Home > Caregivers, Dignity, Dressing, Long-term care > Wardrobe Concerns

Wardrobe Concerns

Today, I would like to discuss some concerns that I have regarding how residents in long-term care facilities are dressed.  During my years working in these places, I have made a few observations and have developed a few opinions as to how some things should be managed.  To be honest, I have some definite pet peeves in this area, and will be mentioning these along the way as well.  To clarify things, most of my observations will have to do with residents who have mid- to latter-stage dementia and require a considerable amount of assistance with dressing.

Often, one of the ways that I can tell a particular individual is starting to decline is by looking at her wardrobe.  I’ve seen a number of women who, even when residing in a long-term care facility, are immaculate about their clothing as well as their hair and make-up.  I recall one woman in particular who had 10 pairs of shoes in her closet, each one carefully put away in its own box when she was done with it.  Silk blouses were matched with trim slacks, jewelry, a trim sweater buttoned around her shoulders, and make-up carefully applied before leaving her room in the morning.  Fortunately, the facility staff encouraged her in this.

I strongly believe that facility residents should be allowed to dress as they have been accustomed to during their lives, if at all possible.  There will undoubtedly need to be a few changes, such as encouraging the resident to have a smaller wardrobe due to storage limitations, opting for clothing that can easily stand up in the industrial washing machines that many facilities use, and discouraging expensive jewelry for security considerations.  But asking a resident to wear clothing that is unfamiliar to her may add to her confusion, and may actually prove to be distressing.

Now, some changes in wardrobe can be beneficial, and to be recommended.  Some men, after they reach a certain stage in their dementia, may give in to the urges to unzip their pants and fondle themselves.  Or, they may have so much difficulty unzipping their pants that they become overly agitated.  Women, likewise, may do better with pull-on slacks.  Athletic shoes or more “sensible” lace-up flats with textured soles are usually safer than heels.

It’s not unusual for persons in the latter stages of dementia to have difficulty choosing and donning clothes.  They have problems choosing coordinating colors, or determining what clothing is appropriate for a particular season, and have been known to layer clothing.  There are strategies to get around this, however, and most skilled nursing assistants will know and use these.  Family members should bring in a few outfits at a time, chosen for the particular season.  Putting coordinating slacks and shirts/blouses on the same hangers aids in matching.  When the aide is helping the person get dressed, it can help to offer two or three choices to prevent her undue anxiety related to decision-making.

There is something that goes on, however, in some long-term care facilities, that bothers me.  Most staff members are wonderfully concerned about their residents’ appearance, and their efforts show that concern.  But, especially in the latter stages of the disease, some individuals can become rather messy at meal-time.  Either they have fine motor problems, or develop eating behaviors, or have issues with saliva management, for example, that causes them to spill food down their front.  Now, the worst way to deal with this problem is to feed the resident.  I would much rather have the person make a bit of a mess, but still be able to feed herself, than to have to be fed.  Not only is this demeaning to the resident, but she will decline in her skills at a greater rate — and may actually die sooner.

But, in my opinion, something equally as demeaning to the residents is to allow them to make a mess and then to ignore that mess. More than once, I’ve seen an individual wandering the halls of the facility with the remains of breakfast or lunch still spilled down the front of their shirts.  And I have to say that this really ticks me off.  I’ve worked as a nursing assistant, and I know how busy these folks are — especially right after a meal.  But it shouldn’t take too long to usher a resident back to her room and quickly help her change tops.  Now, most facilities do encourage residents to use a clothing protector (like a large bib) during meals, and there are efforts being made to make these look more dignified.

There are times when it isn’t possible to offer a change in clothing.  I have seen some residents who become distressed, and even agitated.  Or they can become overly embarrassed when it is pointed out to them that they have spilled food down their fronts.  But a lot of this is in the approach.  Instead of saying, “Oh, Mrs. Brown, you spilled your coffee down the front of your shirt.  Let’s go and clean up that mess,” try a gentle, “Mrs. Brown, I spill my food sometimes, too.  How about if we find something else for you to wear?”

Something else I see occasionally, that bothers me, is when residents continue to wear clothing that is worn out or too large or too small.  This can be for a variety of reasons.  Sadly, many residents no longer have any friends or family who can shop for them.  Some facilities do keep a stock of clothing, left over from residents who have moved out or passed away, and often distribute this to residents in need.  At other times, there are churches or other community agencies who will donate clothing when needed, and sometimes a few wonderful staff members will volunteer to buy a resident some new clothes.  But, too many times, I see some dear soul roaming the halls day after day in the same bedraggled clothing.

There are a few companies out there who specialize in making, or selling, clothing designed for the infirmed.  Dresses and shirts that button down the back, attractive slip-on slacks, shoes with Velcro fasteners that make them easier to put on, and so on, are becoming more and more common.  And there are those dear angels who adopt residents who no longer have any family that can shop for them, or take them on outings, or just take time to visit occasionally.  We’re getting better.  But we still have a little way to go.

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