What is the best way to handle this...forcibly removed the paper from her hands and then deal with a complete meltdown or just wait and pick it up when she finally sets it down? Also she won't always wash her hands but is it the end of the world? Should I make it a big issue or just keep my own hands clean and wash the doorknobs etc.
Some older people grew up putting used TP in a trash can, not the toilet. It may seem strange to many, but it really is not that uncommon in some communities.
I do not know the solution for Maryco, except as she suggests, pick it up, when Mum sets it down and wipe down everything Mum touches, if she has not washed her hands.
when he lived in AL (dementia) he would ~use~ a Kleenex and STICK IT BACK in his pocket to use again. I would catch him sometimes and try to take it. DAD, I would say, here take a clean one! but he wouldn't let me have it!
I know he was frugal, but geez dad!
The tissue, if held on to, will disintegrate.
Or, try giving her a zip-lock baggie to put the tissue in by herself, avoiding a meltdown.
Or, when she is seated, bring her a hot/warm washcloth to clean her hands. Add a sanitizer to the wash cloth.
Do wash the doorknobs and your own hands.
Get her a pretty, fancy, smell good bottle of liquid soap or a pretty bar of soap, make a big deal, use persuasion, not force.
You've got this!