How can I broach the subject about my aunts accidents that she does NOT remember and insists she doesn't need any help?

How does she go on an outing without her caregiver? Is she still driving?

Besides incontinence, what are her impairments? Why does she need a caregiver?

She is 99 years old and living in an assisted living facility with a full time aid. When we take her out she sometimes doesn't want the aid to come with us which makes it tough when she has an accident. I'm looking for ways to speak to her without upsetting her. She always says the aid doesn't do anything for her because her short term memory is really bad. Any suggestions?

Does she wear Depends or something similar?

I doubt you can convince her that she needs the aid. Could you try something like, "The ALF insists that when their residents leave the grounds they need to be accompanied by a licensed assistant" ? Or "Of course you would be OK without the aide, but I'm getting a little worried about my balance and I want to make sure someone else could help you if I have to sit down."

Agree with her that she doesn't "need" the aide but try to convince her that the aide needs to come with you anyway.

Thanks Jeanne. Appreciate your help!

Jeanne has a good idea. There is no way to convince someone that age that they even have accidents, or to convince them they need help. My mother was in her late 90's when she did the same. Arguing and resisting is the only tool left in the box for them since they are powerless and physically weak and mentally confused. Mom refused help up until the age of 100 and only accepted it then because she was wheelchair/bedridden. When Mom got stubborn and argued, we found the best thing to do was not even ask her if she wanted help, we just did it whether she liked it or not (and she soon forgot what she was fighting with us over)

I like jeannegibbs and AmyGraces ideas and approach. Once upon a time I was able to take my mother out with my adult disabled son coming along. Now I could no more do that than I could fly. In fact, now I can't even take my mom out - just the two of us. One of those little mysteries in life is why my mother will do things - like bear weight and help get herself in and out of a car for her hired "companion" but for no one else. Sorry, I digress- given your mothers age I'm guessing you're getting up there in years yourself - sorry, no offense intended. So put it on you - you hurt your back, your knee, whatever - and just tell your mom if she going to go out with you, you have to have the help of the caregiver or the outing will be impossible. Then just do it. If mom kicks up a fuss, skip an outing or two and re-explain why.

Can you sneak a box of Depends or pads in? Does she dress herself or do you or the aide help in that way? If so, either you or the aide could casually put a pad in the underwear or try the Depends and not say anything. People have given me several boxes of heavy duty pads, and these have helped me tremendously with mom (even overnight), who no longer fights me since she can see she has problems with the incontinence (just can't get to the toilet quick enough). I no longer have to clean my carpeting or wash so many clothes or the chair pad where she so much. I also just told her there's no way I'll take her to the beauty shop or to see her sister-in-law anymore with the possibility of her making a mess. She seems to get it now and realizes even younger people have problems like this.

Your mom may feel that not having to wear diapers is her last hold on independence and life as she remembers it. My husband was the same way, and he was in his late fifties. It was embarrassing when he would come out of the men's room with a large wet spot on the front of his trousers, or actually having an accident in public. I had to begin reasoning with him as one would with a child. "Use the bathroom before we leave even if you don't think you need to go." Finally, after actually rotting the floorboards under his chair, he capitulated to wearing a diaper, but still won't wear one at night. My mom, age 94, and in a NH, also wouldn't wear her diaper. I worked with the staff to convince her she needed to wear them. Could you speak with her aide and ask her to kindly but continuously enforce that if she wants to go out, especially by herself,she needs to wear protection? "You don't want to be embarrassed if you might have a little accident, right, Mom?" Or "You know, Mom, all us old ladies have those little leaks every now and then. I sure do. And I don't want to have to leave to go home and change if I'm having a good time!" And, with hubby, I always made sure that he wore dark trousers.

Remove all her regular underwear and replace it with Depends or whatever brand you are going to use. Many of them are colored pink for women so it will still look like "pretty underwear"
If she asks about her other underwear just tell her it is in the laundry.
Keep her drawer or wherever she keeps her underwear filled with the incontinence product. I would put enough for using one or two a day in the drawer so you can monitor that she is in fact changing them daily.

