Terrified about my new job! Advice on changing adult diapers.

I asked my husband, and he’s worked with adults with disabilities. This is what he said:

You’re helping someone who can’t help themselves and are potentially open to being victimized. You can bring comfort and dignity to them by being a caring person. The main thing is, they don’t want this to happen any more than you do. You know how you would like to be cared for, gently and with dignity. Before it happens, you think about it from your perspective and it being about you. Once you do it, it’ll be all about them and their needs. If you can’t take the focus off you, it’s probably not the best job. This is a really important job and society doesn’t pay enough for this kind of care. One stroke or head injury and it could be any of us. 

I’m in a HS for context. I taught an Applied Skills classroom for 10 years before switching into a Resource role.

Most of the time it was the TAs that did the changes but I always jumped in when needed. I think it is something you work through. It isn’t my favorite thing in the world but I always thought that no matter how bad it was I wouldn’t gag or make comments. I never did.

The students deserve to be treated with dignity and having someone gagging while changing them isn’t that. Just consider that everyone you are changing is someone’s son/daughter/brother/sister and treat them with the dignity and respect that you would want someone close to you to be treated.

For me personally, a butt is a butt. Bodily fluids do not bother me, I am more concerned about the person (and I had pooped wiped on me yesterday).

Please consider how you would feel if it were you or a family member and the respect you would want them shown. My mother and grandmother have both had severe strokes where I've had to be the caretaker for them.

As for the smells, you could use the trick chicken plant workers use. They put smelly stuff under their noses when they go in. You could try some essential oils or something near your nose to see if it helps.

I nanny for a 10 year old who still poops in a diaper (not an adult, but still!) and when I first realized it would be a part of the job I was nervous too. Don’t be too hard on yourself! I will say in the moment it’s less bad than I worked it up to be in my head, at least personally. It’s one of those things that you don’t really have a choice about so you just get it done, as the alternative is a person sitting in their own feces which by nature us humans want to avoid other people feeling that way. Just hold your breath if you need to, but I can attest from my experience it’s far less bad than I thought it would be!

So way back when I was in college in the 90s, I was a personal care assistant for adults with both cognitive and developmental disabilities. I had a man in his late 60s with a cognitive age of around 7 or 8, in a man’s body. I had to apply basically “bag balm” (a petroleum based protectant for cow udders) to his privates due to excessive masturbation.

Since I grew up on a ranch, I have an extremely high tolerance for smells and situations that others might find appalling. So, every day, I went in and repeated to myself, this person needs me for this at this time. I cannot judge them. God cherished the meek, and my duty is to care for them. And I learned so much from these dependent adults during my college years.

And, Vick’s vapor rub in the nostrils works miracles for really bad situations (medical mask if needed). Thank you for caring for these needy adults, especially in areas where services are few and far between. God sees you.

It's less about roughening the stomach and more about recontextualizing what you are doing in your mind.

A smell is just a smell, and all bodies make smells. You are helping remove the smell, and in that way, helping yourself and your clients (that's the word my mom used when she worked a position like yours and it's a good term I think).

Be as clinical about this aspect of the job as you can be. You may gag the first few times but in my experience both as a mom and as someone who worked on a care home with a person who wore diapers, you do grow somewhat desensitized.

You can do this! I'm proud of you for facing your fears, and I hope the job goes well!

I'm going to give some very literal advice, based on caring for my grandma with demtia through her passing . . .

When removing, tear the sides and remove at butt level. Don't try pulling them down.

I had a bad accident in 2023. Multiple surgeries, long rehab. I can not tell you how grateful I am for the people who cared for me when I could not care for myself. They were kind and respectful. We got through it together. Put compassion front and center. I am sure you will do a great job,

I've not worked with adults. Only children.

I've found that I didn't struggle much with wet diapers. Not much smell and typically quick and easy to clean. Dirty diapers were very difficult for me. Perhaps a mask with like mint or Vicks would help with the smell. I try to remove and contain the diaper (we put them in a grocery bag, tie it, and would later take them straight to the dumpster) as quickly as possible before working on clean up.

