Dad wears pajamas all day and doesn’t change clothes for a week.

After Mom died, Dad was in a funk for a long time and didn’t get up, get dressed, brush his teeth or do any of the normal stuff. And I understood that—the rock upon which he built his whole life had just been knocked out from under him. That was five years ago, and eventually, I got him to put on some real pants and shave once in a while. But it didn’t last. After it was clear that Dad couldn’t live alone and needed some help, we moved him to a senior living place that lets residents age-in-place. They have dementia care housing and that’s where he is now.

Lately, Dad’s been back to sitting around all day in his pajamas and not changing clothes for a week. The staff are aware of this but don’t seem too concerned. I feel like it’s unsanitary and verges on neglect.

Who’s right here, and what do I do about it?

Acknowledge the reality.

It goes without saying that not changing clothes, especially underwear, for a week isn’t sanitary. It smells bad and creates a place for germs to live and for rashes and other problems to occur. Filthy clothes can also be itchy and uncomfortable. All other things being equal, Dad should change clothes and the staff should help him if he can’t do it himself.

There may be reasons why Dad’s doing this. Here are just a few.

• He’s depressed.

• He get his own clothes off, due to a lack of strength, dexterity, or some other physical problem.

• He doesn’t understand why people should change clothes.

• He doesn’t know how to change his clothes any more.

• He doesn’t want to take off what he has on because it gets cold when he doesn’t have clothes on.

• The clothes he’s wearing feel comfortable to him, and a new outfit feels “scratchy”, “heavy”, etc.

• He thinks other people are stealing his clothes, has given them to another resident, has hidden and forgotten them, thrown them out, or lost track of them in some other bizarre way.

• He just doesn’t like the new outfit you want him to wear.

Deal with the reality.

It’s pretty common that someone like Dad REALLY needs to change clothes and doesn’t want to. Here are some tips for dealing with the situation and MAYBE getting Dad to put on some pants.

• Don’t take it out on the staff. Unless the situation is TRULY EGREGIOUS—and we’re talking lawyers here, chances are that they’ve probably already tried several times to help Dad change clothes, and gave up after deciding that dealing with a screaming, hallucinating or combative resident was more urgent.

• Switch out Dad’s normal clothes for ones that slip on, use snaps instead of buttons, or whatever is easiest to put on. His problem MAY just be that he’s forgotten how to use buttons or can’t work the details of putting them through buttonholes.

• Ask Dad to “try on” a couple of shirts or pants you “bought” (from his closer!) and tell you which one he likes the best.

• Tell Dad that you’re going out to eat together and hand him the clothes. He’ll take forever to put them on, and will most likely get distracted, but stick with it and you may coax him into his trousers.

• Tell Dad you need to wash the clothes he’s wearing and hand him a new set. Don’t ask him to try them on; just tell him he can’t leave the room naked and wait for him to take them off.

• Ask him if you could try on the shirt he’s wearing. The more it’s about you, the likelier he’ll cooperate.

• Similarly, ask if you could borrow his shirt, perhaps “to see if his grandson would like one just like it.”

• If a bath our shower is available, tell Dad he’s won a spa treatment but that he can’t do it with clothes on. Then give him a bath or shower, make sure it’s full of warm water, foam, nice smells, and a big soft towel, and lay out a fresh change of clothes.

• Tell Dad you accidentally spilled something on his clothes. Then start taking them off while you hand him a fresh set.

• Be ready to accept compromises. Getting Dad to change his shirt may be as far as you get today. Change what you can and wipe what you must—a bath with a moist towelette is better than none at all, and getting him to change ANYTHING is a victory.

Let it go. If Dad refuses to bathe or put on new clothes, you can always try again tomorrow to get him to change clothes.

What’s the real problem here?

There are many reasons that elderly people, regardless of dementia, don’t like changing clothes. You have to ask yourself what suffering, if any, it would bring to just let them do what they want, as long as it doesn’t endanger their health, safety, or life. Mama used to wear the same t-shirt all day. She had broken her arm in a fall before the transfer to her dementia home, so she had legitimate reasons for not wanting to change it. I didn’t feel like pushing her to take it off was a top priority unless it was giving her trouble somewhere else. Instead, I adjusted her wardrobe to include garments I could help her out of easily and made sure what I brought was bright, pretty, warm, and smelled nice.

Dwelling on whether Dad’s behaviors fit the normal models of a civilized society is a fool’s errand. That train has already left the station, and you’ll be forced to choose between adjusting your expectations accordingly and insisting on her world being something it isn’t.

In this situation, patience and compassion are your best tools. Dad’s doing the best he can.