I don't think there's really going to be any easy way to approach this. Remember she's a woman and she's probably pretty embarrassed and I don't blame her. As suggested here, I like the idea of skipping or canceling outings if she won't comply. If she's making these messes in your home, you're really going to have to crack down on this because it's a threat to everyone's health, especially if she happens to live with you. She probably doesn't like the idea of meeting personal care, and she probably gets tired of seeing the same personal aid all the time. It also sounds to me like she wants to be able to just go out on outings with just family and no one else, and I don't blame her for wanting private family time with no one else. She probably feels like her space and private time are being invaded, and I don't blame her for feeling that way if she happens to see just a little too much of the same person she knows is not part of the family. Again, this is definitely not going to be easy for anyone, especially her, but the dirty work must be done even if you have to end up putting her into a facility if all else fails. You may want her about this being a last resort, because if she lands at a facility she can blame herself. Tell her that noncompliance is exactly what will land her in a facility. You must somehow get a handle on the problem and gain the upper hand.
One thing I'm wondering is that she still live at home on her own? Does she happen to live alone? If so, this could pose a serious problem. If she lives with you then it can pose a health problem to not only her but anyone else living in that same house. You really don't want the problem persisting, it can lead to the eventual condemnation of the home. This is a very serious threat to the health of not only the individual but others around her. Maybe mentioning nursing home will get her attention because if she happens to enjoy her freedom, warn her that she will lose her freedom and everything she owns if she must go to a nursing home. This may work depending on how much she really wants and appreciates her freedom and everything she owns. You may want to have a serious talk with her and tell her what all is at stake and that if she ends up in a nursing home for noncompliance, she can blame no one but herself for the loss of her freedom and her belongings

Is she only having accidents when on outings? I would think that they would put her in Depends in the AL for everyday use if she's incontinent. That's what happened with my cousin. After repeated inability to notify someone she had to use the bathroom, they had the doctor write a script for them.

Also, we learned to double the Depends when she left the facility and take extras and a change of clothing, along with wipes, plastic bag, etc. We had a huge accident at the dentist office. I had to go next door and purchase Depends, clean up supplies and a pair of pants for her to put on. Lesson learned on that one.

While I certainly understand 1RareFind's suggestion and I have received similar suggestions on disciplining compliance, stating that she will have to go into a NH if she does not comply is taken as a threat by seniors who are struggling to maintain their independence and dignity. Threats increase fear which increases resistance, agitation and lack of trust in someone who is already feeling very vulnerable. Plus if she does eventually have to go into a NH it will have vestiges of punishment not a positive thing. If the senior has dementia it is hard to reason logically since dementia impedes reasoning and short term memory does not allow for retained explanations. When my mother acts out I do stay away, but without threats and she gets to missing me and then behaves better so that I won't mysteriously go away. Threats backfire when used on my mom, she digs her heals in deeper. I find the gentler approaches to the situation as given by jeannegibbs, AmyGraces, murphyclm, Hugemom, and Grandma1954 work best for me. I explain I can't manage on my own (bad shoulder), and just slip things in that she needs (like exchanging the undies for pretty adult depends and such. We don't want to treat them like children who are dominated- they resent that and after living 90+ years, they have earned whatever respect and dignity that can be given.

Mthr's home said it was time for Depends, and to simply take the other undies away. My DIL recently had a baby and had some left from the post-partum time, so I brought those in to show mthr. I told her these were a gift from xx, because all the young girls are wearing these now so they don't have to do laundry and we all know how much she dislikes to do her laundry. I explained that if they get wet or dirty, you just throw them away because it's cheaper (little fib: the home does not let them do laundry, but not about the price of depends - they are cheaper than her breaking a hip doing laundry). I took the undies to "donate to charity." No argument, and she's been on a subscription to Sam's brand ever since.

I must add that an elderly friend of mine who long since died in January was incontinent, he's the one who is abusing the system by wearing out the ambulance service by going not once but twice daily when he really never had much of a need to go as what was discovered about him. He was very incontinent and he did eventually end up in a nursing home. I don't know who had this talk with him but it had to be the hospital and I know now that also the paramedics were also cracking down because this was getting ridiculous when he really never had much need to go by squad as what was discovered. A lot of his problems where discovered to be his own making and he brought most of it on himself as what was discovered in careful examination and investigation. Much of what he was experiencing was just for attention because he mostly did certain things and called the squad when he was alone. I noticed this for myself and the strangest things what always happen behind our back when he was alone. He would purposely poop himself, and boy was it mushy! One time I went over to see him and there was poop all over the bathroom and was it a huge mess! This happened right toward the end of his ability to stay in his apartment and live independently right before he was forced into a nursing home. He had no family around to him discuss this with him, so it was not walk to the hospital and the paramedics. I don't know what was said in the last discussion, but I know now they really put the screws to him long and hard because he was put into a nursing home and not brought home as he always was. I'm sure the hospital has also warned him about being admitted to a nursing home because it eventually happened. He was also in his 90s, about 93. He died January 3 2015. What I noticed is he started talking bad about this hospital but I really never knew why until everything unfolded. I now understand he bad talk the hospital because the hospital most likely had the nursing home discussion with him. I'm sure they probably called in a social worker to talk with him and when they most likely had this discussion with him he resented that hospital and wanted to go to Wade Park where they had no clue what was going on (or so he thought). What he didn't realize is that things have gone digital and your records can be accessed with the right information between hospitals. When do you go from one hospital to another, they can access your records with your information. He didn't realize this when he kept talking about wanting to go to Wade Park. It's a good thing I didn't have a car at the time because he probably would've used me for a ride to Wade Park. I think he probably tried to use someone else at the time because at the time he approach them at a time they couldn't take him somewhere and he admitted to having busted out their car's headlights when they said no to transporting him at that time. It was probably bad timing or maybe they caught on to what was going on, I don't know. However, whatever happened may be a good thing I didn't have a car at the time because the same thing may have happened to my car if I couldn't transport him for some reason. I learned a lot through this particular situation and I can share what I learned with others just for my own observances and what I was through with the person