Always wear disposable gloves and wash hands after. And have your hair pulled up- bun or braids. Sometimes a ponytail can be annoying and get in your face. You absolutely shouldn't try to fix it once you have gloves on and before you've completely finished assisting and cleaned up yourself afterwards. Diaper changes in a school typically require two adults to be present. Even though, generally one would be doing most of the changing work and the other witnessing and assist to transfer/lift the person if needed.

Ask some clarifying questions. How often would you personally need to do this? How will you be trained? How many staff members will assist with this procedure?

To be completely honest, I have a smell gag reflex and I really struggled at times with changing dirty diapers on children. It's not always something that gets better. Some people just aren't built for that kind of task and it's ok.

If this is a super minor part of your job, you may be able to just be an assist for lifting. Don't count on that though.

Vicks in your nose. I'm super sensitive to smells of many but not Vicks. I get migraines from a bunch of smells and I was one of my grandmother's caregivers for a while so I've done changing duty. Vicks solved the problem for me. If the menthol is too intense, they make one that also has lavender scent that isn't as strong. Your sensitivity is not a problem to feel bad about, just a challenge to work around.

Others have said quite a bit about dignity, and remembering this is someone’s family, friend, etc and we are all just one bad day away from the same position, which is so important and will help.  But look at logistics of how you can make this less unpleasant for you, the client, and those who use the bathroom after.

Turn on the fan the minute you go into the bathroom.  As gross as it feels, breathing through your mouth will help.  If it helps you feel ok about it, remember your mouth and nose are totally connected and it’s not actually any grosser to breathe through your mouth, it just seems like it.  It will greatly help with smell. I don’t recommend holding your breath in an obvious manner, but you can time turning your head to get gloves, throw away the diaper, etc to get a good breath. 

If you are working with adults who can stand and sit on the toilet as part of the process, use that to your advantage.  If it’s on the firmer side, it goes straight from the diaper to the toilet and gets flushed.  If it’s on the softer side, straight into the garbage bag to get tied off as soon as you finish wiping.   For any number 2, wipes should be contained:  heads up, flushable wipes are almost never flushable.  Containing the smell as quickly as possible will help.

I never worked with adults only children however when I got my first job as a daycare teacher I was terrified of changing diapers. The first few poos I changed I was gagging and almost throwing up. My mom got me some vicks to put under my nose and this was peak covid so I had my mask on as well and it helped sooo much with the smell. Now I don’t even need vicks I have just become so accustomed.

My tips are to put some VapoInhaler on the inside of a mask, it can help block bad smells. Encourage the adult to do as much of the process independently as they reasonably can which promotes dignity and can make your job easier.

Swimming nose clips.

I had severe morning sickness when I worked in an MDS classroom. I am super sensitive to smell and pregnancy made it worse. All the students needed diaper changes. We also had a student who needed their food grinded in a food processor. I did a lot of holding my breath, peppermint and ginger candy for nausea.

Then I’d go outside on my break and throw up.

You do get used to it and if you need a job, you find ways to deal with it. A mask, vapor rub may all help.

Congratulations on the job. You’ll be fine OP.

Tear the sides and use it to wipe off as much as you can when it’s a BM. that helped me so much. Wear gloves and always pinch them off from the center once you’re done! Try finding some videos of how paramedics remove their gloves, that’s how I learned.

I have a strong gag reflex so I wore a mask with a drop of essential oils, but I eventually got used to it. You just learn to breathe through your mouth 😅

But you got this! It takes time. And remember you’re helping someone live properly and safely.

Wear a mask and breathe through your mouth. I have trouble changing my own kid's diaper sometimes, especially if my nose is stuffy, it sets off my gag reflex. I take a nice deep breath before I undo the diaper and then only breathe through my mouth if I have to. I used to be a mortician and there are all kinds of things that set me off, but somehow, using gloves and a mask makes a difference for me mentally and allows me to deal with it. Except for dirty dentures, lol. I can't control myself when there are really dirty dentures in someone's mouth.

A mask and peppermint oil under the nose can be hugely helpful! I don’t gag at smells but some of my coworkers do. A little dab under the nose and a mask (which is a good thing to do anyway- many of your clients will be immunocompromised) takes most of the worst of it away. If the sight makes you gag then you’ll have more of a problem however.

