Bath
time tops
the list of frustrations for most caregivers of people in the more advanced
stages of dementia.
Most
of us shower once a day. However, it wasn’t always like that and many of our elders
are of a generation that bathed only once a week. To them it may appear that
we’re obsessive about bathing.-
Of course it’s important that we keep clean; showers and tub-baths are not the
only methods. A sponge bath or a no-rinse cloth wipe-down is just as effective
at cleaning a person as a vigorous shower.
Bathroom Basics
SAFETY: Install grab bars on the
walls, both by the tub or shower. If you’re using a tub, you can also attach a
clamp-on railing to the side of the tub to make getting in and out easier.
Place a non-skid pad in the bottom of the tub or shower. Also, make sure all
the floor mats are non-skid. Replace the showerhead with a handheld shower,
which gives you more flexibility.
Toilets:
If
the toilet sits next to the wall, you can install a grab bar. Otherwise you can
use a portable support.
Most
residential toilets are low, making it difficult for an older person to
maneuver getting up or down. There are products on the market that combine grab
bars with a raised toilet seat:
Go
to your favorite search engine and look up: “Elder bathroom products”
Short
list of tips for a successful bath time:
Important: Prepare the bathroom by warming it up (90º minimum) and laying out everything you need,
including change of clothes. If possible, set the water temperature ahead of
time.
• Use a tub or shower chair and handheld shower
• Lay a soft towel on the shower chair
• Avoid bath oils that make the tub or shower slippery
• Assist the person in and out of the tub or shower
• Never leave the person alone
•
Use shampoo, soap, bath gel etc. very sparingly. Elderly people already have a
problem with drying and fragile skin. All these substances tend to dry out the
skin and scalp.
•
After the bath use a body lotion
Bonus:
To brighten up the bathroom,
you can bring in plants or flowers and play music (CD player)
Consider the History
You’ll have greater success when you conform to her customary
routines:
Did she shower
or did she prefer tub-baths?
How
frequently did she bathe?
At
what time of the day did she bathe? (Morning or evening?)
Did
she use a washcloth, sponge or brush?
Did
she wash her hair in the shower or have it done in a salon?
Problems
Living Alone: If
she’s in the early stages of dementia and still living alone, poor hygiene
often goes hand-in-hand with physical safety, other self-neglect, confusion
over medications, and poor eating routines with subsequent nutritional
repercussions. Thus neglect of personal hygiene often indicates the need for
intervention. You may consider bringing in a personal aide a few times a week
to help with personal hygiene. If she still operates a microwave oven safely,
you can have frozen meals ready to heat up.
Refusal: If she’s living with
you, but still handles her own baths, she may suddenly be confused about the
washing routine or may be uncertain about how to work the faucets. Another
common problem is the inability to gauge the temperature of the water: hot may
feel cold and the opposite. It’s probably time for you to step in and offer to
help her. To get off to a good start, the two of you can go on a special
shopping trip for luxury bath products.
Even if things have gone relatively
smoothly up until now, don’t be shocked if one day she absolutely refuses. You
can drag, push or argue her into the bath. However even if you succeed, this is
a no-win situation, because her anger is likely to linger and spoil much of the
rest day for both of you. A better option is to look at the situation through
her eyes.
• She may honestly believe that she just
took a bath. In that case, wait half an hour before returning to the topic with
a different approach. You may tell her that you had promised her to help her
today or she would want to get freshened up for a special event (that you’ve
just made up – like tea at a favorite shop of hers.)
• She may suddenly fear the water.
Alzheimer’s sometimes alters the sensitivity of the skin and a spray of shower
can be outright painful. Her head may be particularly sensitive. These issues
may be hard to discern because of her communication problems, so be patient. If
these seem to be serious issues for her, try some of the alternative bathing
methods.
• Ask yourself if you might be
uncomfortable with your role. Sometimes it’s difficult for us to perform these
intimate roles with our parents. She may be reacting to your discomfort.
Acute: If this is a sudden problem, she simply may
not be feeling well. She could have the flu, a cold or an infection, like a UTI
(urinary tract infection.)
Consistent Reluctance:
She may be suffering from depression.