You are absolutely right about younger people having accidents. I was a teenager, riding my bike, when a boy yelled at me from the top of a hill to go home. I didn't quite make it to the bathroom at time; I realized I had Irritable Bowel aka Angry Gut. It got pretty bad about 7 years ago; it turns out I now have malabsorption syndrome. I take my Vitamin D along with other meds; I only have had a little bit of leakage problems since then and now it seems to have gone away - the poop is willing to wait until I get to the bathroom, turn on the light, and sit on the toilet seat comfortably

1rarefind, I just want to point out that Lacypeach's Mom is already at a facility. Lacypeach covered those questions a few messages down from her original post. She writes:"She is 99 years old and living in an assisted living facility with a full time aid."

lacypeach, at some point you get to where they just can't do outings anymore. For now, limit the outing to a short ride in the car, no more than a cruise around the park. No meal outings, please, that just makes the bowel move things out.

I just happened to think of something because I just now remembered when my elderly friend was alive and he became incontinent. Have you ever spoken to the patient's doctor and suggested a full internal cleanse? I happen to remember something when my friend was alive that he became very constipated and his guts were full of BM. He never drank much fluids, Especially not enough water which caused the problem. As soon as his insides were internally flushed and cleaned out, he wasn't incontinent for quite some time because everything started working normally again. This may sound strange, but sometimes a person may have bowel leakage when their system is just too full and it's just an overflow. Even younger people can notice this. I've even notice that cleansing my own plumbing means I don't have continual seepage after him already done. Cleansing the plumbing really works wonders! This is really worth a try, it worked for my friend and has also work for me though I'm not incontinent. Internal cleansing would definitely be worth it because you should notice tremendous improvement. Continually drinking plenty of water will maintain normal function afterwards

Lacey lots of ideas here on wearing depends but I wondered if Aunt just wanted to go out WITHOUT the aid sometimes? I agree that you need the aid. I've been in that position where my mother had an accident and she was wearing depends. Just because you have depends on doesn't mean you can ignore a bowel movement. I would have loved having an aid with me when that happened. I agree with the suggestions to tell Aunt that you need the help. Do you spend time with aunt at the ALF without the aid present? Perhaps she just wants some individual attention. So good that you are getting your aunt out.

lacypeach: You might say something like "it's so much fun when we go on an outing TOGETHER." Turn the focus onto togetherness and see if it lightens the anxiety of the event.

I would hide her underware and replace it with adult pull ups.

If your aunt is not bothered by bathroom accidents, doesn't remember them and is not interested in having an aid assist her, that would let me know that she's not thinking clearly. With that in mind, things just have to be handled. Convincing her, or getting her to see things your way, isn't likely to happen. I'd just focus on getting her in the Depends, carrying the supplies and having the aid available. You might just say, the aid needs the work, or something like that. Whatever works in the moment.

I've had to assist as my cousin's aid cleaned her up a couple of times while on outings. She had on Depends, but overflowed and had BM. You need the aid, believe me. Besides, your aunt is not likely to recall any conversations about it. If she doesn't recall bathroom accidents, then I would consider her memory pretty compromised and deal with things in the moment.

Sunnygirl, I really like the idea about telling mom that the aide needs the work! That is one thing that really will affect many old folks, and that is giving work to those in need.

Yes, and it's probably true too. lol I've also said that the insurance required something be done a certain way or we had to get a waiver in the mail to stop doing it. It sounds reasonable and will usually work in the moment to satisfy an unsound request by the loved one.

Just one additional suggestion if it hasn't already been made. I personally would really dislike the association of the word "diapers" with anything to do with an adult. Same goes for "adult daycare" - simply demeaning and demoralizing to refer to these things as you would a child going to daycare. So, I try to use terms that are less likely to engender a negative response such as "do you need more panties, underwear or liners" (even though they are Depends or Poise underwear) and "the club where you get together with other folks" for something like adult daycare. Anyway, just a couple of thoughts......

Yes, don't refer to the diapers/Poise in a negative connotation. You could say "I found some really pretty panties (that will be Depends, of course) and I liked them so much that I bought some for you AND some for me, too because I realize that sometimes I'm having trouble making it to the BR. We're all women here and we can talk about these things."
Funny and true story was that my late mother (bless her soul) urged me about 5 years ago to get some Poise liners because sometimes I WAS running to the BR!