Battling Bathing

Dementia is a disease that is ever progressing. This disease process may be slowed down or plateau for a while but will eventually continue to progress. As the disease progresses an individual will need more assistance with basic activities of daily living. A sensitive and personal task that most caregivers and individuals with dementia seem to struggle with is personal hygiene, particularly bathing. Tending to personal hygiene can be exasperating for caregivers and is often a source of anxiety for individuals with dementia. For some caregivers, bathing can be the most frustrating activity faced because of the fact that it is a private and personal task. For an individual with dementia bathing can be perceived as a threatening or simply unpleasant experience. The list below describes some reasons bathe time can be a difficult time but it also gives suggestions to managing the difficulties.

Tips to keep in mind:
 

• Doctors recommend older adults shower or bathe a minimum of twice a week to reduce the chance of infection (such as UTI). If you can get them to bathe more, kudos to you. If not, be satisfied with twice a week.
   
• To combat the “NO’s” try to make it seem as if the request is just a routine part of daily life as in, “It’s Tuesday morning. We always take our bath on Tuesday morning. Let’s go get cleaned up, and then I’ll make you a nice breakfast.”
   
• Have everything ready (soap, shampoo, towels, and washcloth) in advance, all laid out ready to go. The room temperature is warm, maybe soft music is playing. You say something on the order of “your bath is ready for you. Here, let me help you with your shirt. Start helping, turn the water on in the tub and temper it and say something like “madam you spa awaits you.”
   
• If there is no other way to get them to bathe. Ask their doctor to write on a prescription pad something like this: “Mr. Smith must bathe two times a week for infection control”. Make several copies of the prescription (in case they tear it up). Show the prescription to them and say “Doctor’s orders.” 
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• The bathing should take place at the time and in the manner the person always used to bathe, meaning if they were a morning bather, then you should have them bathe in the morning. If they were a shower person, then they should have a shower, not a bath, unless medical or physical reasons preclude that.
   
• Some persons with dementia actually grow afraid of the water, especially water coming out of a wall mounted shower head. It becomes threatening to them. If this is the case consider getting a flexible hand held shower head. That way you or your loved one can control where it sprays on them.
   
• Allow your loved one to do as much as they possibly can to wash themselves while in the bath. If they can do a credible job on their own with just reminders from you to wash here and there, let them do that. Even if they don’t do a credible job and you have to redo the washing, I suggest you have them wash themselves first. It gives them “ownership” of the task and gives them something to be successful, even if all they can do is hold a washcloth while you do everything else, let them do that. At least they are participating in the task as much as they can.
   
• Some people need to be distracted with something while you give them the bath or shower. Distractions that could be used are singing in the shower, giving them something colorful to hold and look at while in the shower.
   
• Some people are extremely modest, be aware that that may be the reason for saying “NO”. Respect their dignity by allowing them to cover up with something while in the shower. Perhaps a towel or a sheet or even a poncho. Just wash under whatever they use to cover up.
   
• Safety comes first. There need to be grab bars positioned for them to hold on to while getting in and while bathing and appliqués on the shower or tub floor to give them traction under their feet. If the person is scared to get into the tub because they have to step over the tub wall, try using a “transfer board”. It is a fairly long straight plastic board that you place in the tub with one set of legs outside the tub and the other set of legs inside the tub. Your loved one sits on the outside part and you help slide to the inside part.
   
• ALWAYS PRAISE AND COMPLEMENT THEM AFTER THE BATHING IS DONE. After the bathing is completed and your loved one is dressed, PRAISE AND COMPLEMENT THEM and ask them to cross off that day on a yearlong calendar showing the year by months. Have them do this every time. Eventually you will have visual proof that they have taken their shower or bath every Tuesday and Friday (for example) for months and that it is a normal thing to do. It also squashes the “I took a bath/shower earlier today or yesterday” protest. 

When you are helping someone with dementia to wash, it is important to be sensitive and tactful and to respect their dignity. Caregivers are not there to change an individual’s routine to fit the caregiver; the caregiver’s goal is to assist an individual in activities that will give him or her, a quality of life.