Hey! It totally seems scary at first, I can see why you're nervous. I've been working with teens/ adults with disabilities since I was a teenager, and my first time changing someone I was pretty nervous, but it's really not a big deal. If you're nervous about smells, try wearing a mask when changing. The best advice I can give is to just be cool about it. Don't make things a big deal, because that can be embarrassing for the person you're helping. But if you're chill about it, they'll be chill too. Remember, even though it might be awkward for you, they've been doing this their whole lives. Good luck at your job!!!

I have an incredibly sensitive noise, I always have. I’ve worked with adults and older children with disabilities for years. Getting used to toileting them was just something I had to face head on. I think all of the comments about re-contextualizing are perfect. Be gentle with yourself and acknowledge that it’s going to seem weird. It is normal to feel uncomfortable about it. But that also shows that you’re aware of the gravity of the situation. There is a lot of trust being placed on you in that moment. You are being expected to take care of someone in an incredibly vulnerable moment. What I ended up doing was focusing on the person, not the situation. I was careful and proper in doing what I had to do, but remembering that there was a person attached to this job, a person I had been placed in charge of, a person who you will probably grow to care a lot for, helped immensely. I also remembered that, if we as their workers didn’t do it, our clients would be the ones that suffered. They cannot do anything about it themselves, and that’s not fair to them. They are trusting us to treat them with kindness and respect. The first few times will likely be rough, and that’s okay. I promise the more you do it and the more you familiarize yourselves with your clients, the more comfortable you will become.

Good luck!

StinkBalm. It has different scents and looks like chapstick so it is discrete. Apply it under your nose. 

Lot of comments on here about dignity and respect. I’ve got no doubt that you know how to do that but one area that a lot of people miss that can make such a huge difference is all the nonverbal stuff but especially tone of voice.

I work with adults with disabilities and I speak to them like I speak to anyone else. I also make a point of acknowledging that theyre in the room meaning if someone brings them up like they’re not there I respond by asking the resident and giving them a few seconds to respond in whatever way they’re capable of.

Just a heads up, if someone is escalating and you’re not sure what you’re supposed to do, your best bet is to limit your own talking and give them as much space as you’re allowed to. Talking generally escalates people more.

Some people will use you to co-regulate. So attempting to stay calm is good. You can use deep breathing but it has to be a long slow breath in with your belly expanding not your shoulders and a long exhale with your mouth in the shape of an ‘o’.

I get hired to help when an adult is in crisis and I can’t tell you the number of times I’ve seen residents and staff accidentally escalate themselves by deep breathing wrong. It needs to be very slow. Its actually a lot harder than I think we realize.

There’s a very specific person where I really see this happen. Highly anxious individuals on the autism spectrum who appear to have a need to be in constant motion. They probably talk a lot too. Very repetitive, asking a question about something that happened in the past or is going to happen. They often will pace with their head down while talking aloud. They often have echolalia.

They can escalate to some pretty intense stuff like aggression and elopement.

The biggest thing with this group is to catch it early and try to redirect. If they use PWNs to calm down it early. Work with your team to try to identify signs for when they’ve escalated to a point where it’s unlikely they can be calmed and I almost recommend, that at that point staff should stop initiating with them.

It may seem like they’re talking to you or asking you a question but what they’re actually doing is attempting to self-regulate through self-talk. You might see a lot of repetitive sensory behaviors. Mostly things like squeezing, pushing their hands into a part of their body, tensing their muscle. Often it’s this sensory need that starts the escalation to aggression. If they grab and squeeze staff that’s an indication of this being the case.

They often use staff to co-regulate too. So if I’m working with someone like this I’ll wait until they pause after completing a sentence aloud, they often stand still too at this point, and I’ll calmly ask, ‘do you want me to respond to your question/statement, be close to you but silent, or do you want space?’ With very limited eye contact.

What’s so tough is that they almost intentionally escalate just to get to a point where they can have some kind of catharsis and then calm down. Also, very common that the self-talk seems random. Maybe it’s about an experience in the past that was almost a big deal but they actually did really well. It might not be that experience theyre having anxiety about. They’re actually using that experience because they don’t have enough information or whatever it is to cope with what’s actually causing them anxiety. So they take the emotions and transfer them to this thing they can cope with it. They’re very verbal processors so speaking can actually interfere with the process and cause them to escalate further.