Tub Bath Problems: She was a “tub-person”
all her life, but suddenly she’s reluctant to step into the tub. This is the
unpredictable nature of Alzheimer’s and other dementias. These diseases affect
a person’s perceptions. She may have lost her depth perception and may not want
to step into the water, for fear of drowning. As the disease progresses the
person with advanced Alzheimer’s spends more and more time in altered realities,
often drawn from childhood experiences. In this situation, something may have
awakened a long forgotten trauma.
Tip: Using colored bubble bath or a colored
tub mat make it easier to judge the depth of water and distinguish the water
from the tub edge and sides. (Avoid a very dark colored mat, which may look
like a hole or cavity to a person with Alzheimer’s.)
If this doesn’t work, you may have to
switch to a shower or one of the alternative bathing methods. – see “Alternatives” below
If
the person with Alzheimer’s has moved to a facility you may face new issues:
His modesty may be challenged. He may be
uncomfortable with a staff person (stranger) assisting him. Ask the staff to
let him keep his underwear on or drape a towel over his lap when he’s sitting
on the chair in the shower. Staff can wash everything on top and then
everything on the bottom and then quickly wash the remainder as he’s standing
up to get out of the shower.
If he wears a hearing aid, you’ll want to
watch for water getting into the ear. You may need to remove the hearing aid if
you are washing the person's hair. Keep the person busy with washing and then
take out the hearing aid when it is time to wash his hair. Or, use shampoos
that don't require water – see “Alternatives” below
I often hear from hospice personnel of the
reluctance of staff at care homes to support alternatives to a tub bath or a
shower. If you are associated with a facility, you might want to reiterate this
fact with your staff and remind them that by the time a person needs the
services of hospice, his skin is often extremely sensitive to touch and a
regular bathing routine can be painful.
Alternatives
Change
location: If she’s too
spooked by the bathroom, you can give her a sponge bath or no-rinse wipe-down
anywhere in the house where she’s comfortable.
No-rinse
productsare available from many different
sources. Check with your local pharmacy or go to your search engine and type in
“no-rinse washcloths” and “no-rinse shampoo.”
Communication
The
above assumes that your person is somewhat cooperative with you. What do you do
when the person refuses?
The following
exchange will sound familiar to many a caregiver of an Alzheimer’s person:
“Do
you want to take a bath?”
“No!”
“But
you need one.”
“No,
I just had one yesterday!!”
“Dad,
it’s been a long time since your last bath.”
“I’m
not dirty.”
“You’re
starting to smell, Dad.”
“You
take a bath. Leave me alone!!!”
What
are the problems with this exchange?
First you’ll
want to drop the phrase “Do you want to . . . “ It will often elicit an
immediate NO.
You’ll want to
avoid arguments. If he thinks that he took a bath yesterday, there’s probably
no way you can dissuade from that belief.
Compliments are
very effective, especially when you tie them to the situation.
Try
this version:
“Hey
Dad, you said you wanted to take a bath; I have everything ready for you.” (It’s his idea rather than yours)
“No!”
You’ll ignore
his protest and keep talking.
“You
wanted to try the new great smelling soap.”
Get him in a
gentle arm-hold as you steer him into the bathroom, while you keep talking
about the soap:
“Come,
let me show you. - You know Dad, you’ve always had a particularly good nose for
soaps.”
As you help him
with his bath, keep talking to him about this or that, sprinkling your chatter
with compliments. If he starts to get anxious, you can tell that in Florida
it’s illegal toshower
naked. (This is an
actual Florida law still on the books today.)
He
will mimic your attitude. If you’re worried or in a rush, he’ll pick up on your
vibes and it’s almost a guarantee that you’ll have problems. Stay positive and
cheerful.
The terms “bath”
or “shower” may evoke an immediate negative reaction. In that case, don’t use
the words. Instead, you can take him by the arm and as you gently lead him to
the bathroom, as you cheerfully say:
“Come Dad,
let’s go this way”
Help him undress
while talking about something unrelated. Stay upbeat and positive. Use
compliments as much as possible.
Encourage him to
wash himself as much as he can without stress. When necessary, use clear single
sentence directions, one at a time. Give him plenty of time.
After the bath,
share a cup of tea, relaxed conversation, or a good story. Chances are that
this “after-bath” ritual will help make the your future bath routines positive
for both of you.
Good
Luck
Best
Book: “Bathing Without a
Battle” ISBN-13: 9780826101242
