space and current plumbing. I can't give you an estimate on the costs for this as I don't know your current set-up. Real estate agents used to say that having just a shower without a bath was not considered a "full bath" and thus decreased the value of the home, but with more people "aging in place" and boomers becoming older themselves, they are seeing the advantages of stand alone showers.

   So those are your options. My personal opinion is that seniors ought not be having to step over bath tub siding in order to bathe. It is difficult and dangerous for both them and the caregiver who is trying to help them (even if that's the hired CNA). When elders are nervous about getting hurt while bathing, they are less likely to want to take their baths which can lead to additional complications.

   Also, remember that whatever option you choose, safety grab bars, a bath chair, anti-slip flooring and good lighting should be available.

   Best wishes. If you have any further questions, don't hesitate to ask.

   Shelley

2. Rating: +1

   

   Challenge: Dementia "Sundowner" syndrome - becoming delusional, agitated, and combative at sundown and through the night. We don't know how to deal with my 82-year-old Dad in this regard. He's fighting his caregivers, won't take meds, is suspicious of them, and calls us kids all hours of the night telling they're trying to put one over on him, etc. He sits up most the night and is angry if they try to talk to him or help him. Help!! Thanks so much. Nancy

   Hi Nancy,

   Thank you for your question and thank you for your patience as we worked out some bugs in this section of our web site.

   As you know, "sundowning" refers to a state of confusion or agitation that often occurs in dementia patients at the end of the day. There can be anxiety, pacing, suspiciousness and sometimes hearing or seeing things that aren't there. It is also a time when many of them "want to go home". It is not a condition, but an occurence and can be quite daunting for caregivers, their families and certainly not a pleasant experience for the loved-one either.

   While there is no one explanation for sundowning, many experts suggest that it is caused by the decreasing of light, the increasing of shadows and the fatique of the loved one, so many of the strategies that are used to decrease these activities revolve around this theory.

   One strategy is to plan all activities early in the morning so that the afternoon remains peaceful. The activity might even be followed by a mid-morning nap. Is there a way that your father can take his "evening meds" earlier in the day or must they be taken at an exact time?

   You mentioned his caregivers.........are these caregivers in his home or at a facility? If they are in his home, do they stay all night?

   If they are in his home, they can do much to influence the environment and redirect his actions. In the afternoon, the TV should not be constantly in the "ON" position; music should be soft and lighting should be adjusted to appropriate soft levels as the sun sets (a dimmer works well for this; as the sun goes down, the dimmer goes up). Leave the lights on low at night. The goal of lighting is to mimic daylight, and too many light bulbs on can cause shadows. There are now bulbs that you can buy called "day glow" or "vita light" or "pink light" that help to eliminate shadows.

   Redirection is also important. I know of one person who redirected her agitated "patient" by "accidentally" dropping an entire deck of cards and asked for help in picking them up. Other activities that can help redirect a person are drying silverware and sweeping the floor, although these two tasks work better for women. My father was always calmed by looking at (and describing) a favorite book of photographs that we prepared for him.

   Caffeine and sugar should be decreased or withdrawn in the afternoon.

   A caregiver should always remain calm because their mood will affect his. Conversations should be kept simple without a lot of questions - they can cause confusion and agitation. Sitting quietly with him is perfectly fine - they are there to monitor his safety, not to entertain him.

   Other than removing the telephone completely (or making it "broken") redirection by the caregiver is probably the only way that your father will stop calling you during the night. Would turning off your own phone be out of the question for you?

   Patients with dementia WILL have problems sleeping at night, so perhaps a television at the bedside might be helpful if he is still able to enjoy that.

   If all else fails, there are anti-anxiety medications that can be of some help in decreasing sundowning symptomology. It may require a trial of several different medications in order to find one that works well.

   Best of luck to you and your family as you struggle through this difficult disease.

   Shelley