And back to the original one sentence I intended to write. If you notice this group or really any one using deep breathing in a way that’s closer to hyperventilating, try having them count aloud slowly. You should probably guide it. This prevents the hyperventilating and slows their heartbeat.

Hope this helps, but of course each individual is unique. What works for one person often seems to not work with any other human being. JK, but it does feel like that sometimes.

Vapo run under the nose for the smell, potentially also a mask.

I am quite used to changing people so this wasn’t too big of an issue for me, but the smells will get me every now and then. Especially when I worked as a CNA. We would have to clean out poop/vomit out of bed pads,blankets,clothes,etc before sending to laundry. I wore glasses to protect my eyes from the splash. If you are allowed to wear a mask, that can help with the odor and help you mask any facial expressions you may accidentally make. A lot of CNAs will use essential oils,etc to help with the smells but a mask does help as well. So you maybe able to do that has well.

I’ve never changed a diaper on anyone older than a toddler, but I wanted to give some advice on strong smells. When I went to clean out the place my dad died (and had been for a while before being found), we used the vaporub trick. It tried the hell out of my upper lip and nose and I had a rash for days. An essential oil mixed with a carrier oil (like coconut oil) may be better if you have sensitive skin. Good luck!

Breathe through your mouth. Treat them with the respect and dignity that you’d want if the situation was reversed.

It’s not something I love about this work, but depending on what setting, it happens. The first time I had to help with diapering, the student (who was 17) laughed and said “this is a bad one, you might not come back after today.” It gave me a ton of perspective about what it was like to be her.

You can do loads of with with people who have disabilities that doesn’t involve diapering. However, it is a part of it.

a lot of great advice has been given, but i'd like to add- as someone who has been through agoraphobia & panic, now a para for special ed, i say: you've got this! i was worried/terrified starting my new job but it has been so rewarding. and it completely got me out of my head-spiral-worry-thoughts. you will be too concerned with helping your wards that soon you won't even flinch that time someone vomits all over you*.
i am so proud of you for taking this step!

*true story- the student was mortified and i just made a joke that "hey, we are bonded for life now :)" somehow, i did not even gag.

Plenty of people gave you advice on how to show respect and treat people with dignity while changing diapers so I’ll give you some practical advice as someone who works with geriatric adults with I/DD.

9 times out of 10, you’re still going to have them sit on the toilet. If you’re using the type of brief that’s more like a pull up (I.e. no tabs on the side) this is the best time to put a new one on them. Obviously when there’s a bowel movement you’re going to have to (usually) first stand them up to take it off and clean them up before you sit them on the toilet (when there’s a bm you have to clean it right away to reduce risk of infection or rash). When you’re standing them up to do that, put a couple chucks on the ground below them just in case to make clean up easier. Keep extra gloves in your pocket just in case. Wear waterproof shoes like crocs and keep extra pairs of socks in your work bag.

If you see any signs of a UTI (particularly foul smelling urine, blood in the urine, etc), tell nursing right away. I’m assuming there will be nurses there to distribute meds and treat injuries. If they have colostomy bags/catheters, you still have to check/change them every two hours or so. Also, if any of the clients are geriatric, be prepared to see a rectal prolapse at some point. People with multiple disabilities and chronic medical issues deal with chronic constipation because of their medication side effects and dehydration. As they age, the constipation and pushing may result in rectal prolapse, particularly in women ages 70+. If it you see it (you’ll know it when you see it) then inform nursing. Finally, push fluids to prevent dehydration. If they don’t like water, push kool aid, jell-o, popsicles, etc. Pedialyte popsicles are great for this purpose. Make sure what you give them is within their diet texture requirements. Feel free to PN me if you have more questions.

I work in a special day class for adolescents where we have daily pooptastrophes and poop apocalypse’s. We all pitch in. You will get used to it. As other commenters of said it’s about taking care of the vulnerable. If it was you or a family member, you would want to be treated with respect and dignity, and of course, cleaned quickly for skin integrity.

Treat then how you wish to be treated. With kindness, respect, and dignity. Imagine how you would feel, and act appropriately.

Congrats on the job!!